Feasibility of integrated, multilevel care for cardiovascular diseases (CVD) and HIV in low- and middle-income countries (LMICs): A scoping review

Ojo, Temitope; Lester, Lynette; Iwelunmor, Juliet; Gyamfi, Joyce; Obiezu-Umeh, Chisom; Onakomaiya, Deborah; Aifah, Angela; Nagendra, Shreya; Opeyemi, Jumoke; Oluwasanmi, Mofetoluwa; Dalton, Milena; Nwaozuru, Ucheoma; Vieira, Dorice; Ogedegbe, Gbenga; Boden‐Albala, Bernadette

doi:10.1371/journal.pone.0212296

Cited by 23 publications

(18 citation statements)

References 34 publications

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“…To be successful, interventions must be designed to reach the population of interest; however, most importantly, they must be based on a rigorous theoretical underpinning to explain why they may succeed or fail (Nilsen, 2015). Only when interventions are targeted specifically within the socio‐environmental setting for which they are intended will implementation succeed (Lizarondo et al, 2019; Ojo et al, 2019). This concept was supported by an umbrella review of 67 systematic reviews that found that the EPOC framework enabled different intervention types to be classified and mapped to common and effective interventions (Johnson & May, 2015).…”

Section: Discussionmentioning

confidence: 99%

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Mapping Clinical Barriers and Evidence‐Based Implementation Strategies in Low‐to‐Middle Income Countries (LMICs)

Whitehorn

Porritt

et al. 2021

Worldviews Ev Based Nurs

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Background: Low-to-middle income countries (LMICs) experience a high burden of disease from both non-communicable and communicable diseases. Addressing these public health concerns requires effective implementation strategies and localization of translation of knowledge into practice.Aim: To identify and categorize barriers and strategies to evidence implementation in LMICs from published evidence implementation studies.Methods: A descriptive analysis of key characteristics of evidence implementation projects completed as part of a 6-month, multi-phase, intensive evidence-based clinical fellowship program, conducted in LMICs and published in the JBI Database of Systematic Reviews and Implementation Reports was undertaken. Barriers were identified and categorized to the Donabedian dimensions of care (structure, process, and outcome), and strategies were mapped to the Cochrane effective practice and organization of care taxonomy.Results: A total of 60 implementation projects reporting 58 evidence-based clinical audit topics from LMICs were published between 2010 and 2018. The projects included diverse populations and were predominantly conducted in tertiary care settings. A total of 279 barriers to implementation were identified. The most frequently identified groupings of barriers were process-related and associated predominantly with staff knowledge. A total of 565 strategies were used across all projects, with every project incorporating more than one strategy to address barriers to implementation of evidence-based practice; most strategies were categorized as educational meetings for healthcare workers.Linking Evidence to Action: Context-specific strategies are required for successful evidence implementation in LMICs, and a number of common barriers can be addressed using locally available, low-cost resources. Education for healthcare workers in LMICs is an effective awareness-raising, workplace culture, and practice-transforming strategy for evidence implementation. BACKGROUNDLow-to-middle income countries (LMICs) experience a high burden of disease from both non-communicable and communicable diseases (Ojo et al., 2019). Addressing these public health concerns requires effective implementation strategies and localization of translation of knowledge into practice (Edwards, Zweigenthal, & Olivier, 2019). In LMICs, where resources are scarce and burden of disease is high, justification to intervene in healthcare practice must be based on high-quality, evidence-based findings (Edwards et al., 2019). However, despite a growing body of research to inform clinical decision-making that considers the best available evidence (

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Section: Discussionmentioning

confidence: 99%

“…Low-to-middle income countries (LMICs) experience a high burden of disease from both non-communicable and communicable diseases (Ojo et al, 2019). Addressing these public health concerns requires effective implementation strategies and localization of translation of knowledge into practice (Edwards, Zweigenthal, & Olivier, 2019).…”

Section: Introductionmentioning

confidence: 99%

Mapping Clinical Barriers and Evidence‐Based Implementation Strategies in Low‐to‐Middle Income Countries (LMICs)

Whitehorn

Porritt

et al. 2021

Worldviews Ev Based Nurs

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“…[163][164][165][166][167][168][169] Different projects have been working towards improving the health system, at all levels (primary care, hospitals or specialized institutes) and working with all stakeholders (health workers, managers, regional health directors) to improve access to care, increase availability and affordability of medicines, improve coordination of care or improve patient satisfaction. [170][171][172][173] Given the comorbidity between mental health and cardiometabolic conditions, some projects have promoted the opportunistic screening of mental health disorders in this group of patients and their referral using existing resources. 174 Other ongoing initiatives are using mHealth technologies to treat mild to moderate depressive symptoms among patients with cardiometabolic conditions.…”

Section: Improving Healthcarementioning

confidence: 99%

Understanding the rise of cardiometabolic diseases in low- and middle-income countries

Miranda

Barrientos‐Gutiérrez

Corvalán

et al. 2019

Nat Med

228

178

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Increases in the prevalence of non-communicable diseases (NCDs), but in particular cardiometabolic diseases such as cardiovascular disease, stroke and diabetes, and their major risk factors, have not been uniform across settings; for example, cardiovascular disease mortality has declined over recent decades in high-income countries but increased in low-and middle-income countries (LMICs). The factors contributing to this rise are varied and are contributed to by the environmental, social, political and commercial determinants of health, among other factors. This Review focuses on understanding the rise of cardiometabolic diseases in LMICs, with particular emphasis on obesity and its drivers, together with broader environmental and macro determinants of health, and the LMIC-based responses to counteract cardiometabolic diseases.

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“…[9, 10] There is little understanding of how HIV clinics in SSA countries operationalize, build, and maintain capacity, particularly as it relates to translation of EBIs into practice. [11] Because of the dynamic nature of the contexts of HIV care in SSA, an assessment of the capacity of HIV clinics to manage NCDs may provide stakeholders with the knowledge needed for a systematic planning of its implementation.…”

Section: Introductionmentioning

confidence: 99%

Capabilities, opportunities and motivations for integrating evidence-based strategy for hypertension control into HIV clinics in Southwest Nigeria

et al. 2019

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Background Given the growing burden of cardiovascular diseases in sub-Saharan Africa, global donors and governments are exploring strategies for integrating evidence-based cardiovascular diseases prevention into HIV clinics. We assessed the capabilities, motivations and opportunities that exist for HIV clinics to apply evidence-based strategies for hypertension control among people living with HIV (PLHIV) in Nigeria. Methods We used a concurrent Quan-Qual- study approach (a quantitative first step using structured questionnaires followed by a qualitative approach using stakeholder meetings).We invited key stakeholders and representatives of HIV and non-communicable disease organizations in Lagos, Nigeria to 1) assess the capacity of HIV clinics (n = 29) to, and; 2) explore their attitudes and perceptions towards implementing evidence-based strategies for hypertension management in Lagos, Nigeria (n = 19)The quantitative data were analyzed using SPSS whereas responses from the stakeholders meeting were coded and analyzed using thematic approach and an implementation science framework, the COM-B (Capabilities, Opportunities, Motivations and Behavior) model, guided the mapping and interpretation of the data. Results Out of the 29 HIV clinics that participated in the study, 28 clinics were public, government-owned facilities with 394 HIV patients per month with varying capabilities, opportunities and motivations for integrating evidence-based hypertension interventions within their services for PLHIV. Majority of the clinics (n = 26) rated medium-to-low on the psychological capability domains, while most of the clinics (n = 25) rated low on the physical capabilities of integrating evidence-based hypertension interventions within HIV clinics. There was high variability in the ratings for the opportunity domains, with physical opportunities rated high in only eight HIV clinics, two clinics with a medium rating and nineteen clinics with a low rating. Social opportunity domain tended to be rated low in majority of the HIV clinics (n = 21). Lastly, almost all the HIV clinics (n = 23) rated high on the reflective motivation domain although automatic motivations tended to be rated low across the HIV clinics. Conclusion In this study, we found that with the exception of motivations, the relative capabilities whether physical or psychological and the relative opportunities for integrating evidence-based hypertension intervention within HIV clinics in Nigeria were minimal. Thus, there is need to strengthen the HIV clinics in Lagos for the implementation of evidence-based hypertension interventions within HIV clinics to improve patient outcomes and service delivery in Southwest Nigeria.

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Feasibility of integrated, multilevel care for cardiovascular diseases (CVD) and HIV in low- and middle-income countries (LMICs): A scoping review

Cited by 23 publications

References 34 publications

Mapping Clinical Barriers and Evidence‐Based Implementation Strategies in Low‐to‐Middle Income Countries (LMICs)

Mapping Clinical Barriers and Evidence‐Based Implementation Strategies in Low‐to‐Middle Income Countries (LMICs)

Understanding the rise of cardiometabolic diseases in low- and middle-income countries

Capabilities, opportunities and motivations for integrating evidence-based strategy for hypertension control into HIV clinics in Southwest Nigeria

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