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Task shifting interventions for cardiovascular risk reduction in low-income and middle-income countries: a systematic
Gbenga Ogedegbe1,2, Joyce Gyamfi1, Jacob Plange-Rhule3
1Department of Population Health, NYU School of Medicine, NYU Langone Medical Center, New York, USA.
Insights
Limited studies show task-shifting strategies effectively reduce cardiovascular disease (CVD) risk in low- and middle-income countries (LMICs). More research is urgently needed to implement these interventions and combat the global CVD epidemic.
Area of Science:
- Public Health
- Cardiovascular Medicine
- Health Systems Research
Background:
- Cardiovascular diseases (CVDs) pose a significant global health burden, particularly in low- and middle-income countries (LMICs).
- Task-shifting, involving non-physician healthcare workers in patient management, is a potential strategy to address healthcare access and workforce shortages in LMICs.
- Evidence from randomized controlled trials (RCTs) is needed to evaluate the effectiveness of task-shifting for CVD risk reduction in these settings.
Purpose of the Study:
- To systematically review published RCTs on the effectiveness of task-shifting strategies for cardiovascular disease (CVD) risk reduction in LMICs.
- To identify and synthesize evidence on the implementation and outcomes of task-shifting interventions for managing CVD risk factors.
Main Methods:
- Systematic review of RCTs identified through comprehensive database searches (PubMed, EMBASE, Global Health, etc.) and ClinicalTrials.gov.
- Inclusion criteria focused on RCTs published in English, utilizing task-shifting by non-physician healthcare providers for CVD risk factors (hypertension, diabetes, etc.) in LMICs.
- Studies excluded those not meeting RCT design or relevant intervention/setting criteria.
Main Results:
- Only three RCTs met the inclusion criteria out of 2771 identified articles.
- The included trials focused on hypertension and diabetes management in practice-based settings, with durations of 3-12 months.
- Task-shifting strategies included nurse/pharmacist prescribing and telephone follow-up, resulting in significant blood pressure reduction (2/1-30/15 mmHg) and HbA1c reduction (1.87%).
Conclusions:
- There is a significant lack of published RCT evidence on task-shifting for CVD risk reduction in LMICs.
- Existing evidence, though limited, suggests that task-shifting interventions can be effective in managing hypertension and diabetes.
- Urgent development and implementation of effective task-shifting strategies are crucial to address the growing CVD epidemic in LMICs.
Objective:
To evaluate evidence from published randomised controlled trials (RCTs) for the use of task-shifting strategies for cardiovascular disease (CVD) risk reduction in low-income and middle-income countries (LMICs).
Design:
Systematic review of RCTs that utilised a task-shifting strategy in the management of CVD in LMICs.
Data Sources:
We searched the following databases for relevant RCTs: PubMed from the 1940s, EMBASE from 1974, Global Health from 1910, Ovid Health Star from 1966, Web of Knowledge from 1900, Scopus from 1823, CINAHL from 1937 and RCTs from ClinicalTrials.gov.
Eligibility Criteria For Selecting Studies:
We focused on RCTs published in English, but without publication year. We included RCTs in which the intervention used task shifting (non-physician healthcare workers involved in prescribing of medications, treatment and/or medical testing) and non-physician healthcare providers in the management of CV risk factors and diseases (hypertension, diabetes, hyperlipidaemia, stroke, coronary artery disease or heart failure), as well as RCTs that were conducted in LMICs. We excluded studies that are not RCTs.
Results:
Of the 2771 articles identified, only three met the predefined criteria. All three trials were conducted in practice-based settings among patients with hypertension (2 studies) and diabetes (1 study), with one study also incorporating home visits. The duration of the studies ranged from 3 to 12 months, and the task-shifting strategies included provision of medication prescriptions by nurses, community health workers and pharmacists and telephone follow-up posthospital discharge. Both hypertension studies reported a significant mean blood pressure reduction (2/1 mm Hg and 30/15 mm Hg), and the diabetes trial reported a reduction in the glycated haemoglobin levels of 1.87%.
Conclusions:
There is a dearth of evidence on the implementation of task-shifting strategies to reduce the burden of CVD in LMICs. Effective task-shifting interventions targeted at reducing the global CVD epidemic in LMICs are urgently needed.
