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Challenges and opportunities for implementation of interventions to prevent and control CVD in low-resource settings:
Adolfo L Rubinstein1, Vilma E Irazola1, Rosana Poggio1
1South American Center of Excellence for Cardiovascular Health, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.
Insights
Cardiovascular diseases cause significant deaths and costs in Argentina. This study details three implementation science trials addressing hypertension and hypercholesterolemia to improve cardiovascular health outcomes.
Area of Science:
- Public Health
- Implementation Science
- Cardiovascular Epidemiology
Background:
- Cardiovascular diseases (CVDs) are a major public health concern in Argentina, causing substantial mortality and economic burden.
- Despite existing programs, health resources in Argentina are disproportionately allocated to infectious diseases and maternal/child health, neglecting noncommunicable diseases like CVDs.
- The South American Centre of Excellence in Cardiovascular Health (CESCAS) focuses on research to address this gap.
Purpose of the Study:
- To describe the rationale, design, and evaluation of three ongoing randomized clinical trials focused on implementation science in cardiovascular health.
- To investigate complex interventions aimed at changing provider and patient behaviors for better CVD risk factor management.
- To identify barriers and facilitators for implementation research in cardiovascular health in low-resource settings.
Main Methods:
- Three randomized clinical trials are described: a mobile health intervention for prehypertension, a comprehensive approach for hypertension control, and an educational intervention for hypercholesterolemia management.
- Interventions are designed for low-resource settings in Argentina, Guatemala, and Peru, targeting low-income urban populations.
- The studies employ implementation science methodologies to assess the feasibility and effectiveness of interventions.
Main Results:
- The article details the design and implementation strategies for complex interventions targeting provider and patient behaviors.
- Evaluation of processes and outcomes for each trial is presented, highlighting key findings related to intervention effectiveness.
- Barriers and enabling factors encountered during the implementation research are discussed.
Conclusions:
- There is a critical need to build health research capacity and infrastructure in Argentina and Latin America for implementation studies.
- Translating research findings into improved health policy and practice for cardiovascular diseases and risk factors is essential.
- Successful implementation research can lead to significant improvements in cardiovascular health outcomes in the region.
Abstract:
In Argentina, cardiovascular diseases cause an estimated 100,000 deaths and more than 250,000 coronary heart disease and stroke events annually, at a cost of more than $1 billion international dollars. Despite progress in the implementation of several programs to combat noncommunicable diseases in Argentina over the past few years, most health resources are still dedicated to infectious diseases and maternal and child health. The Institute for Clinical Effectiveness and Health Policy, an independent academic institution affiliated with the University of Buenos Aires medical school, runs the South American Centre of Excellence in Cardiovascular Health (CESCAS), a center devoted to epidemiology, implementation, and policy research. At the CESCAS, there are 3 ongoing randomized clinical trials focused on implementation science: 1) a mobile health intervention, for preventing the progression of prehypertension in low-income, urban settings in Argentina, Guatemala, and Peru; 2) a comprehensive approach to preventing and controlling hypertension in low-resource settings in Argentina; and 3) an educational approach to improving physicians' effectiveness in the detection, treatment, and control of hypercholesterolemia and high cardiovascular disease risk in low-resource settings in Argentina. All of these trials involve the design and implementation of complex interventions for changing the behaviors of providers and patients. The rationale of each of the 3 studies, the design of the interventions, and the evaluation of processes and outcomes are described in this article, together with the barriers and enabling factors associated with implementation-research studies. There is a strong need in Argentina and all of Latin America for building the health-research capacity and infrastructure necessary for undertaking implementation studies that will translate evidence from research findings into improvements in health policy and practice with regard to cardiovascular diseases and their risk factors.
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