Kisoro District Hospital, Kisoro, Uganda.
Doctors for Global Health, Decatur, Georgia, United States of America.
PLoS One. 2021 Feb 25;16(2):e0247464. doi: 10.1371/journal.pone.0247464. eCollection 2021.
Although hypertension, the largest modifiable risk factor in the global burden of disease, is prevalent in sub-Saharan Africa, rates of awareness and control are low. Since 2011 village health workers (VHWs) in Kisoro district, Uganda have been providing non-communicable disease (NCD) care as part of the Chronic Disease in the Community (CDCom) Program. The VHWs screen for hypertension and other NCDs as part of a door-to-door biannual health census, and, under the supervision of health professionals from the local district hospital, also serve as the primary providers at monthly village-based NCD clinics.
OBJECTIVE/METHODS: We describe the operation of CDCom, a 10-year comprehensive program employing VHWs to screen and manage hypertension and other NCDs at a community level. Using program records we also report hypertension prevalence in the community, program costs, and results of a cost-saving strategy to address frequent medication stockouts.
RESULTS/CONCLUSIONS: Of 4283 people ages 30-69 screened for hypertension, 22% had a blood pressure (BP) ≥140/90 and 5% had a BP ≥ 160/100. All 163 people with SBP ≥170 during door-to-door screening were referred for evaluation in CDCom, of which 91 (59%) had repeated BP ≥170 and were enrolled in treatment. Of 761 patients enrolled in CDCom, 413 patients are being treated for hypertension and 68% of these had their most recent blood pressure below the treatment target. We find: 1) The difference in hypertension prevalence between this rural, agricultural population and national rates mirrors a rural-urban divide in many countries in sub-Saharan Africa. 2) VHWs are able to not only screen patients for hypertension, but also to manage their disease in monthly village-based clinics. 3) Mid-level providers at a local district hospital NCD clinic and faculty from an academic center provide institutional support to VHWs, stream-line referrals for complicated patients and facilitate provider education at all levels of care. 4) Selective stepdown of medication doses for patients with controlled hypertension is a safe, cost-saving strategy that partially addresses frequent stockouts of government-supplied medications and patient inability to pay. 5) CDCom, free for village members, operates at a modest cost of 0.20 USD per villager per year. We expect that our data-informed analysis of the program will benefit other groups attempting to decentralize chronic disease care in rural communities of low-income regions worldwide.
尽管高血压是全球疾病负担中最大的可改变风险因素，但在撒哈拉以南非洲地区普遍存在，其知晓率和控制率却很低。自 2011 年以来，乌干达基索罗区的乡村卫生工作者（VHW）一直作为慢性疾病在社区（CDCom）项目的一部分，提供非传染性疾病（NCD）护理。VHW 作为门到门每两年一次的健康普查的一部分，筛查高血压和其他 NCD，并在当地地区医院的卫生专业人员监督下，每月在乡村 NCD 诊所担任主要提供者。
目的/方法：我们描述了 CDCom 的运作情况，这是一个为期 10 年的综合项目，通过乡村卫生工作者在社区层面筛查和管理高血压和其他 NCD。我们使用项目记录报告了社区中高血压的患病率、项目成本以及解决频繁药物短缺的节省成本策略的结果。
结果/结论：在对 4283 名 30-69 岁的人进行高血压筛查中，22%的人血压（BP）≥140/90mmHg，5%的人血压≥160/100mmHg。所有在门到门筛查中收缩压（SBP）≥170mmHg 的 163 人都被转诊到 CDCom 进行评估，其中 91 人（59%）的 SBP 再次≥170mmHg，并被纳入治疗。在 761 名参加 CDCom 的患者中，413 名患有高血压，其中 68%的患者最近的血压低于治疗目标。我们发现：1）农村、农业人口的高血压患病率与全国水平之间的差异反映了撒哈拉以南非洲许多国家的城乡差距。2）乡村卫生工作者不仅能够筛查高血压患者，还能够在每月的乡村诊所中管理他们的疾病。3）当地地区医院 NCD 诊所的中级医务人员和学术中心的教师为乡村卫生工作者提供机构支持，简化复杂患者的转诊，并在各级护理中促进提供者教育。4）对血压控制良好的患者选择性减少药物剂量是一种安全、节省成本的策略，可以部分解决政府供应药物的频繁短缺和患者无力支付的问题。5）CDCom 对村民免费，每年每位村民的运营成本为 0.20 美元。我们希望我们对该项目的数据驱动分析将使其他试图在全球低收入地区的农村社区分散慢性病护理的团体受益。
