Fighting Cardiovascular Disease and Hypertension in Latin America and the Caribbean: TEPHINET Helps to Implement the Global Hearts Initiative

In 2016, the World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC) launched the Global Hearts Initiative with the goal of improving practices—at the primary health care level—in controlling cardiovascular diseases (CVDs) and hypertension. The Global Hearts Initiative consists of five technical packages, each of which provides evidence-based interventions towards a specific goal. The HEARTS technical package, for instance, is aimed at strengthening the management of CVDs and hypertension in primary healthcare.

In collaboration with the Pan-American Health Organization and CDC, TEPHINET consultants are working to implement the HEARTS technical package within Latin America and the Caribbean. Implementation of the HEARTS technical package entails sharing knowledge and best practices in diagnosis, treatment, and surveillance with local health care professionals. The package provides practical toolkits for CVD and hypertension management in primary care and standardized protocols for prevention, service delivery, referral and monitoring.

In 2018, four TEPHINET consultants* with expertise in CVD and hypertension participated in site visits coordinated by PAHO in Buenos Aires, Argentina; Santiago, Chile; Quito, Ecuador; and Port of Spain, Trinidad and Tobago. In each country, the consultants met with authorities from local ministries of health, including the ministers, senior managers and other decision-makers, as well as local management, planning and coordination teams of the ministry and other health authorities. The consultants also visited local implementing sites, including health centers and hospitals, as part of the overall technical team sharing expectations and verifying the health systems created for HEARTS implementation.

Some of the challenges faced by these countries in battling CVD and hypertension include a low adherence rate of hypertension treatment (for example, a lack of blood pressure monitoring in the home following medical appointments), as well as gaps in time between diagnosis and pharmacological intervention. As one example, Chile—where consultants participated in a site visit in September—has seen significant turnover in healthcare personnel, including physicians, and a significant increase in its aging population. In Trinidad and Tobago, where consultants visited in November, prevalence of hypertension is estimated at 33 percent yet control rates are as low as six to eight percent.

In Ecuador, consultant Norman Campbell conducted a training masterclass, the core learning objectives of which included:

  • outlining the key components of HEARTS,
  • engaging learners in a problem-solving exercise of clinical cases highlighting components of HEARTS,
  • identifying potential barriers to implementation, and
  • clarifying the role of leadership in the program.

By the end of the masterclass, learners were able to analyze the main components of the HEARTS package, apply the package in the management of a CVD patient, construct and demonstrate the use of a standardized treatment algorithm in the management of a case, and create an outline of an implementation action plan for pilot sites.

A challenge in obtaining the resources necessary for health systems to tackle the full scope of the problem of NCDs is that this is not always prioritized by local authorities. One strategy to address this lies in demonstrating the economic burden of NCDs and the value of investing in better NCD detection, prevention and control. To this end, through a contract with TEPHINET and support from CDC, RTI International has developed and piloted a Microsoft Excel-based costing tool that local health departments can use to estimate the cost burden of NCDs. This costing tool is provided to the countries implementing the HEARTS package so that local stakeholders can better explain to decision-makers, in economic terms, the burden of disease—and, perhaps more importantly, the economic value generated by its treatment.

TEPHINET is supporting HEARTS through funding from CDC as part of a larger global initiative to improve the prevention and control of NCDs through surveillance, capacity building and evidence generation. HEARTS implementation in the LAC region is a continuation of previous related work by TEPHINET consultants beginning with the Million Hearts initiative in US insular areas. TEPHINET also supports NCD prevention and control activities worldwide through its NCD mini-grant program for FETP trainees, the development of a curriculum for cancer prevention and control in low- and middle-income countries, and other projects.

*The consultants working on this project are Dr. Sonia Y. Angell (New York City Department of Health and Mental Hygiene), Dr. Norman Campbell (University of Calgary), Dr. Kenneth Connell (University of West Indies), and Dr. Donald DiPette (University of South Carolina).

For more information about TEPHINET’s NCD initiatives, please contact Claire Jennings at cjennings [at] tephinet [dot] org.