Abstract
Introduction: Arterial hypertension (aHT) is the most important cardiovascular risk factor (CVRF) in adults living in sub-Saharan Africa (SSA), leading to an excess of cardiovascular disease (CVD) morbidity and mortality. Life-long aHT service delivery models in the region remain mostly anchored to health facilities and are provided by physicians or nurses, thus limiting access to care. Over the past years, decentralized community-based aHT care models have been piloted, aiming to improve access to prevention, diagnosis, and treatment. Although individual studies suggest that community-based care is well-received and potentially efficacious, a synthesized overview of such care models is missing. Hence, the aim of this scoping review is to map out and summarize existing interventions for community-based aHT diagnosis and care in non-pregnant adults in SSA. Additionally, we will describe outcomes in terms of acceptability, blood pressure control, patient engagement in care, and occurrence of aHT caused end-organ damage. Methods and analysis: We will apply the Arksey and O’Malley scoping review methodology and best practice, as outlined by Levac and the Joanna Briggs Institute scoping review guidelines. The research questions have been identified through a literature review and expert consultation. A systematic literature search will be conducted in four databases using a tailored search strategy, including a supplemental search through backward and forward citation. Abstracts and full text screening as well as the extraction of data will be conducted by two independent reviewers. Discrepancies will be resolved by a third reviewer. Information will be presented in both tabular and narrative form. Ethics and dissemination: This scoping review will summarize findings from existing publications, rather than primary data, and as such, does not require ethics review. Findings will be disseminated through stakeholder meetings, conference presentations, websites, and a peer-reviewed publication.
Highlights
Arterial hypertension is the most important cardiovascular risk factor (CVRF) in adults living in sub-Saharan Africa (SSA), leading to an excess of cardiovascular disease (CVD) morbidity and mortality
CVDs encompass a group of disorders that include coronary heart disease, cerebrovascular disease, peripheral arterial disease, deep vein thrombosis, pulmonary embolism, rheumatic, and congenital heart disease
These conditions add more than 22.9 million disability adjusted life years (DALYs) lost in the region[1] and are a major driver of poverty at the household level in the region due to catastrophic, out-of-pocket expenditure for health care.[7]
Summary
The sub-Saharan Africa (SSA) region is experiencing an increased burden of non-communicable diseases (NCDs) linked to demographic ageing, rapid urbanization, and the expansion of unhealthy lifestyles, which include sedentarism, unhealthy diet, and tobacco consumption.[1,2,3,4] In this region, cardiovascular diseases (CVDs) heavily contribute to the NCDs burden.[5,6] CVDs encompass a group of disorders that include coronary heart disease, cerebrovascular disease, peripheral arterial disease, deep vein thrombosis, pulmonary embolism, rheumatic, and congenital heart disease These conditions add more than 22.9 million disability adjusted life years (DALYs) lost in the region[1] and are a major driver of poverty at the household level in the region due to catastrophic, out-of-pocket expenditure for health care.[7]. We will categorize such models in three dimensions: “who provides care in the community?”, “how often is care in the community provided?” and “what kind of interventions are included in the community care?”26 (Table 1)
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