Implementation of low-cost, point-of-care cardiovascular diagnostics by non-healthcare professionals in rural Uganda

Abstract

• Non-communicable diseases (NCDs) account for the majority of adult deaths worldwide, and 80% of these deaths occur in low and middle-income countries (LMICs).1 • The burden of NCDs in LMICs is predicted to grow with improvements in sanitation and infectious disease control, and will be altered by local diet, smoking rates, and HIV co-infection.2 • There is a critical need to identify and implement low-cost, wellvalidated diagnostic tests to elucidate the epidemiology of NCDs, and enable diagnostic monitoring and therapeutic interventions.3 • Tests that enable non-healthcare professionals to lead care provision will augment the scalability of this strategy. • In 2010, the WHO recommended a package of essential noncommunicable disease technologies for use in low-resource settings including a digital blood pressure measurement device, electrocardiograph, and glucometer.4 • Validation of such tools in appropriate settings will be crucial to developing a strategy for strengthening health systems to address the growing burden of NCDs. We recently completed implementation and evaluation of a bundle of point-of-care, low-cost diagnostics for NCD measurement in rural Uganda. The objective was to assess the feasibility, reproducibility, and cost of testing in a resource-poor setting for a variety of cardiovascular conditions including hypertension, diabetes, and subclinical atherosclerosis.