Cost-effectiveness of leveraging existing HIV primary health systems and community health workers for hypertension screening and treatment in Africa: An individual-based modeling study.
<h4>Background</h4>Cardiovascular disease (CVD) morbidity and mortality is increasing in Africa, largely due to undiagnosed and untreated hypertension. Approaches that leverage existing primary health systems could improve hypertension treatment and reduce CVD, but cost-effectiveness is...
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Public Library of Science (PLoS)
2025-01-01
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| Series: | PLoS Medicine |
| Online Access: | https://doi.org/10.1371/journal.pmed.1004531 |
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| author | Matthew D Hickey James Ayieko Jane Kabami Asiphas Owaraganise Elijah Kakande Sabina Ogachi Colette I Aoko Erick M Wafula Norton Sang Helen Sunday Paul Revill Loveleen Bansi-Matharu Starley B Shade Gabriel Chamie Laura B Balzer Maya L Petersen Diane V Havlir Moses R Kamya Andrew N Phillips |
| author_facet | Matthew D Hickey James Ayieko Jane Kabami Asiphas Owaraganise Elijah Kakande Sabina Ogachi Colette I Aoko Erick M Wafula Norton Sang Helen Sunday Paul Revill Loveleen Bansi-Matharu Starley B Shade Gabriel Chamie Laura B Balzer Maya L Petersen Diane V Havlir Moses R Kamya Andrew N Phillips |
| author_sort | Matthew D Hickey |
| collection | DOAJ |
| description | <h4>Background</h4>Cardiovascular disease (CVD) morbidity and mortality is increasing in Africa, largely due to undiagnosed and untreated hypertension. Approaches that leverage existing primary health systems could improve hypertension treatment and reduce CVD, but cost-effectiveness is unknown. We evaluated the cost-effectiveness of population-level hypertension screening and implementation of chronic care clinics across eastern, southern, central, and western Africa.<h4>Methods and findings</h4>We conducted a modeling study to simulate hypertension and CVD across 3,000 scenarios representing a range of settings across eastern, southern, central, and western Africa. We evaluated 2 policies compared to current hypertension treatment: (1) expansion of HIV primary care clinics into chronic care clinics that provide hypertension treatment for all persons regardless of HIV status (chronic care clinic or CCC policy); and (2) CCC plus population-level hypertension screening of adults ≥40 years of age by community health workers (CHW policy). For our primary analysis, we used a cost-effectiveness threshold of US $500 per disability-adjusted life-year (DALY) averted, a 3% annual discount rate, and a 50-year time horizon. A strategy was considered cost-effective if it led to the lowest net DALYs, which is a measure of DALY burden that takes account of the DALY implications of the cost for a given cost-effectiveness threshold. Among adults 45 to 64 years, CCC implementation would improve population-level hypertension control (the proportion of people with hypertension whose blood pressure is controlled) from mean 4% (90% range 1% to 7%) to 14% (6% to 26%); additional CHW screening would improve control to 44% (35% to 54%). Among all adults, CCC implementation would reduce ischemic heart disease (IHD) incidence by 10% (3% to 17%), strokes by 13% (5% to 23%), and CVD mortality by 9% (3% to 15%). CCC plus CHW screening would reduce IHD by 28% (19% to 36%), strokes by 36% (25% to 47%), and CVD mortality by 25% (17% to 34%). CHW screening was cost-effective in 62% of scenarios, CCC in 31%, and neither policy was cost-effective in 7% of scenarios. Pooling across setting-scenarios, incremental cost-effectiveness ratios were $69/DALY averted for CCC and $389/DALY averted adding CHW screening to CCC.<h4>Conclusions</h4>Leveraging existing healthcare infrastructure to implement population-level hypertension screening by CHWs and hypertension treatment through integrated chronic care clinics is expected to reduce CVD morbidity and mortality and is likely to be cost-effective in most settings across Africa. |
| format | Article |
| id | doaj-art-5a27b4642a474aba9c9e86ab972cfc48 |
| institution | Kabale University |
| issn | 1549-1277 1549-1676 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS Medicine |
| spelling | doaj-art-5a27b4642a474aba9c9e86ab972cfc482025-02-12T05:30:28ZengPublic Library of Science (PLoS)PLoS Medicine1549-12771549-16762025-01-01221e100453110.1371/journal.pmed.1004531Cost-effectiveness of leveraging existing HIV primary health systems and community health workers for hypertension screening and treatment in Africa: An individual-based modeling study.Matthew D HickeyJames AyiekoJane KabamiAsiphas OwaraganiseElijah KakandeSabina OgachiColette I AokoErick M WafulaNorton SangHelen SundayPaul RevillLoveleen Bansi-MatharuStarley B ShadeGabriel ChamieLaura B BalzerMaya L PetersenDiane V HavlirMoses R KamyaAndrew N Phillips<h4>Background</h4>Cardiovascular disease (CVD) morbidity and mortality is increasing in Africa, largely due to undiagnosed and untreated hypertension. Approaches that leverage existing primary health systems could improve hypertension treatment and reduce CVD, but cost-effectiveness is unknown. We evaluated the cost-effectiveness of population-level hypertension screening and implementation of chronic care clinics across eastern, southern, central, and western Africa.<h4>Methods and findings</h4>We conducted a modeling study to simulate hypertension and CVD across 3,000 scenarios representing a range of settings across eastern, southern, central, and western Africa. We evaluated 2 policies compared to current hypertension treatment: (1) expansion of HIV primary care clinics into chronic care clinics that provide hypertension treatment for all persons regardless of HIV status (chronic care clinic or CCC policy); and (2) CCC plus population-level hypertension screening of adults ≥40 years of age by community health workers (CHW policy). For our primary analysis, we used a cost-effectiveness threshold of US $500 per disability-adjusted life-year (DALY) averted, a 3% annual discount rate, and a 50-year time horizon. A strategy was considered cost-effective if it led to the lowest net DALYs, which is a measure of DALY burden that takes account of the DALY implications of the cost for a given cost-effectiveness threshold. Among adults 45 to 64 years, CCC implementation would improve population-level hypertension control (the proportion of people with hypertension whose blood pressure is controlled) from mean 4% (90% range 1% to 7%) to 14% (6% to 26%); additional CHW screening would improve control to 44% (35% to 54%). Among all adults, CCC implementation would reduce ischemic heart disease (IHD) incidence by 10% (3% to 17%), strokes by 13% (5% to 23%), and CVD mortality by 9% (3% to 15%). CCC plus CHW screening would reduce IHD by 28% (19% to 36%), strokes by 36% (25% to 47%), and CVD mortality by 25% (17% to 34%). CHW screening was cost-effective in 62% of scenarios, CCC in 31%, and neither policy was cost-effective in 7% of scenarios. Pooling across setting-scenarios, incremental cost-effectiveness ratios were $69/DALY averted for CCC and $389/DALY averted adding CHW screening to CCC.<h4>Conclusions</h4>Leveraging existing healthcare infrastructure to implement population-level hypertension screening by CHWs and hypertension treatment through integrated chronic care clinics is expected to reduce CVD morbidity and mortality and is likely to be cost-effective in most settings across Africa.https://doi.org/10.1371/journal.pmed.1004531 |
| spellingShingle | Matthew D Hickey James Ayieko Jane Kabami Asiphas Owaraganise Elijah Kakande Sabina Ogachi Colette I Aoko Erick M Wafula Norton Sang Helen Sunday Paul Revill Loveleen Bansi-Matharu Starley B Shade Gabriel Chamie Laura B Balzer Maya L Petersen Diane V Havlir Moses R Kamya Andrew N Phillips Cost-effectiveness of leveraging existing HIV primary health systems and community health workers for hypertension screening and treatment in Africa: An individual-based modeling study. PLoS Medicine |
| title | Cost-effectiveness of leveraging existing HIV primary health systems and community health workers for hypertension screening and treatment in Africa: An individual-based modeling study. |
| title_full | Cost-effectiveness of leveraging existing HIV primary health systems and community health workers for hypertension screening and treatment in Africa: An individual-based modeling study. |
| title_fullStr | Cost-effectiveness of leveraging existing HIV primary health systems and community health workers for hypertension screening and treatment in Africa: An individual-based modeling study. |
| title_full_unstemmed | Cost-effectiveness of leveraging existing HIV primary health systems and community health workers for hypertension screening and treatment in Africa: An individual-based modeling study. |
| title_short | Cost-effectiveness of leveraging existing HIV primary health systems and community health workers for hypertension screening and treatment in Africa: An individual-based modeling study. |
| title_sort | cost effectiveness of leveraging existing hiv primary health systems and community health workers for hypertension screening and treatment in africa an individual based modeling study |
| url | https://doi.org/10.1371/journal.pmed.1004531 |
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