ABSTRACT
Hypertension remains the leading cause of cardiovascular disease worldwide and disproportionately impacts patients living in low- and middle-income countries (LMICs). Telemedicine offers a potential solution for improving access to health care for vulnerable patients in LMICs. OBJECTIVES: The purpose of this scoping review was to summarize the evidence for telemedicine interventions for blood pressure management in LMICs and assess the relationships between the telemedicine intervention characteristics and clinical outcomes. DESIGN: Published studies were identified from the following databases (from their inception to May 2020): PubMed, Scopus, and Embase. Search terms related to "Low and Middle Income Countries," "Telemedicine," and "Hypertension" were used, and clinical outcomes were extracted from the screened articles. RESULTS: Our search resulted in 530 unique articles, and 14 studies were included in this review. Five studies assessed telemedicine interventions for patient-provider behavioral counseling, four assessed patient-provider medical management, and five assessed provider-provider consultation technologies. Out of fourteen individual studies, eleven demonstrated a significant improvement in systolic or diastolic blood pressure in the intervention group. Of the eight studies that reported difference-in-differences changes in systolic blood pressure, between-arm differences ranged from 13.2 mmHg to 0.4 mmHg. CONCLUSIONS: The majority of the studies in this review demonstrated a significant reduction in blood pressure with use of the telemedicine intervention, though the magnitude of benefit was not consistently large. Limitations of the studies included small sample sizes, short duration, and intervention heterogeneity. Current evidence suggests that telemedicine may provide a promising approach to increase access to care and improve outcomes for hypertension in LMICs, especially during events that limit access to in-person care, such as the COVID-19 pandemic. However, high-quality clinical trials of sufficient size and duration are needed to establish the impact and role of telemedicine in hypertension care. The protocol for this review was not registered.
Subject(s)
COVID-19/epidemiology , Developing Countries , Hypertension/therapy , Pandemics , SARS-CoV-2 , Telemedicine , Humans , Hypertension/epidemiology , Hypertension/physiopathologyABSTRACT
La triple elimination est une initiative visant a soutenir l'éradication de la transmission mere-enfant de trois maladies - l'infection au virus de l'immunodéficience humaine (VIH), la syphilis et l'hépatite B. Bien que des avancées considerables aient été observées en ce sens dans certaines régions, les progres demeurent lents en Afrique subsaharienne, pourtant durement touchée par ces maladies. Les caractéristiques communes aux trois affections, notamment leur épidémiologie, les interactions entre elles et les principales interventions nécessaires a leur prise en charge permettent aux systemes de santé d'adopter une approche intégrée pour éviter la transmission mere-enfant. Plusieurs obstacles entravent actuellement la triple élimination en Afrique subsaharienne, parmi lesquels l'absence de politiques, de stratégies et de ressources pour garantir la disponibilité de traitements préventifs et curatifs bien établis. Les outils existants offrent déja de nombreuses solutions;mais pour accélérer la progression de cette triple élimination en Afrique subsaharienne, il est indispensable de développer de nouveaux produits et modeles de soins, ainsi qu'un programme de recherche prioritaire. Dans le présent document, nous voulons montrer que si les systemes de santé collaborent avec les communautés en Afrique subsaharienne, ils pourront obtenir des résultats rapides et durables en vue d'éradiquer la transmission mere-enfant des trois maladies susmentionnées. Néanmoins, une telle démarche implique un soutien politique massif, l'expansion des interventions fondées sur des données scientifiques, et une meilleure utilisation des sources de financement afin d'améliorer l'efficacité et de s'appuyer sur les réussites en matiere de prévention de la transmission du VIH de la mere a l'enfant. La triple élimination représente une occasion stratégique de réduire la morbidité et la mortalité liées a l'infection au VIH, a la syphilis et a l'hépatite B, tant chez les meres que chez les nourrissons, dans un contexte de couverture maladie universelle.Alternate abstract:Ð¢Ñ€Ð¾Ð¹Ð½Ð°Ñ ÑлиминациÑ, Ñто инициатива, Ð¿Ð¾Ð´Ð´ÐµÑ€Ð¶Ð¸Ð²Ð°ÑŽÑ‰Ð°Ñ Ñлиминацию передачи от матери ребенку трех заболеваний: инфекции, вызванной вируÑом иммунодефицита человека (ВИЧ), ÑифилиÑа и гепатита Ð’. Ð’ некоторых регионах был доÑтигнут значительный прогреÑÑ Ð² направлении тройной Ñлиминации, однако на территориÑÑ… к югу от Сахары (в регионе Ðфрики Ñ Ñамым выÑоким бременем Ñтих болезней) такой прогреÑÑ Ð±Ñ‹Ð» медленным. Общие характериÑтики трех болезней, Ð²ÐºÐ»ÑŽÑ‡Ð°Ñ Ð¸Ñ… Ñпидемиологию, взаимодейÑтвие болезней и оÑновные меры по борьбе Ñ Ð½Ð¸Ð¼Ð¸, позволÑÑŽÑ‚ иÑпользовать комплекÑный подход в рамках ÑиÑтем Ð·Ð´Ñ€Ð°Ð²Ð¾Ð¾Ñ…Ñ€Ð°Ð½ÐµÐ½Ð¸Ñ Ðº Ñлиминации передачи от матери ребенку. Текущие препÑÑ‚ÑÑ‚Ð²Ð¸Ñ Ð½Ð° пути тройной Ñлиминации в Ñтранах Ðфрики к югу от Сахары включают отÑутÑтвие политик, Ñтратегий и реÑурÑов Ð´Ð»Ñ Ð¿Ð¾Ð´Ð´ÐµÑ€Ð¶ÐºÐ¸ Ð²Ð½ÐµÐ´Ñ€ÐµÐ½Ð¸Ñ Ñ…Ð¾Ñ€Ð¾ÑˆÐ¾ зарекомендовавших ÑÐµÐ±Ñ Ð¿Ñ€Ð¾Ñ„Ð¸Ð»Ð°ÐºÑ‚Ð¸Ñ‡ÐµÑких и лечебных мер. ÐеÑÐ¼Ð¾Ñ‚Ñ€Ñ Ð½Ð° то что Ñ Ð¿Ð¾Ð¼Ð¾Ñ‰ÑŒÑŽ ÑущеÑтвующих инÑтрументов можно добитьÑÑ Ð¼Ð½Ð¾Ð³Ð¾Ð³Ð¾, Ð´Ð»Ñ ÑƒÑÐºÐ¾Ñ€ÐµÐ½Ð¸Ñ Ð¿Ñ€Ð¾Ð³Ñ€ÐµÑÑа в облаÑти тройной Ñлиминации в Ñтранах Ðфрики к югу от Сахары необходима разработка новых продуктоРи моделей Ð¾ÐºÐ°Ð·Ð°Ð½Ð¸Ñ Ð¼ÐµÐ´Ð¸Ñ†Ð¸Ð½Ñкой помощи, а также повеÑтка Ð´Ð½Ñ Ð² облаÑти приоритетных научных иÑÑледований. Ð’ Ñтом документе авторы ÑтремÑÑ‚ÑÑ Ð¿Ð¾ÐºÐ°Ð·Ð°Ñ‚ÑŒ, что ÑиÑтемы здравоохранениÑ, работающие вмеÑте Ñ Ð¾Ð±Ñ‰ÐµÑтвенноÑтью в Ñтранах Ðфрики к югу от Сахары, могут обеÑпечить быÑтрые и уÑтойчивые результаты в направлении Ñлиминации передачи вÑех трех заболеваний от матери ребенку. Однако Ð´Ð»Ñ Ð¿Ð¾Ð²Ñ‹ÑˆÐµÐ½Ð¸Ñ ÑффективноÑти и доÑÑ‚Ð¸Ð¶ÐµÐ½Ð¸Ñ ÑƒÑпехов в профилактике передачи ВИЧ от матери ребенку необходимы: более ÑÐ¸Ð»ÑŒÐ½Ð°Ñ Ð¿Ð¾Ð»Ð¸Ñ‚Ð¸Ñ‡ÐµÑÐºÐ°Ñ Ð¿Ð¾Ð´Ð´ÐµÑ€Ð¶ÐºÐ°, раÑширение научно обоÑнованных мер и лучшее иÑпользование потоков финанÑированиÑ. Ð¢Ñ€Ð¾Ð¹Ð½Ð°Ñ ÑлиминациÑ, Ñто ÑтратегичеÑÐºÐ°Ñ Ð²Ð¾Ð·Ð¼Ð¾Ð¶Ð½Ð¾ÑÑ‚ÑŒ Ñнизить заболеваемоÑÑ‚ÑŒ и ÑмертноÑÑ‚ÑŒ от ВИЧ-инфекции, ÑифилиÑа и гепатита B Ð´Ð»Ñ Ð¼Ð°Ñ‚ÐµÑ€ÐµÐ¹ и их младенцев в контекÑте вÑеобщего охвата уÑлугами здравоохранениÑ.Alternate abstract:Triple elimination is an initiative supporting the elimination of mother-to-child transmission of three diseases - human immunodeficiency virus (HIV) infection, syphilis and hepatitis B. Significant progress towards triple elimination has been made in some regions, but progress has been slow in sub-Saharan Africa, the region with the highest burden of these diseases. The shared features of the three diseases, including their epidemiology, disease interactions and core interventions for tackling them, enable an integrated healthsystems approach for elimination of mother-to-child transmission. Current barriers to triple elimination in sub-Saharan Africa include a lack of policies, strategies and resources to support the uptake of wellestablished preventive and treatment interventions. While much can be achieved with existing tools, the development of new products and models of care, as well as a prioritized research agenda, are needed to accelerate progress on triple elimination in sub-Saharan Africa. In this paper we aim to show that health systems working together with communities in sub-Saharan Africa could deliver rapid and sustainable results towards the elimination of mother-to-child transmission of all three diseases. However, stronger political support, expansion of evidence-based interventions and better use of funding streams are needed to improve efficiency and build on the successes in prevention of mother-to-child transmission of HIV. Triple elimination is a strategic opportunity to reduce the morbidity and mortality from HIV infection, syphilis and hepatitis B for mothers and their infants within the context of universal health coverage.