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Background: More than 75% of deaths from cardiovascular diseases (CVD) occur in low- and middle-income countries, yet there is limited adoption of evidence-based interventions to prevent CVD in these settings. The HEARTS Technical Package in Primary Care is the model recommended by the WHO to address this implementation gap. A key barrier of HEARTS is that many health systems lack sufficient resources to provide free access to medications for CVD and lack a system for patient monitoring and follow-up. Methods: We evaluated the implementation of the first official HEARTS project in the Ministry of Health (MoH) of Guatemala. The project was carried out in 6 primary healthcare facilities across 3 rural municipalities over 8 months. The population were predominantly of Indigenous Maya ethnicity, an ethnic group historically underserved by the MoH. HEARTS consists of six evidence-based, cost-effective components. These were complemented by 3 patient-centered strategies to enhance sustainability: (1) community-based social accountability intervention; (2) revolving-fund pharmacy operated by municipal governments to provide low-cost generic medications; and (3) facility-based digital monitoring tool (DHIS2). Results: We observed a 4-fold increase in treatment rate and a 14% absolute increase in the proportion of patients achieving blood pressure control. The availability of free antihypertensive medications was enhanced through the MoH and the revolving-fund pharmacy, improving adherence in 37%. Additional process outcomes include: 28 health personnel received training on hypertension clinical management; 16 self-help groups for hypertensive patients were supported; 178 patient visits were tracked in the DHIS2 monitoring system. Conclusions: The results demonstrated significant improvements in hypertension control. The implementation of patient-centered strategies, coupled with intersectoral collaboration, contributed to the program's success. Challenges in the sustainability of the model were identified due to financial limitations. Overall, the project set an important precedent for addressing hypertension in rural communities. This pilot HEARTS project serves as a model for scaling-up hypertension management in the MoH primary care system.
Wellmann et al. (Sun,) studied this question.