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Cardiovascular disease in Kyrgyzstan

Implementation strategy for CVD risk factors

By Dhwani Babla

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Screening and management of

hypertension & diabetes in Kyrgyzstan’s primary care settings.

What is the public health issue you will address, and in what geographic and health system context?
CVD is the leading cause of death globally. Among the WHO Europe region, Kyrgyzstan has the highest premature mortality from CVDs - 50% of all deaths are due to CVD in the country
While CVD has many risk factors, hypertension is the leading modifiable risk factor for CVD and premature death worldwide. Diabetes has also been noted to be an important modifiable risk factor for CVD. This is a major cause of concern because globally and Kyrgyzstan since prevalence and absolute burden of both hypertension and diabetes have been continuously increasing.
The high burden of CVD often results from ineffective or insufficient detection and management of cardiometabolic risk factors - Awareness, treatment, and control of hypertension and diabetes are unacceptably low around the world and LMICs
There is strong evidence that primary care is one of the most cost-effective strategies in curbing morbidity, disability and premature mortality of hypertension and diabetes management. In Kyrgyzstan, the availability of CVD risk assessment and management was self-assessed as not achieved in 50% or more primary care facilities
Which is why in this presentation, we will be focusing on the screening and management of CVD risk factors such hypertension and diabetes in Kyrgyzstan's PHC settings

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2. What intervention or program have you decided to focus on?

To address the burden of CVD and other NCDs, Kyrgyzstan implemented the WHO PEN (package of essential noncommunicable) disease interventions as pilot projects within multiple primary care centers across the country. One of the PEN protocols is to train primary health care (PHC) workers in cardiovascular risk stratification and management.
However, evaluations of the PEN implementation were unable to demonstrate effectiveness after a year. In 2013, a WHO survey found that although 43% of Kyrgyzstan’s adult population has hypertension, only 39.8% of adults previously diagnosed with hypertension and only 20% of those identified as having raised blood pressure through the survey were on medication. Given that the PEN interventions have shown success in improving some or all aspects of the CVD cascade of care in other settings, it is vital to focus on the CVD-related PEN protocols in Kyrgyzstan.

3. What implementation strategy will you examine to deliver the intervention?

Hence, the implementation strategy is to focus on training PCH workers to enhance the implementation of the PEN protocols for the screening and management of hypertension and diabetes in PHC centers in Kyrgyzstan.

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Research question & study design

Research question

Does the addition of comprehensive and targeted PHC worker training increase the effectiveness of PEN protocols for the screening and management of hypertension and diabetes in Kyrgyzstan?

Study design

Influence based study design: hybrid study

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Consolidated Framework for Implementation Research

Evaluate implementation effectiveness of PHC work training to hypertension and diabetes PEN interventions

6. Is there an implementation science framework or theory you have learned about in class or elsewhere that you can apply to the concept you have developed?

We can apply the Consolidated Framework for Implementation Research to assess the implementation effectiveness of PHC worker training on hypertension and diabetes PEN interventions
It has been used in other PEN or hypertension-related program evaluations
This framework is a validated tool that allows national governments to predict and plan around factors known to be influential for implementation and successfully increasing access to quality essential health services.

It guides data collection, analysis and interpretation could help to identify the determinants of implementation that apply to a specific context and assist in achieving the goal of generalizing and building on findings across studies and contexts AND