{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T11:45:17Z","timestamp":1782819917918,"version":"3.54.5"},"reference-count":65,"publisher":"Ubiquity Press, Ltd.","issue":"1","license":[{"start":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:00:00Z","timestamp":1773273600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"crossref","award":["D43TW011976"],"award-info":[{"award-number":["D43TW011976"]}],"id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["D43TW011976"],"award-info":[{"award-number":["D43TW011976"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["gh"],"abstract":"Background: This review assessed the cost-effectiveness and implementation strategies of hypertension management by non-physician healthcare workers (NPHCWs) in low- and middle-income countries (LMICs).\nMethods: A systematic search (inception\u2013May 2024) included adults \u226518 years managed by NPHCWs LMICs, following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Economic evaluations were assessed using Drummond\u2019s checklist and ROBINS-I.\nResults: Seven studies (2002\u20132022) conducted across eight countries enrolled 96\u201310,000 participants and included randomized, modeling, observational, and quasi-experimental designs. NPHCWs included pharmacists, community and village health workers, and nurses. Patients\u2019 mean age ranged 58\u201371 years, with 57\u201382% female. Outcomes assessed included cost per mmHg reduction ($INT 2.25 systolic, $INT 2.03 diastolic), per controlled patient ($INT 1.48), annual cost ($INT 0.22\u2013232.31), cost per disability-adjusted life year (DALY) averted ($INT 411.39\u20134709.96), and per quality-adjusted life year (QALY) gained ($INT 1.04\u201313.30). Incremental cost-effectiveness ratio (ICERs) varied ($INT 0.41\u201314,373.97). Strategies included NPHCWs training and community engagement\/counseling.\nConclusion: Hypertension management by NPHCWs appears cost-effective in LMICs, though more studies are needed for generalizability.<\/jats:p>","DOI":"10.5334\/gh.1533","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T10:14:58Z","timestamp":1773310498000},"page":"18","source":"Crossref","is-referenced-by-count":0,"title":["Cost-Effectiveness and Implementation Strategies for Hypertension Management Using Non-Physician Healthcare Workers in Low- and Middle-Income Countries: A Systematic Review"],"prefix":"10.5334","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2295-908X","authenticated-orcid":false,"given":"Gabriel Lamkur","family":"Shedul","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4972-1098","authenticated-orcid":false,"given":"Olutobi Adekunle","family":"Sanuade","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9103-9899","authenticated-orcid":false,"given":"Emmanuel Iroboudu","family":"Okpetu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6524-6464","authenticated-orcid":false,"given":"Molly","family":"Beestrum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2084-1988","authenticated-orcid":false,"given":"Dike Bevis","family":"Ojji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4355-7437","authenticated-orcid":false,"given":"Lisa R.","family":"Hirschhorn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7412-2519","authenticated-orcid":false,"given":"Mark D.","family":"Huffman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4064-3206","authenticated-orcid":false,"given":"Dustin D.","family":"French","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3285","published-online":{"date-parts":[[2026,3,12]]},"reference":[{"key":"key20260312101450_B1","unstructured":"World Health Organization. Global report on hypertension: the race against a silent killer. Geneva: World Health Organization; 2023. Licence: CC BY-NC-SA 3.0 IGO. 2023 [cited 2024 Jan 15]. Available from: https:\/\/www.who.int\/publications\/i\/item\/9789240081062."},{"key":"key20260312101450_B2","unstructured":"World Bank. World Bank Country and Lending Groups [cited 2025 January 15 ]. Available from: https:\/\/datahelpdesk.worldbank.org\/knowledgebase\/articles\/906519-world-bank-country-and-lending-groups."},{"key":"key20260312101450_B3","unstructured":"World Health Organization. Hypertension Key Facts, 2023 [cited 2025 Jun 6]. Available from: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/hypertension."},{"issue":"10396","key":"key20260312101450_B4","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/S0140-6736(23)01171-6","article-title":"Addressing disparities and challenges in global health from an LMIC perspective","volume":"402","year":"2023","journal-title":"The Lancet"},{"issue":"10199","key":"key20260312101450_B5","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1016\/S0140-6736(19)30955-9","article-title":"The state of hypertension care in 44 low-income and middle-income countries: A cross-sectional study of nationally representative individual-level data from 1\u20221 million adults","volume":"394","year":"2019","journal-title":"The Lancet"},{"issue":"3","key":"key20260312101450_B6","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1007\/s12134-021-00898-y","article-title":"\u201cWhat Are You Really Doing in This Country?\u201d: Emigration intentions of Nigerian doctors and their policy implications for human resource for health management","volume":"23","year":"2022","journal-title":"Journal of International Migration & Integration"},{"key":"key20260312101450_B7","unstructured":"World Health Organization. Non communicable diseases and their risk factors. Third UN high-level meeting on NCDS; 2018 [cited 2024 Jun 12]. 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Implementation strategies to improve blood pressure control in the United States: A scientific statement from the American Heart Association and American Medical Association","volume":"80","year":"2023","journal-title":"Hypertension"},{"issue":"5","key":"key20260312101450_B13","article-title":"Implementation outcomes and strategies for delivering evidence-based hypertension interventions in lower-middle-income countries: Evidence from a multi-country consortium for hypertension control","volume":"18","year":"2023","journal-title":"PLoS One"},{"issue":"2","key":"key20260312101450_B14","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1177\/1077558711430690","article-title":"A compilation of strategies for implementing clinical innovations in health and mental health","volume":"69","year":"2012","journal-title":"Medical Care Research and Review"},{"issue":"8","key":"key20260312101450_B15","article-title":"Task shifting for non-communicable disease management in low and middle income countries \u2013 A systematic review","volume":"9","year":"2014","journal-title":"PLoS One"},{"issue":"6","key":"key20260312101450_B16","doi-asserted-by":"crossref","first-page":"e761","DOI":"10.1016\/S2214-109X(19)30077-4","article-title":"Task sharing with non-physician health-care workers for management of blood pressure in low-income and middle-income countries: A systematic review and meta-analysis","volume":"7","year":"2019","journal-title":"The Lancet Global Health"},{"issue":"1","key":"key20260312101450_B17","article-title":"The contribution of non-physician clinicians to the provision of surgery in rural Zambia\u2014a randomised controlled trial","volume":"17","year":"2019","journal-title":"Human Resources for Health"},{"key":"key20260312101450_B18","article-title":"Task shifting for point of care ultrasound in primary healthcare in low- and middle-income countries-a systematic review","volume":"45","year":"2022","journal-title":"eClinicalMedicine"},{"key":"key20260312101450_B19","unstructured":"CDC. 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