Masks During Pandemics Caused by Respiratory Pathogens-Evidence and Implications for Action.

Importance: As demonstrated by the influenza virus and SARS-CoV-2, viruses spread by the respiratory route can cause deadly pandemics, and face masks can reduce the spread of these pathogens. The effectiveness of responses to future epidemics and pandemics will depend at least in part on whether evidence on masks, including from the COVID-19 pandemic, is utilized. Observations: Well-designed observational studies have demonstrated the association of mask use with reduced transmission of SARS-CoV-2 in community settings, and rigorous evaluations of mask mandates have found substantial protection. Disagreement about whether face masks reduce the spread of SARS-CoV-2 has been exacerbated by a focus on randomized trials, which are limited in number, scope, and statistical power. Many effective public health policies have never been assessed in randomized clinical trials; such trials are not the gold standard of evidence for the efficacy of all interventions. Masking in the community to reduce the spread of SARS-CoV-2 is supported by robust evidence from diverse settings and populations. Data on the epidemiologic, environmental, and mask design parameters that influence the effectiveness of masking provide insights on when and how masks should be used to prevent transmission. Conclusions and Relevance: During the next epidemic or pandemic caused by a respiratory pathogen, decision-makers will need to rely on existing evidence as they implement interventions. High-quality studies have shown that use of face masks in the community is associated with reduced transmission of SARS-CoV-2 and is likely to be an important component of an effective response to a future respiratory threat.

The road to achieving epidemic-ready primary health care.

Millions of avoidable deaths arising from the COVID-19 pandemic emphasise the need for epidemic-ready primary health care aligned with public health to identify and stop outbreaks, maintain essential services during disruptions, strengthen population resilience, and ensure health worker and patient safety. The improvement in health security from epidemic-ready primary health care is a strong argument for increased political support and can expand primary health-care capacities to improve detection, vaccination, treatment, and coordination with public health-needs that became more apparent during the pandemic. Progress towards epidemic-ready primary health care is likely to be stepwise and incremental, advancing when opportunity arises based on explicit agreement on a core set of services, improved use of external and national funds, and payment based in large part on empanelment and capitation to improve outcomes and accountability, supplemented with funding for core staffing and infrastructure and well designed incentives for health improvement. Health-care worker and broader civil society advocacy, political consensus, and bolstering government legitimacy could promote strong primary health care. Epidemic-ready primary health-care infrastructure that is able to help prevent and withstand the next pandemic will require substantial financial and structural reforms and sustained political and financial commitment. Governments, advocates, and bilateral and multilateral agencies should seize this window of opportunity before it closes.

Keep it simple: designing a user-centred digital information system to support chronic disease management in low/middle-income countries.

OBJECTIVE: Implement a user-centred digital health information system to facilitate rapidly and substantially increasing the number of patients treated for hypertension in low/middle-income countries. METHODS: User-centred design of Simple, an offline-first app for mobile devices to record patient clinical visits and a web-based dashboard to monitor programme performance. RESULTS: The Simple mobile application scaled rapidly over the past 4 years to reach more than 11 400 primary care facilities in four countries with over 3 million patients enrolled. Simple achieved median duration for new patient registration of 76 s (IQR 2 s) and follow-up visit entry of 13 s (IQR 1 s). CONCLUSIONS: A fast, easy-to-use digital information system for hypertension programmes that accommodates healthcare worker time constraints by minimising data entry and focusing on key performance indicators can successfully reach scale in low-resource settings.

Preparing for Pandemics and Other Health Threats: Societal Approaches to Protect and Improve Health.

This Viewpoint discusses 3 areas in need of progress regarding societal approaches to pandemics and other health threats: a renaissance in public health; robustness of primary health care; and resilience of individuals and communities, with higher levels of trust in government and society.

HEARTS en las Américas: salvar vidas de la enfermedad más letal del mundo

[EXTRACTO]. HEARTS en las Américas, la adaptación a nivel regional de la iniciativa de la OMS dirigida por la Organización Panamericana de la Salud (OPS), está iniciando ahora su sexto año de implementación, al mes de junio del 2022, más de un millón de pacientes estaban recibiendo tratamiento en el marco de esta iniciativa en aproximadamente 2 000 centros de atención primaria de salud en 24 países. Los programas de salud pública funcionan mejor cuando se centran en metas específicas, cuantificables, ambiciosas y alcanzables. En el caso del control de la hipertensión, esto significa centrarse en el aumento sostenido de la proporción de todas las personas con problemas de hipertensión que reciben un tratamiento adecuado. Actualmente, más de seis de cada 10 personas que presentan hipertensión en la Región no reciben un trata- miento adecuado. A menos que se acelere sustancialmente el progreso en la provisión de un tratamiento antihipertensivo que salve vidas, y se aborde con ello esta necesidad de salud y este derecho humano que son fundamentales, la Región no proporcionará un tratamiento eficaz ni siquiera a la mitad de la población que lo necesita hasta el 2050, y es probable que no alcance la meta de los Objetivos de Desarrollo Sostenible (ODS) de prevenir la muerte por enfermedades no transmisibles a una edad joven. De actuarse con intención y rapidez, la mayoría de las personas de la Región puede ser tratada eficazmente. La aplicación generalizada de la estrategia HEARTS con un énfasis en el logro de la meta 80-80-80 para el diagnóstico, tratamiento y control de la hipertensión podría salvar millones de vidas, prevenir gastos y sufrimientos evitables, acelerar el progreso hacia el logro de los ODS y hacer de la Región de las Américas un modelo de prevención de las enfermedades cardiovasculares para el resto del mundo.

HEARTS in the Americas: saving lives from the world’s deadliest disease

[EXTRACT]. The articles in this special issue on HEARTS in the Americas illustrate a wide range of important research on implementing the comprehensive HEARTS model throughout the Americas. Results show that this approach works in countries with differ- ing social and political environments and can be scaled up to serve large populations. Public health programs work best when they focus on specific, measurable, ambitious, achievable targets. In hypertension con- trol, this means focusing on steadily increasing the proportion of all people with estimated hypertension who are adequately treated.

A simple six-step guide to National-Scale Hypertension Control Program implementation.

Hypertension is the leading single preventable risk factor for death worldwide, and most of the disease burden attributed to hypertension weighs on low-and middle-income countries. Effective large-scale public health hypertension control programs are needed to control hypertension globally. National programs can follow six important steps to launch a successful national-scale hypertension control program: establish an administrative structure and survey current resources, select a standard hypertension treatment protocol, ensure supply of medication and blood pressure devices, train health care workers to measure blood pressure and control hypertension, implement an information system for monitoring patients and the program overall, and enroll and monitor patients with phased program expansion. Resolve to Save Lives, an initiative of global public health organization Vital Strategies, and its partners organized these six key steps and materials into a structured, stepwise guide to establish best practices in hypertension program design, launch, maintenance, and scale-up.

Leveraging Telemedicine for Chronic Disease Management in Low- and Middle-Income Countries During Covid-19.

In response to the Covid-19 pandemic, many low- and middle-income countries (LMICs) expanded access to telemedicine to maintain essential health services. Although there has been attention to the accelerated growth of telemedicine in the United States and other high-income countries, the telemedicine revolution may have an even greater benefit in LMICs, where it could improve health care access for vulnerable and geographically remote patients. In this article, we survey the expansion of telemedicine for chronic disease management in LMICs and describe seven key steps needed to implement telemedicine in LMIC settings. Telemedicine can not only maintain essential medical care for chronic disease patients in LMICs throughout the Covid-19 pandemic, but also strengthen primary health care delivery and reduce socio-economic disparities in health care access over the long-term.