title: Task shifting interventions for cardiovascular risk reduction in low-income and middle-income countries: a systematic review of randomised controlled trials.
abstract: OBJECTIVE
  To evaluate evidence from published randomised controlled trials (RCTs) for the use of task-shifting strategies for cardiovascular disease (CVD) risk reduction in low-income and middle-income countries (LMICs).
  
  
  METHODS
  Systematic review of RCTs that utilised a task-shifting strategy in the management of CVD in LMICs.
  
  
  METHODS
  We searched the following databases for relevant RCTs: PubMed from the 1940s, EMBASE from 1974, Global Health from 1910, Ovid Health Star from 1966, Web of Knowledge from 1900, Scopus from 1823, CINAHL from 1937 and RCTs from ClinicalTrials.gov.
  
  
  METHODS
  We focused on RCTs published in English, but without publication year. We included RCTs in which the intervention used task shifting (non-physician healthcare workers involved in prescribing of medications, treatment and/or medical testing) and non-physician healthcare providers in the management of CV risk factors and diseases (hypertension, diabetes, hyperlipidaemia, stroke, coronary artery disease or heart failure), as well as RCTs that were conducted in LMICs. We excluded studies that are not RCTs.
  
  
  RESULTS
  Of the 2771 articles identified, only three met the predefined criteria. All three trials were conducted in practice-based settings among patients with hypertension (2 studies) and diabetes (1 study), with one study also incorporating home visits. The duration of the studies ranged from 3 to 12 months, and the task-shifting strategies included provision of medication prescriptions by nurses, community health workers and pharmacists and telephone follow-up posthospital discharge. Both hypertension studies reported a significant mean blood pressure reduction (2/1 mm Hg and 30/15 mm Hg), and the diabetes trial reported a reduction in the glycated haemoglobin levels of 1.87%.
  
  
  CONCLUSIONS
  There is a dearth of evidence on the implementation of task-shifting strategies to reduce the burden of CVD in LMICs. Effective task-shifting interventions targeted at reducing the global CVD epidemic in LMICs are urgently needed.
authors.affiliation: Department of Population Health, NYU School of Medicine, NYU Langone Medical Center, New York, USA.|NYU Global Institute of Public Health, New York University, New York, USA.
authors.forename: Gbenga
authors.initials: G
authors.lastname: Ogedegbe
authors.affiliation: Department of Population Health, NYU School of Medicine, NYU Langone Medical Center, New York, USA.
authors.forename: Joyce
authors.initials: J
authors.lastname: Gyamfi
authors.affiliation: School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors.forename: Jacob
authors.initials: J
authors.lastname: Plange-Rhule
authors.affiliation: NYU Health Sciences Libraries, NYU Langone Medical Center, New York, USA.
authors.forename: Alisa
authors.initials: A
authors.lastname: Surkis
authors.affiliation: Department of Population Health, NYU School of Medicine, NYU Langone Medical Center, New York, USA.
authors.forename: Diana Margot
authors.initials: DM
authors.lastname: Rosenthal
authors.affiliation: Department of Biobehavioral Health, Pennsylvania State University, University Park, Pennsylvania, USA.
authors.forename: Collins
authors.initials: C
authors.lastname: Airhihenbuwa
authors.affiliation: Department of Kinesiology and Community health, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA.
authors.forename: Juliet
authors.initials: J
authors.lastname: Iwelunmor
authors.affiliation: Stritch School of Medicine, Loyola Chicago Medical Center, Chicago, Illinois, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Cooper
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D003376:Counseling; D003906:Developing Countries; D006282:Health Personnel; D006801:Humans; D008403:Mass Screening; D011320:Primary Health Care / Q000458:organization & administration*; D016032:Randomized Controlled Trials as Topic; D012017:Referral and Consultation; D040242:Risk Reduction Behavior; D016526:Workload
keywords: Cardiovascular diseases; Diabetes; Low-and middle-income countries; Systematic review; Task shifting