Table 1

Table 1

Characteristics of studies using task-shifting to manage hypertension

Project	Country	Aim	Tasks-shifted	Task-sharing team	Qualifications of NPHWs
DREAM-Global15	Tanzania and indigenous communities in Canada	To develop and implement a programme of training for community health workers and community nurses to diagnose and manage HTN among rural dwelling people with HTN. At the core of this intervention is education regarding HTN delivered to patients’ mobile phones and improved access to antihypertensive medications through an SMS (eVoucher) programme in partnership with the private, informal pharmacy sector	Diagnosis of hypertension by community health workers Management by community nurses based at government health centres	Clinical officer at health centre supervises nurses who manage hypertension. CHWs work independently in the communities to diagnose hypertension and follow-up	Clinical officer (trained at CO school) Nurse—diploma nursing programme CHW has primary school education and 1–3 years of high school. CHWs trained informally by government
HOPE-4	Colombia and Malaysia	Screening and identification of participants with hypertension and moderate CVD risk, initiation of appropriate CVD combination medications (appropriate to local policy-statin and antihypertensives), lifestyle counselling and follow-up of participants	Screening and identification of participants with high CVD risk, initiation of appropriate CVD medications, lifestyle counselling and follow-up. Assisted by mobile tablets with decision support and data collection	Study physician and NPHW	Minimum high school education Combination of CHWs trained in other areas of healthcare-repurposed for CVD care Current research assistants trained as CHWs
Nkateko Trial20	South Africa	To improve the functioning of clinics by providing support to nurses	Patient reminders, BP measurements, Booking appointments, Pulling files and refiling, Health education, tracking defaulters. Assist with prepacking of medicines	Nurse and CHW. Manager—professional nurse	CHWs (lay)—10 years of education. Experience as a CHW (identification from local NGOs, they are not part of the government)
CHIRI18	India	Develop and pilot a group led education intervention strategy to improve the control of hypertension	Facilitating group meetings, BP measurement, Education and information about the management of hypertension	Tasks shared between doctors and ASHAs	8 years of education
SmartHealth India: A smart phone based clinical decision support system for primary healthcare workers in rural India26	India	To develop and evaluate a multifaceted clinic decision support tool	Screening and identification pf patients with high CVD risk, risk communication and referral to doctors, follow-up of patients and counselling. Smartphone for decision making and health records	Physician, ASHA	8 years of education
Task-shifting and BP control in Ghana16	Ghana	To evaluate the comparative effectiveness of the implementation of the WHO Package targeted at CV risk assessment vs provision of health insurance coverage, on BP reduction.	Screening and identification of patients with hypertension, CVD risk assessment, BP measurement, medication adjustment based on a prespecified algorithm, lifestyle behavioural counselling and patient referral for specialist care	Physician, community health nurses	14 years of education (6 years primary, 6 years high school, 2 years nursing training)
Optimising linkage and retention to hypertension care in rural Kenya19	Kenya	To use a multidisciplinary implementation research approach to address the challenge of linking and retaining hypertensive individuals to a hypertension management programme	Linkage and Retention of patients by CHWs by equipping them with behavioural assessment tools, communication strategies, motivational interviewing. Smartphone for decision making and health records, and audiovisual tools such as images and videos	Nurses, CHEWs and CHW	At the minimum, they are literate, most have attained O level/Grade 12 education, with experience of more than 5 years
Comprehensive approach to hypertension control in Argentina14	Argentina	To test whether a comprehensive intervention programme within a national public primary healthcare system will improve hypertension control among uninsured hypertensive patients and their families in Argentina	Education and counselling (lifestyle, risk factors) in the community. Teach participants to control BP, use BP machines	Physicians, nurses and CHWs 20 in all. Nurses were supervisors	At the minimum primary school education, about 50% high school. MCH training from government.

ASHAs, accredited social health activists; BP, blood pressure; CHEW, community health extension workers; CHIRI, Control of Hypertension In Rural India; CHWs, community health workers; CVD, cardiovascular disease; HTN, hypertension; NPHW, non-physician health workers.