Implementation research on noncommunicable disease prevention and control interventions in LMICs

2 August, 2022

This new paper in PLOS Medicine finds that 'While implementation research on priority NCDs has grown substantially, from under 10 studies per year in early 2000s to 51 studies in 2020, this is still vastly incommensurate with the health burden of NCDs'.

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CITATION: Hategeka C, Adu P, Desloge A, Marten R, Shao R, Tian M, et al. (2022) Implementation research on noncommunicable disease prevention and control interventions in low- and middle-income countries: A systematic review. PLoS Med 19(7): e1004055. https://doi.org/10.1371/journal.pmed.1004055

ABSTRACT

Background: While the evidence for the clinical effectiveness of most noncommunicable disease (NCD) prevention and treatment interventions is well established, care delivery models and means of scaling these up in a variety of resource-constrained health systems are not. The objective of this review was to synthesize evidence on the current state of implementation research on priority NCD prevention and control interventions provided by health systems in low- and middle-income countries (LMICs).

Methods and findings: On January 20, 2021, we searched MEDLINE and EMBASE databases from 1990 through 2020 to identify implementation research studies that focused on the World Health Organization (WHO) priority NCD prevention and control interventions targeting cardiovascular disease, cancer, diabetes, and chronic respiratory disease and provided within health systems in LMICs... 222 eligible studies evaluated 265 priority NCD prevention and control interventions implemented in 62 countries (6% in low-income countries and 90% in middle-income countries)...

Conclusions: Despite growth in implementation research on NCDs in LMICs, we found major gaps in the science. Future studies should prioritize implementation at scale, target higher levels health systems (meso and macro levels), and test sustainability of NCD programs. They should employ designs with stronger internal validity, be more conceptually driven, and use mixed methods to understand mechanisms. To maximize impact of the research under limited resources, adding implementation science outcomes to effectiveness research and regional collaborations are promising.

AUTHOR SUMMARY [extracts]

'We performed a systematic review search in MEDLINE and EMBASE databases from 1990 through 2020 to identify implementation research studies that focused on the WHO priority NCD prevention and control interventions targeting cardiovascular disease, cancer, diabetes, and chronic respiratory disease and provided within health systems in low- and middle-income countries (LMICs).

We identified 222 eligible studies that evaluated 265 priority NCD prevention and control interventions implemented in 62 countries (6% in low-income countries and 90% in middle-income countries). The number of studies published has been increasing over time. The majority of interventions were focused on either screening (49%) or treatment (39%), while prevention accounted for only 12%.

Reviewed studies emphasized a few health areas, such as cervical cancer, with many other high-burden conditions little researched. The majority of studies were proof of concept or pilot, quantitative using weaker study designs and targeted the micro level of health system.

While implementation research on priority NCDs has grown substantially, from under 10 studies per year in early 2000s to 51 studies in 2020, this is still vastly incommensurate with the health burden of NCDs.

Future studies should prioritize implementation at scale, target higher levels health systems (meso and macro levels), and test sustainability of NCD programs. They should employ designs with stronger internal validity, be more conceptually driven, and use mixed methods to understand mechanisms.

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Neil Pakenham-Walsh, Global Coordinator HIFA, www.hifa.org neil@hifa.org

Working in official relations with WHO