ANDES trial and integration of the HEARTS model in Puno, Peru

Background: HEARTS is the regional strategy led by the Pan American Health Organization to strengthen hypertension and diabetes control in primary health care. This report summarizes formative and process evidence from the ANDES trial in Puno, Peru, and its alignment with HEARTS implementation. Meth...

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Autores principales: Gonzalo Cuentas, Lucy Cordova-Ascona, Lisa de las Fuentes, Anderson N. Soriano-Moreno, Lindsay J. Underhill, Kendra N. Williams, Zoila Vela-Clavo, Carlos Diaz‐Arocutipa, Juan Carlos Mendoza, Elvin Geng, William Checkley, Stella M. Hartinger, Víctor G. Dávila‐Román
Formato: Artículo
Lenguaje:inglés
Publicado: 2025
Materias:
Psychological intervention
Medicine
Geography
Diabetes mellitus
Primary care
Health care
Healthcare system
Work (physics)
Primary health care
Disease
Environmental health
Economic growth
Business
Community health
Government (linguistics)
Life Sciences Biochemistry, Genetics and Molecular Biology Genetics High Altitude and Hypoxia
Health Sciences Medicine Cardiology and Cardiovascular Medicine Blood Pressure and Hypertension Studies
Health Sciences Medicine Cardiology and Cardiovascular Medicine Cardiovascular Health and Risk Factors
Acceso en línea:Ver en el sistema de origen
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Sumario:Background: HEARTS is the regional strategy led by the Pan American Health Organization to strengthen hypertension and diabetes control in primary health care. This report summarizes formative and process evidence from the ANDES trial in Puno, Peru, and its alignment with HEARTS implementation. Methods: We assessed 414 health facilities using an adapted World Health Organization Service Availability and Readiness Assessment (SARA-NCD), conducted 55 semi-structured interviews with health professionals, and applied the Hill-Bone adherence scale to 204 hypertensive patients. Results: Facility readiness was 28% for hypertension and 29% for diabetes. Lower-level facilities - posts and basic health centers - showed markedly lower readiness (OR = 0.20 for hypertension; OR = 0.03 for diabetes). Provider interviews identified limited prioritization of hypertension, weak supply chains, and insufficient training. Mean adherence score was 48.3 ± 4.0 (medication 31.6 ± 3.5; appointment-keeping 5.98 ± 1.27; salt reduction 10.67 ± 1.18). Conclusions: Findings reveal major readiness gaps and systemic barriers to hypertension and diabetes management in high-altitude Andean regions. Community health worker-supported interventions such as ANDES can facilitate adoption of HEARTS strategies in resource-limited primary care settings.

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