The overall quality of evidence based on GRADE criteria was moderate for systolic blood pressure , but low for diastolic blood pressure .
INTERPRETATION Task-sharing interventions are effective in reducing blood pressure .
BACKGROUND Task sharing for the management of hypertension could be useful for understaffed and re source -poor health systems .
We assessed the effectiveness of task-sharing interventions in improving blood pressure control among adults in low-income and middle-income countries .
Can lay health workers support the management of hypertension? Findings of a cluster randomised trial in South Africa
Introduction In low/middle-income countries with substantial HIV and tuberculosis epidemics , health services often neglect other highly prevalent chronic conditions , such as hypertension , which as a result are poorly managed . This paper reports on a study to assess the effect on hypertension management of lay health workers ( LHW ) working in South African rural primary healthcare clinics to support the provision of integrated chronic care . Methods A pragmatic cluster r and omised trial with a process evaluation in eight rural clinics assessed the effect of adding  two LHWs supporting nurses in providing chronic disease care in each intervention clinic over 18 months . Control clinics continued with usual care . The main outcome measure was the change in the difference of percentage of clinic users who had elevated cardiovascular risk associated with high blood pressure ( BP ) before and after the intervention , as measured by two cross-sectional population surveys . Results There was no improvement in BP control among users of intervention clinics as compared with control clinics . However , the LHWs improved clinic functioning , including overall attendance , and attendance on the correct day . All clinics faced numerous challenges , including rapidly increasing number of users of chronic care , unreliable BP machines and cuffs , intermittent drug shortages and insufficient space . Conclusion LHWs improved the process of providing care but improved BP control required improved clinical care by nurses which was compromised by large and increasing numbers of patients , the dominance of the vertically funded HIV programme and the poor st and ards of equipment in clinics . Trial registration number IS RCT N12128227
The overall quality of evidence based on GRADE criteria was moderate for systolic blood pressure , but low for diastolic blood pressure .
INTERPRETATION Task-sharing interventions are effective in reducing blood pressure .
BACKGROUND Task sharing for the management of hypertension could be useful for understaffed and re source -poor health systems .
We assessed the effectiveness of task-sharing interventions in improving blood pressure control among adults in low-income and middle-income countries .