Challenges and Opportunities in the Continuity of Care for Hypertension : A Mixed-Methods Study Embedded in a Primary Health Care Intervention in Tajikistan

Hypertension, a significant risk factor for ischemic heart disease and other chronic conditions, is thethird-highest cause of death and disability in Tajikistan. Thus, ensuring the early detection and appropriatemanagement of hypertension is a core element of strategies to improve population health in Tajikistan. For astrategy to be successful, it should be informed by the causes of gaps in service delivery and feasible solutions tothese challenges. The objective of this study was to undertake a systematic assessment of hypertension casedetection and retention in care within Tajikistan’s primary health care system, and to identify challenges andappropriate solutions. We review the results for the case detection stage of the cascade of care, which had the most significantgaps. Of the half a million people with hypertension in Khatlon and Sogd Oblasts (administrative regions), about10% have been diagnosed in Khatlon and only 5% in Sogd. Barriers to case detection include misinformation abouthypertension, ambiguous protocols, and limited delivery capacity. Solutions identified to these challenges weremobilizing faith-based organizations, scaling up screening through health caravans, task-shifting to increaseprovider supply, and introducing job aids for providers. Translating findings on discontinuities in care for hypertension and other chronic diseases toactionable policy insights can be facilitated by collaboration with local stakeholders, triangulation of data sources,and identifying the intersection between the feasible and the effective in defining solutions to service deliverychallenges.