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Papers by Anupam Pathni

Research paper thumbnail of Phone calls for improving blood pressure control among hypertensive patients attending private medical practitioners in India: Findings from Mumbai hypertension project

The Journal of Clinical Hypertension, 2021

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-... more This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Research paper thumbnail of Private Health Sector Preferences in Treatment of Hypertension in India: Evidence from Hypertension Drugs Market Data

Journal of Hypertension, 2021

Research paper thumbnail of Interventions to Ensure the Continuum of Care for Hypertension During the COVID-19 Pandemic in Five Indian States—India Hypertension Control Initiative

Global Heart, 2021

Background: Hypertension is the leading risk factor for cardiovascular disease in India, but less... more Background: Hypertension is the leading risk factor for cardiovascular disease in India, but less than 10% of the estimated people with hypertension have blood pressure under control. The India Hypertension Control Initiative (IHCI) was implemented to strengthen hypertension management and control in public sector health facilities. Since late March 2020, lockdown due to the COVID-19 pandemic limited healthcare access and disrupted the provision of essential health services. IHCI quickly implemented adaptive interventions to improve access to medications. Objectives: To estimate the availability of antihypertensive drugs in peripheral public sector facilities during the lockdown and the proportion of patients who received drugs through community drug distribution, i.e., through Health and Wellness Centers (HWCs)/Sub-Centers (SCs), the most peripheral public sector health facilities for primary care, and home delivery. Methods: We collected data from 29 IHCI districts of 5 states (Ke...

Research paper thumbnail of Validation of a Practical Approach to Blood Pressure Measurement: Secondary Analysis of Data from a Nationally Representative Survey in India

Research paper thumbnail of A Predictive Tool for Forecasting Anti-Hypertension Medication Requirements in Low- and Middle-Income Countries

Journal of Hypertension, 2021

Research paper thumbnail of Research Letter: Unmet Need for Hypertension Treatment in India: Evidence from Hypertension Drugs Market Data

Research paper thumbnail of Research Letter: Antihypertensive Drugs Market in India: An Insight on Size, Trends, and Prescribing Preferences in the Private Health Sector, 2016–2018

Research paper thumbnail of Decentralization of India Hypertension Control Initiative services to maintain continuum of care for hypertensive patients during COVID-19 pandemic in Telangana

WHO South-East Asia Journal of Public Health, 2021

The India Hypertension Control Initiative (IHCI) was launched in Telangana, India, with the visio... more The India Hypertension Control Initiative (IHCI) was launched in Telangana, India, with the vision of maintaining the continuum of care for hypertensive patients and improving treatment outcomes through provision of free hypertension medication. Decentralization of the IHCI towards more patient-centred services was undertaken to bring free medication and follow-up services closer to the community in the hopes of improving follow-up and control rates for hypertensive patients. To determine if decentralization of hypertension follow-up services and free medication to peripheral health centres improved continuity of care and treatment outcomes in hypertensive patients and helped to mitigate disruption during the coronavirus disease 2019 (COVID-19) pandemic, hypertension outcomes were reviewed before and during the COVID-19 pandemic, for patients registered in health centres that decentralized free medication and follow-up services to subcentres – the intervention group – and in health centres that did not decentralize these services – the non-intervention group. Hypertensive patients had higher rates of monthly follow-up and controlled blood pressure in the decentralized facilities than in the non-decentralized facilities, where these services were limited to primary and secondary health centres. Comparing follow-up rates and blood pressure control rates before and during the COVID-19 pandemic, these were maintained for patients in the decentralized facilities whereas they were significantly lower for patients in the non-decentralized facilities. The IHCI decentralized model appears to have contributed to continuity of care for people with hypertension and to have maintained this continuity against system shocks such as that of the COVID-19 pandemic. Decentralization of free medicines and follow-up services to the first and most peripheral point of contact in the primary health care system brings these essential services closer to home, which can encourage patients to seek services from the public sector – capturing a strong case for a primary health care foundation to the strengthening of systems for universal health coverage.

Research paper thumbnail of Cost-Effectiveness of Improved Hypertension Management in India through Increased Treatment Coverage and Adherence: A Mathematical Modeling Study

Background: Despite the availability of effective and affordable treatments, only 14% of hyperten... more Background: Despite the availability of effective and affordable treatments, only 14% of hypertensive Indians have controlled blood pressure. Increased hypertension treatment coverage (the proportion of individuals initiated on treatment) and adherence (proportion of patients taking medicines as recommended) promise population health gains. However, governments and other payers will not invest in a large-scale hypertension control program unless it is both affordable and effective. Objective: To investigate if a national hypertension control intervention implemented across the private and public sector facilities in India could save overall costs of CVD prevention and treatment. Methods: We developed a discrete-time microsimulation model to assess the cost-effectiveness of population-level hypertension control intervention in India for combinations of treatment coverage and adherence targets. Input clinical parameters specific to India were obtained from large-scale surveys such as ...

Research paper thumbnail of Access to Single Pill Combinations in National Hypertensive Control Programs: Is Pricing a Barrier?

Research paper thumbnail of Prices of combination medicines and single‐molecule antihypertensive medicines in India's private health care sector

The Journal of Clinical Hypertension, 2020

More than half of patients with hypertension require two or more medicines to control blood press... more More than half of patients with hypertension require two or more medicines to control blood pressure. Combinations of anti‐hypertensive medicines are available as Single Pill Combinations (SPCs) or Single Agent Pills (SAPs). SPCs of two or more anti‐hypertensive medicines facilitate simpler dosing schedules, decrease pill burden, increase adherence to medicine, and simplify procurement and distribution. Despite this, equivalent combinations of separate pills (SAPs) are often prescribed instead of SPCs under the assumption that SAPs are priced lower. This study compared prices of anti‐hypertensive SPCs and equivalent SAPs in the private health care sector of India. High sales volume anti‐hypertensive SPCs and SAPs were selected from 2018 private sector pharmaceutical sales data. SPCs and SAPs price information was collected from online pharmacy websites between November 2019 and January 2020. Anti‐hypertensive SPCs represent approximately 39.1% of India's private sector anti‐hypertensive drug market. Multiple manufacturers produce the same top‐selling SPCs, suggesting a viable and competitive market. A comparison of SPCs and SAPs across different manufacturers showed that the lowest prices of both SPCs and the sum of component SAPs were nearly identical across different manufacturers. An analysis of dual‐drug SPCs and SAPs by the same manufacturer showed that most manufacturers (five of six) had priced their SPCs higher than SAPs. These observations suggest that the price of SPCs could be lowered to match the combined price of the component SAPs, and manufacturing costs and market forces do not present a barrier to the implementation of anti‐hypertensive SPCs.

Research paper thumbnail of A perspective of private health care providers in the state of Madhya Pradesh on adopting key strategies of the India hypertension control initiative

The Journal of Clinical Hypertension, 2020

The India Hypertension Control Initiative (IHCI) has been implemented in public health facilities... more The India Hypertension Control Initiative (IHCI) has been implemented in public health facilities. This study assessed the perspective of private physicians (PPs) on adopting the core strategies of the IHCI in Bhopal district of Madhya Pradesh. A semi‐structured interview was purposely applied to 30 PPs to obtain their opinions on standardized hypertension treatment protocols, patient‐centered services, and easy‐to‐use information system in their private practices. Verbatim data were recorded and analyzed thematically. Only 11 PPs followed the state hypertension treatment protocol. Among the remaining 19 PPs, the major reasons for not adopting protocol were (1) limited availability of single component hypertension drugs, (2) preferences for fixed dose combinations (FDCs), and (3) fear of either losing patients due to a lack of immediate blood pressure control or causing drug‐related adverse effects. None of the interviewed doctors had resources to provide patient‐centered care and use a digital health information system. Overall, the interviewed doctors identified that free supply of hypertension treatment protocol drugs, inclusion of FDCs in treatment protocol, increasing number of staff for follow‐up visits, and patient education, IT‐based solutions

Research paper thumbnail of High rates of reinfection and incidence of bacterial sexually transmitted infections in a cohort of female sex workers from two Indian cities: need for different STI control strategies?

Sexually Transmitted Infections, 2012

Research paper thumbnail of Blood from a stone: funding hypertension prevention, treatment, and care in low- and middle-income countries

Journal of Human Hypertension, 2021

Research paper thumbnail of A simple six-step guide to National-Scale Hypertension Control Program implementation

Journal of Human Hypertension

Hypertension is the leading single preventable risk factor for death worldwide, and most of the d... more Hypertension is the leading single preventable risk factor for death worldwide, and most of the disease burden attributed to hypertension weighs on low-and middle-income countries. Effective large-scale public health hypertension control programs are needed to control hypertension globally. National programs can follow six important steps to launch a successful national-scale hypertension control program: establish an administrative structure and survey current resources, select a standard hypertension treatment protocol, ensure supply of medication and blood pressure devices, train health care workers to measure blood pressure and control hypertension, implement an information system for monitoring patients and the program overall, and enroll and monitor patients with phased program expansion. Resolve to Save Lives, an initiative of global public health organization Vital Strategies, and its partners organized these six key steps and materials into a structured, stepwise guide to e...

Research paper thumbnail of Abstract P170: Validation Of A Practical Approach To Blood Pressure Measurement: Secondary Analysis Of Data From A Nationally Representative Household Survey In India

Hypertension

Background: Various clinical guidelines differ on the required number of blood pressure (BP) meas... more Background: Various clinical guidelines differ on the required number of blood pressure (BP) measurements during clinic visits. The research standard approach is measuring BP three times and using the mean of the last two readings. India’s National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) recommends measuring twice and averaging the two readings. We hypothesized that a selective, practical approach to BP measurement in public health settings would be simpler, avoid calculating the mean, but not substantially erode measurement accuracy. Method: We used the data of adults (aged 30-54 years) from the National Family Health Survey (2015-16), with three seated BP measurements for each participant (N= 372,110). In the practical BP measurement approach, if the first reading is <140/90 mm Hg, the first BP was used. If first BP is ≥140/90 mm Hg, the second BP was used. If the difference between the two systolic or diastolic BP r...

Research paper thumbnail of Phone calls for improving blood pressure control among hypertensive patients attending private medical practitioners in India: Findings from Mumbai hypertension project

The Journal of Clinical Hypertension, 2021

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-... more This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Research paper thumbnail of Private Health Sector Preferences in Treatment of Hypertension in India: Evidence from Hypertension Drugs Market Data

Journal of Hypertension, 2021

Research paper thumbnail of Interventions to Ensure the Continuum of Care for Hypertension During the COVID-19 Pandemic in Five Indian States—India Hypertension Control Initiative

Global Heart, 2021

Background: Hypertension is the leading risk factor for cardiovascular disease in India, but less... more Background: Hypertension is the leading risk factor for cardiovascular disease in India, but less than 10% of the estimated people with hypertension have blood pressure under control. The India Hypertension Control Initiative (IHCI) was implemented to strengthen hypertension management and control in public sector health facilities. Since late March 2020, lockdown due to the COVID-19 pandemic limited healthcare access and disrupted the provision of essential health services. IHCI quickly implemented adaptive interventions to improve access to medications. Objectives: To estimate the availability of antihypertensive drugs in peripheral public sector facilities during the lockdown and the proportion of patients who received drugs through community drug distribution, i.e., through Health and Wellness Centers (HWCs)/Sub-Centers (SCs), the most peripheral public sector health facilities for primary care, and home delivery. Methods: We collected data from 29 IHCI districts of 5 states (Ke...

Research paper thumbnail of Validation of a Practical Approach to Blood Pressure Measurement: Secondary Analysis of Data from a Nationally Representative Survey in India

Research paper thumbnail of A Predictive Tool for Forecasting Anti-Hypertension Medication Requirements in Low- and Middle-Income Countries

Journal of Hypertension, 2021

Research paper thumbnail of Research Letter: Unmet Need for Hypertension Treatment in India: Evidence from Hypertension Drugs Market Data

Research paper thumbnail of Research Letter: Antihypertensive Drugs Market in India: An Insight on Size, Trends, and Prescribing Preferences in the Private Health Sector, 2016–2018

Research paper thumbnail of Decentralization of India Hypertension Control Initiative services to maintain continuum of care for hypertensive patients during COVID-19 pandemic in Telangana

WHO South-East Asia Journal of Public Health, 2021

The India Hypertension Control Initiative (IHCI) was launched in Telangana, India, with the visio... more The India Hypertension Control Initiative (IHCI) was launched in Telangana, India, with the vision of maintaining the continuum of care for hypertensive patients and improving treatment outcomes through provision of free hypertension medication. Decentralization of the IHCI towards more patient-centred services was undertaken to bring free medication and follow-up services closer to the community in the hopes of improving follow-up and control rates for hypertensive patients. To determine if decentralization of hypertension follow-up services and free medication to peripheral health centres improved continuity of care and treatment outcomes in hypertensive patients and helped to mitigate disruption during the coronavirus disease 2019 (COVID-19) pandemic, hypertension outcomes were reviewed before and during the COVID-19 pandemic, for patients registered in health centres that decentralized free medication and follow-up services to subcentres – the intervention group – and in health centres that did not decentralize these services – the non-intervention group. Hypertensive patients had higher rates of monthly follow-up and controlled blood pressure in the decentralized facilities than in the non-decentralized facilities, where these services were limited to primary and secondary health centres. Comparing follow-up rates and blood pressure control rates before and during the COVID-19 pandemic, these were maintained for patients in the decentralized facilities whereas they were significantly lower for patients in the non-decentralized facilities. The IHCI decentralized model appears to have contributed to continuity of care for people with hypertension and to have maintained this continuity against system shocks such as that of the COVID-19 pandemic. Decentralization of free medicines and follow-up services to the first and most peripheral point of contact in the primary health care system brings these essential services closer to home, which can encourage patients to seek services from the public sector – capturing a strong case for a primary health care foundation to the strengthening of systems for universal health coverage.

Research paper thumbnail of Cost-Effectiveness of Improved Hypertension Management in India through Increased Treatment Coverage and Adherence: A Mathematical Modeling Study

Background: Despite the availability of effective and affordable treatments, only 14% of hyperten... more Background: Despite the availability of effective and affordable treatments, only 14% of hypertensive Indians have controlled blood pressure. Increased hypertension treatment coverage (the proportion of individuals initiated on treatment) and adherence (proportion of patients taking medicines as recommended) promise population health gains. However, governments and other payers will not invest in a large-scale hypertension control program unless it is both affordable and effective. Objective: To investigate if a national hypertension control intervention implemented across the private and public sector facilities in India could save overall costs of CVD prevention and treatment. Methods: We developed a discrete-time microsimulation model to assess the cost-effectiveness of population-level hypertension control intervention in India for combinations of treatment coverage and adherence targets. Input clinical parameters specific to India were obtained from large-scale surveys such as ...

Research paper thumbnail of Access to Single Pill Combinations in National Hypertensive Control Programs: Is Pricing a Barrier?

Research paper thumbnail of Prices of combination medicines and single‐molecule antihypertensive medicines in India's private health care sector

The Journal of Clinical Hypertension, 2020

More than half of patients with hypertension require two or more medicines to control blood press... more More than half of patients with hypertension require two or more medicines to control blood pressure. Combinations of anti‐hypertensive medicines are available as Single Pill Combinations (SPCs) or Single Agent Pills (SAPs). SPCs of two or more anti‐hypertensive medicines facilitate simpler dosing schedules, decrease pill burden, increase adherence to medicine, and simplify procurement and distribution. Despite this, equivalent combinations of separate pills (SAPs) are often prescribed instead of SPCs under the assumption that SAPs are priced lower. This study compared prices of anti‐hypertensive SPCs and equivalent SAPs in the private health care sector of India. High sales volume anti‐hypertensive SPCs and SAPs were selected from 2018 private sector pharmaceutical sales data. SPCs and SAPs price information was collected from online pharmacy websites between November 2019 and January 2020. Anti‐hypertensive SPCs represent approximately 39.1% of India's private sector anti‐hypertensive drug market. Multiple manufacturers produce the same top‐selling SPCs, suggesting a viable and competitive market. A comparison of SPCs and SAPs across different manufacturers showed that the lowest prices of both SPCs and the sum of component SAPs were nearly identical across different manufacturers. An analysis of dual‐drug SPCs and SAPs by the same manufacturer showed that most manufacturers (five of six) had priced their SPCs higher than SAPs. These observations suggest that the price of SPCs could be lowered to match the combined price of the component SAPs, and manufacturing costs and market forces do not present a barrier to the implementation of anti‐hypertensive SPCs.

Research paper thumbnail of A perspective of private health care providers in the state of Madhya Pradesh on adopting key strategies of the India hypertension control initiative

The Journal of Clinical Hypertension, 2020

The India Hypertension Control Initiative (IHCI) has been implemented in public health facilities... more The India Hypertension Control Initiative (IHCI) has been implemented in public health facilities. This study assessed the perspective of private physicians (PPs) on adopting the core strategies of the IHCI in Bhopal district of Madhya Pradesh. A semi‐structured interview was purposely applied to 30 PPs to obtain their opinions on standardized hypertension treatment protocols, patient‐centered services, and easy‐to‐use information system in their private practices. Verbatim data were recorded and analyzed thematically. Only 11 PPs followed the state hypertension treatment protocol. Among the remaining 19 PPs, the major reasons for not adopting protocol were (1) limited availability of single component hypertension drugs, (2) preferences for fixed dose combinations (FDCs), and (3) fear of either losing patients due to a lack of immediate blood pressure control or causing drug‐related adverse effects. None of the interviewed doctors had resources to provide patient‐centered care and use a digital health information system. Overall, the interviewed doctors identified that free supply of hypertension treatment protocol drugs, inclusion of FDCs in treatment protocol, increasing number of staff for follow‐up visits, and patient education, IT‐based solutions

Research paper thumbnail of High rates of reinfection and incidence of bacterial sexually transmitted infections in a cohort of female sex workers from two Indian cities: need for different STI control strategies?

Sexually Transmitted Infections, 2012

Research paper thumbnail of Blood from a stone: funding hypertension prevention, treatment, and care in low- and middle-income countries

Journal of Human Hypertension, 2021

Research paper thumbnail of A simple six-step guide to National-Scale Hypertension Control Program implementation

Journal of Human Hypertension

Hypertension is the leading single preventable risk factor for death worldwide, and most of the d... more Hypertension is the leading single preventable risk factor for death worldwide, and most of the disease burden attributed to hypertension weighs on low-and middle-income countries. Effective large-scale public health hypertension control programs are needed to control hypertension globally. National programs can follow six important steps to launch a successful national-scale hypertension control program: establish an administrative structure and survey current resources, select a standard hypertension treatment protocol, ensure supply of medication and blood pressure devices, train health care workers to measure blood pressure and control hypertension, implement an information system for monitoring patients and the program overall, and enroll and monitor patients with phased program expansion. Resolve to Save Lives, an initiative of global public health organization Vital Strategies, and its partners organized these six key steps and materials into a structured, stepwise guide to e...

Research paper thumbnail of Abstract P170: Validation Of A Practical Approach To Blood Pressure Measurement: Secondary Analysis Of Data From A Nationally Representative Household Survey In India

Hypertension

Background: Various clinical guidelines differ on the required number of blood pressure (BP) meas... more Background: Various clinical guidelines differ on the required number of blood pressure (BP) measurements during clinic visits. The research standard approach is measuring BP three times and using the mean of the last two readings. India’s National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) recommends measuring twice and averaging the two readings. We hypothesized that a selective, practical approach to BP measurement in public health settings would be simpler, avoid calculating the mean, but not substantially erode measurement accuracy. Method: We used the data of adults (aged 30-54 years) from the National Family Health Survey (2015-16), with three seated BP measurements for each participant (N= 372,110). In the practical BP measurement approach, if the first reading is <140/90 mm Hg, the first BP was used. If first BP is ≥140/90 mm Hg, the second BP was used. If the difference between the two systolic or diastolic BP r...