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ANDES trial and integration of the HEARTS model in Puno, Peru
Author(s)
Gonzalo Cuentas
EsSALUD
Lucy Cordova-Ascona
Universidad Peruana Cayetano Heredia
Lisa de las Fuentes
Washington University in St. Louis
Universidad Peruana Cayetano Heredia
Lindsay J. Underhill
Washington University in St. Louis
Kendra N. Williams
Johns Hopkins University
Zoila Vela-Clavo
Universidad Peruana Cayetano Heredia
Carlos Diaz‐Arocutipa
Ministry of Health
Juan Carlos Mendoza
Elvin Geng
Washington University in St. Louis
William Checkley
Johns Hopkins University
Stella M. Hartinger
Universidad Peruana Cayetano Heredia
Víctor G. Dávila‐Román
Washington University in St. Louis
Date Issued
16 de diciembre de 2025
Type
Article
Volume
49
Series/Report No.
Revista Panamericana de Salud Pública
Start Page
1
End Page
1
ISSN
1020-4989
1680-5348
Abstract
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.
Keywords