1. Protocol for an evaluation of the initiation of an integrated longitudinal outpatient care model for severe chronic non-communicable diseases (PEN-Plus) at secondary care facilities (district hospitals) in 10 lower-income countries
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Archana Shrestha, Biraj Man Karmacharya, Robert Kalyesubula, Isaac Ssinabulya, Zipporah Ali, Alma J Adler, Ana Olga Mocumbi, Neil Gupta, Meghnath Dhimal, Bhagawan Koirala, Gedeon Ngoga, Symaque Dusabeyezu, Gene Kwan, Gene Bukhman, Lilian Mbau, Beatriz Manuel, Giovanni Putoto, Santigie Sesay, Emily B Wroe, Yogeshwar Kalkonde, Sergio Chicumbe, Lauren Brown, Abha Shrestha, Lucia González, Matthew M Coates, Jones K Masiye, Mary Theodory Mayige, Wubaye Walelgne Dagnaw, Chiyembekezo Kachimanga, Ana Mocumbi, Ryan McBain, Apoorva Gomber, Fabio Manenti, Roma Chilengi, Yogesh Jain, Sam Patel, Gladwell Gathecha, Julie Makani, Amy McLaughlin, Celina Trujillo, Laura Drown, Reuben Mutagaywa, Todd Ruderman, Gina Ferrari, Chantelle Boudreaux, Humberto Muquingue, Mary Mayige, Jonathan Chiwanda Banda, Andrea Atzori, Neusa Bay, Wondu Bekele, Victoria M Bhambhani, Remy Bitwayiki Nkwiro, Dawson Calixte, Katia Domingues, Darius Fenelon, Innocent Kamali, Catherine Karekezi, Alexio Mangwiro, Fastone Mathew Goma, Emmanuel Mensah, Nicole Mocumbi Salipa, Alvern Mutengerere, Marta Patiño, Devashri Salvi, Fameti Taero, Emílio Tostão, Sterman Toussaint, Abhijit Gadewar, Sunil Jadhao, Chetanya Malik, Alma Adler, Victoria Bhambhani, Susan Donnellan, Kaita Domingues, Sheila Klassen, Andrew Marx, Maia Olsen, Catherine Player, Ramon Ruiz, Ada Thapa, Leslie Wentworth, Allison Westervelt, Ariana Wolgin, Emily Yale, Michael Abiyu, Lemma Ayele, Zelalem Mengistu, Temesgen Sileshi, Natnael Alemayehu, Natnael A Abebe, Nancy Larco, Gideon Ayodo, Peter Mokaya, Jones Masiye, Evelyn Chibwe, Noel Kasomekera, Nicole M Salipa, Riaze Rafik, Lucy Ramirez, Shiva Adhikary, Krishna Aryal, Phanindra Baral, Biraj Karmachaya, Abhinav Vaidhya, Ann Akiteng, Frank Mugabe, Sarah Asio Eragu, Bernard Bukar, Namasiku Siyumbwa, Wibroad Mutale, Kudakwashe Madzeke, Alaisa Mbiriri, Nyamayaro Wencelas, Porika Nyawai, Abaden Svisva, and Laura Ruckstuhl
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Medicine - Abstract
Introduction The Package of Essential Noncommunicable Disease Interventions—Plus (PEN-Plus) is a strategy decentralising care for severe non-communicable diseases (NCDs) including type 1 diabetes, rheumatic heart disease and sickle cell disease, to increase access to care. In the PEN-Plus model, mid-level clinicians in intermediary facilities in low and lower middle income countries are trained to provide integrated care for conditions where services traditionally were only available at tertiary referral facilities. For the upcoming phase of activities, 18 first-level hospitals in 9 countries and 1 state in India were selected for PEN-Plus expansion and will treat a variety of severe NCDs. Over 3 years, the countries and state are expected to: (1) establish PEN-Plus clinics in one or two district hospitals, (2) support these clinics to mature into training sites in preparation for national or state-level scale-up, and (3) work with the national or state-level stakeholders to describe, measure and advocate for PEN-Plus to support development of a national operational plan for scale-up.Methods and analysis Guided by Proctor outcomes for implementation research, we are conducting a mixed-method evaluation consisting of 10 components to understand outcomes in clinical implementation, training and policy development. Data will be collected through a mix of quantitative surveys, routine reporting, routine clinical data and qualitative interviews.Ethics and dissemination This protocol has been considered exempt or covered by central and local institutional review boards. Findings will be disseminated throughout the project’s course, including through quarterly M&E discussions, semiannual formative assessments, dashboard mapping of progress, quarterly newsletters, regular feedback loops with national stakeholders and publication in peer-reviewed journals.
- Published
- 2024
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