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. 2024 Jan 30;14(1):e074182.
doi: 10.1136/bmjopen-2023-074182.

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

Alma J Adler  1 , Emily B Wroe  2   3 , Andrea Atzori  4 , Neusa Bay  5 , Wondu Bekele  6 , Victoria M Bhambhani  2 , Remy Bitwayiki Nkwiro  7 , Chantelle Boudreaux  2 , Dawson Calixte  8 , Jonathan Chiwanda Banda  9 , Matthew M Coates  2 , Wubaye Walelgne Dagnaw  10 , Katia Domingues  2 , Laura Drown  2 , Symaque Dusabeyezu  11 , Darius Fenelon  8 , Neil Gupta  2   3 , Isaac Ssinabulya  12 , Yogesh Jain  13 , Yogeshwar Kalkonde  14 , Innocent Kamali  11 , Catherine Karekezi  15 , Biraj Man Karmacharya  16   17 , Bhagawan Koirala  18 , Julie Makani  19 , Fabio Manenti  4 , Alexio Mangwiro  20 , Beatriz Manuel  21 , Jones K Masiye  22 , Fastone Mathew Goma  23 , Mary Theodory Mayige  24 , Amy McLaughlin  3 , Emmanuel Mensah  2 , Nicole Mocumbi Salipa  5 , Reuben Mutagaywa  19   25 , Alvern Mutengerere  26 , Gedeon Ngoga  11 , Marta Patiño  7 , Giovanni Putoto  4 , Todd Ruderman  27 , Devashri Salvi  2 , Santigie Sesay  28 , Fameti Taero  29 , Emílio Tostão  30 , Sterman Toussaint  31 , Gene Bukhman  2   3 , Ana Olga Mocumbi  5   32 ; PEN-Plus Partnership study group
Collaborators, Affiliations

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

Alma J Adler et al. BMJ Open. .

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.

Keywords: Adolescent; General diabetes; HAEMATOLOGY; Health Equity; Heart failure; International health services.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Theory of change. NCD, non-communicable diseases; PEN-Plus, Package of Essential Noncommunicable Disease Interventions—Plus.
See this image and copyright information in PMC

References

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