Browsing by Author "Bay N"

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    Facility readiness for decentralized Package of Essential Noncommunicable Disease Interventions-Plus (PEN-Plus) care in nine lower-income countries.
    (2025) Drown L; Adler AJ; Salvi D; Boudreaux C; Gupta N; Ali Z; Bay N; Chisunka M; Mulenga B; Koirala B; Maharjan B; Marro G; Mengistu Z; Mtumbuka E; Nabadda M; Ruckstuhl L; Wurie I; Thapa A; Mocumbi A; Bukhman G; Wroe EB; Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia.; Department of Global Health and Social Medicine, Program in Global Noncommunicable Disease and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America.; Kathmandu Institute of Child Health, Kathmandu, Nepal.; SolidarMed, Harare, Zimbabwe.; Universidade Eduardo Mondlane, Maputo, Mozambique.; Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda.; Pujehun Hospital, Ministry of Health, Pujehun, Sierra Leone.; Partners In Health, Boston, Massachusetts, United States of America.; Department of Medicine, Center for Integration Science in Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.; Doctors With Africa CUAMM, Padova, Italy.; Mathiwos Wondu-Ye Ethiopia Cancer Society, Addis Ababa, Ethiopia.; Clinton Health Access Initiative, Dar es Salaam, Tanzania.; Noncommunicable Diseases Alliance Kenya, Nairobi, Kenya.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    Severe chronic noncommunicable diseases (SC-NCDs) are important causes of avoidable disease burden in low- and lower-middle income countries (LLMICs) where care is often available only at tertiary, urban facilities. The Package of Essential Noncommunicable Disease Interventions - Plus (PEN-Plus) strategy aims to address gaps in access to care for SC-NCDs by integrating and decentralizing care. This study aims to assess baseline readiness of 16 facilities in nine LLMICs to provide care for SC-NCDs as part of a mixed-methods evaluation of PEN-Plus implementation. Cross-sectional surveys were utilized to collect baseline data from 16 facilities initiating new PEN-Plus programs. These surveys assessed the state of facility infrastructure and the availability of equipment and medicines for three priority conditions (type 1 diabetes (T1D), sickle cell disease (SCD), severe cardiac conditions (SCC)). Analysis consisted of descriptive statistics and summary index scores based on availability of key items. Facilities reported a high baseline availability of basic infrastructure. Readiness to provide care for priority SC-NCDs varied. Availability of functional diagnostic and management equipment and supplies for T1D was especially low in many facilities but higher for SCD. Medicine availability was overall highest for T1D (75%) but lower for SCD (39%) and SCC (49%), with significant gaps in essential medicines including hydroxyurea, anticoagulants, and medium- or long-lasting insulins.These findings highlight the need for tailored, context-driven implementation approaches to address gaps in readiness for SC-NCD care in LLMICs. Baseline results will guide ongoing implementation and evaluation of the PEN-Plus clinics.
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    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.
    (2024-Jan-30) Adler AJ; Wroe EB; Atzori A; Bay N; Bekele W; Bhambhani VM; Nkwiro RB; Boudreaux C; Calixte D; Chiwanda Banda J; Coates MM; Dagnaw WW; Domingues K; Drown L; Dusabeyezu S; Fenelon D; Gupta N; Ssinabulya I; Jain Y; Kalkonde Y; Kamali I; Karekezi C; Karmacharya BM; Koirala B; Makani J; Manenti F; Mangwiro A; Manuel B; Masiye JK; Goma FM; Mayige MT; McLaughlin A; Mensah E; Salipa NM; Mutagaywa R; Mutengerere A; Ngoga G; Patiño M; Putoto G; Ruderman T; Salvi D; Sesay S; Taero F; Tostão E; Toussaint S; Bukhman G; Mocumbi AO; Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia.; Kathmandu Institute of Child Health, Kathmandu, Nepal.; Partners In Health, Maryland County, Liberia.; Doctors with Africa CUAMM, Padova, Italy.; Chhattisgarh NCD Plus Initiative, Ambikapur, Chhattisgarh, India.; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.; Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda.; School of Medical Sciences, Kathmandu University, Kathmandu, Nepal.; Partners In Health Sierra Leone, Kono, Sierra Leone.; Cardiovascular Health Research Unit, University of Washington, Seattle, Washington, USA.; Mozambique Institute for Health Education and Research, Maputo, Mozambique.; Instituto Nacional de Saúde, Maputo, Mozambique.; Clinton Health Access Initiative, Harare, Zimbabwe.; Center for Integration Science, Brigham and Women's Hospital, Boston, Massachusetts, USA aadler2@bwh.harvard.edu.; NCDI Poverty Network, Surguja, Chhattisgarh, India.; Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania.; Department of Agricultural Economics and Development, Universidade Eduardo Mondlane, Maputo, Mozambique.; Center for Integration Science, Brigham and Women's Hospital, Boston, Massachusetts, USA.; Noncommunicable Diseases and Mental Health, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone.; SolidarMed, Harare, Zimbabwe.; Universidade Eduardo Mondlane, Maputo, Mozambique.; NCD Division, Ministry of Health, Lilongwe, Malawi.; Partners In Health, Boston, Massachusetts, USA.; National Institute for Medical Research, Dar es Salaam, Tanzania.; NCDI Poverty Network, Addis Ababa, Ethiopia.; Non-Communicable Diseases Alliance Kenya, Nairobi, Kenya.; Noncommunicable Diseases and Mental Health Clinical Services, Malawi Ministry of Health, Lilongwe, Malawi.; Partners In Health, Neno, Malawi.; Department of Community Health, Universidade Eduardo Mondlane, Maputo, Mozambique.; Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda.; Zamni Lasante, Croix-des-Bouquets, Haiti.; Mathiwos Wondu-Ye Ethiopia Cancer Society, Addis Ababa, Ethiopia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    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.