Browsing by Author "Karmacharya BM"

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    Organization of services for severe chronic Noncommunicable diseases at first-level hospitals in nine lower-income countries: Results from a Baseline assessment of PEN-Plus initiation.
    (2025) Boudreaux C; Wroe EB; Thapa A; Abebe NA; Akiteng AR; Drown L; Gadewar A; Karmacharya BM; Karki S; Mansoor M; Mutagaywa R; Mulenga B; Mutengerere A; Nollino L; Salvi D; Dagnaw WW; Bukhman G; Mocumbi AO; Adler A; Department of Medicine, Endocrine Metabolism and Nutrition Diseases Unit, AULSS 2 Marca Trevigiana, Treviso, Italy.; Sangwari - People's Association for Equity and Health, Ambikapur, Chhattisgarh, India.; Muhimbili Orthopedic Institute, Dar es Salaam, Tanzania.; Uganda, Initiative for Integrated Management of Non communicable Diseases (UINCD), Kampala, Uganda.; SolidarMed, Masvingo, Zimbabwe.; Instituto Nacional de Saúde, Maputo, Mozambique.; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.; Universidade Eduardo Mondlane, Campus Universitário, Maputo, Mozambique.; Division of Global Health Equity, Center for Integration Science in Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.; Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia.; Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal.; Kathmandu Institute of Child Health (KIOCH), Kathmandu, Nepal.; Department of Global Health and Social Medicine, Program in Global NCDs and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America.; Doctors with Africa CUAMM, Padua, Italy.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    Severe chronic noncommunicable diseases pose a significant health burden and challenges for health systems globally. This study aims to advance our understanding of the current organization of care for these conditions in low and lower-middle-income countries. The study was conducted as part of a baseline assessment of facilities prior to the initiation of the Package of Essential NCD Interventions -Plus (PEN-Plus) strategy, which is designed to enhance outpatient care for conditions including rheumatic and congenital heart disease, sickle cell disease, type 1 diabetes, severe asthma, and advanced chronic kidney disease. We employed a cross-sectional survey methodology to collect baseline data from 16 hospitals in nine LLMICs. The survey assessed the organization of common and severe NCD services, focusing on the availability and management of severe NCDs, organized into domains of integrated services. Data were analyzed using summary statistics and heatmaps to evaluate care patterns. We document gaps in the availability of services for both common and severe NCDs. We find that the majority of NCD care occurs in the general outpatient settings, with a smaller proportion provided in specialized internal medicine wards. Despite some hospitals implementing specialized clinics and teams, limitations in specialist access, variability in service fees, and inconsistent definitions of patient follow-up were prominent issues affecting patient care access and continuity. Despite the spectrum of strategies employed by these hospitals to cater to chronically and severely ill patients, notable gaps in care persist, particularly for diagnostic and treatment options that require specialist training or equipment. The sustainable decentralization of effective care for individuals with severe chronic NCDs will require integrated teams and customized systems to ensure seamless and comprehensive care through the entire care continuum-from screening and diagnosis to care linkage, ongoing management, handling of complications, uninterrupted supply of medicines and commodities and maintaining patient retention.
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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; NCDI Poverty Network, Addis Ababa, Ethiopia.; Mathiwos Wondu-Ye Ethiopia Cancer Society, Addis Ababa, Ethiopia.; Partners In Health, Boston, Massachusetts, USA.; Chhattisgarh NCD Plus Initiative, Ambikapur, Chhattisgarh, India.; Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda.; Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania.; School of Medical Sciences, Kathmandu University, Kathmandu, Nepal.; Zamni Lasante, Croix-des-Bouquets, Haiti.; Clinton Health Access Initiative, Harare, Zimbabwe.; SolidarMed, Harare, Zimbabwe.; Noncommunicable Diseases and Mental Health, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone.; Doctors with Africa CUAMM, Padova, Italy.; Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda.; Partners In Health, Maryland County, Liberia.; Department of Agricultural Economics and Development, Universidade Eduardo Mondlane, Maputo, Mozambique.; NCDI Poverty Network, Surguja, Chhattisgarh, India.; Center for Integration Science, Brigham and Women's Hospital, Boston, Massachusetts, USA.; Partners In Health, Neno, Malawi.; NCD Division, Ministry of Health, Lilongwe, Malawi.; Universidade Eduardo Mondlane, Maputo, Mozambique.; Instituto Nacional de Saúde, Maputo, Mozambique.; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.; Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia.; Cardiovascular Health Research Unit, University of Washington, Seattle, Washington, USA.; Noncommunicable Diseases and Mental Health Clinical Services, Malawi Ministry of Health, Lilongwe, Malawi.; National Institute for Medical Research, Dar es Salaam, Tanzania.; Non-Communicable Diseases Alliance Kenya, Nairobi, Kenya.; Partners In Health Sierra Leone, Kono, Sierra Leone.; Center for Integration Science, Brigham and Women's Hospital, Boston, Massachusetts, USA aadler2@bwh.harvard.edu.; Mozambique Institute for Health Education and Research, Maputo, Mozambique.; Kathmandu Institute of Child Health, Kathmandu, Nepal.; Department of Community Health, Universidade Eduardo Mondlane, Maputo, Mozambique.; 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.