Browsing by Author "Koirala B"

Filter results by typing the first few letters
Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    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
    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.
  • Thumbnail Image
    Item
    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
    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.