ArticleBMJ open2024
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.
Article in BMJ open, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Patient and provider experiences with PEN-Plus in rural Mozambique: cohort characteristics at baseline.Global health action · 2026Article
- Bringing severe non-communicable disease care to district-level hospitals in Nepal: PEN-Plus experience and regional policy implications.BMJ global health · 2026Article
- Implementing a national acute rheumatic fever case-finding program and registry in Nepal: protocol for a multi-site implementation study.Frontiers in cardiovascular medicine · 2026Article
- 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.PLOS global public health · 2025Article
- Facility readiness for decentralized Package of Essential Noncommunicable Disease Interventions-Plus (PEN-Plus) care in nine lower-income countries.PLOS global public health · 2025Article
- Article
- Decentralization Matters: Association of Adherence to Treatment and Distance for the Management of Non-Communicable Diseases in Rural Tanzania.International journal of environmental research and public health · 2024Article
Corrections and comments
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Authors and funding
48 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThe 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.
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