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
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...
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| author | Archana Shrestha Biraj Man Karmacharya Robert Kalyesubula Isaac Ssinabulya Zipporah Ali Alma J Adler Ana Olga Mocumbi Neil Gupta Meghnath Dhimal Bhagawan Koirala Gedeon Ngoga Symaque Dusabeyezu Gene Kwan Gene Bukhman Lilian Mbau Beatriz Manuel Giovanni Putoto Santigie Sesay Emily B Wroe Yogeshwar Kalkonde Sergio Chicumbe Lauren Brown Abha Shrestha Lucia González Matthew M Coates Jones K Masiye Mary Theodory Mayige Wubaye Walelgne Dagnaw Chiyembekezo Kachimanga Ana Mocumbi Ryan McBain Apoorva Gomber Fabio Manenti Roma Chilengi Yogesh Jain Sam Patel Gladwell Gathecha Julie Makani Amy McLaughlin Celina Trujillo Laura Drown Reuben Mutagaywa Todd Ruderman Gina Ferrari Chantelle Boudreaux Humberto Muquingue Mary Mayige Jonathan Chiwanda Banda Andrea Atzori Neusa Bay Wondu Bekele Victoria M Bhambhani Remy Bitwayiki Nkwiro Dawson Calixte Katia Domingues Darius Fenelon Innocent Kamali Catherine Karekezi Alexio Mangwiro Fastone Mathew Goma Emmanuel Mensah Nicole Mocumbi Salipa Alvern Mutengerere Marta Patiño Devashri Salvi Fameti Taero Emílio Tostão Sterman Toussaint Abhijit Gadewar Sunil Jadhao Chetanya Malik Alma Adler Victoria Bhambhani Susan Donnellan Kaita Domingues Sheila Klassen Andrew Marx Maia Olsen Catherine Player Ramon Ruiz Ada Thapa Leslie Wentworth Allison Westervelt Ariana Wolgin Emily Yale Michael Abiyu Lemma Ayele Zelalem Mengistu Temesgen Sileshi Natnael Alemayehu Natnael A Abebe Nancy Larco Gideon Ayodo Peter Mokaya Jones Masiye Evelyn Chibwe Noel Kasomekera Nicole M Salipa Riaze Rafik Lucy Ramirez Shiva Adhikary Krishna Aryal Phanindra Baral Biraj Karmachaya Abhinav Vaidhya Ann Akiteng Frank Mugabe Sarah Asio Eragu Bernard Bukar Namasiku Siyumbwa Wibroad Mutale Kudakwashe Madzeke Alaisa Mbiriri Nyamayaro Wencelas Porika Nyawai Abaden Svisva Laura Ruckstuhl |
| author_facet | Archana Shrestha Biraj Man Karmacharya Robert Kalyesubula Isaac Ssinabulya Zipporah Ali Alma J Adler Ana Olga Mocumbi Neil Gupta Meghnath Dhimal Bhagawan Koirala Gedeon Ngoga Symaque Dusabeyezu Gene Kwan Gene Bukhman Lilian Mbau Beatriz Manuel Giovanni Putoto Santigie Sesay Emily B Wroe Yogeshwar Kalkonde Sergio Chicumbe Lauren Brown Abha Shrestha Lucia González Matthew M Coates Jones K Masiye Mary Theodory Mayige Wubaye Walelgne Dagnaw Chiyembekezo Kachimanga Ana Mocumbi Ryan McBain Apoorva Gomber Fabio Manenti Roma Chilengi Yogesh Jain Sam Patel Gladwell Gathecha Julie Makani Amy McLaughlin Celina Trujillo Laura Drown Reuben Mutagaywa Todd Ruderman Gina Ferrari Chantelle Boudreaux Humberto Muquingue Mary Mayige Jonathan Chiwanda Banda Andrea Atzori Neusa Bay Wondu Bekele Victoria M Bhambhani Remy Bitwayiki Nkwiro Dawson Calixte Katia Domingues Darius Fenelon Innocent Kamali Catherine Karekezi Alexio Mangwiro Fastone Mathew Goma Emmanuel Mensah Nicole Mocumbi Salipa Alvern Mutengerere Marta Patiño Devashri Salvi Fameti Taero Emílio Tostão Sterman Toussaint Abhijit Gadewar Sunil Jadhao Chetanya Malik Alma Adler Victoria Bhambhani Susan Donnellan Kaita Domingues Sheila Klassen Andrew Marx Maia Olsen Catherine Player Ramon Ruiz Ada Thapa Leslie Wentworth Allison Westervelt Ariana Wolgin Emily Yale Michael Abiyu Lemma Ayele Zelalem Mengistu Temesgen Sileshi Natnael Alemayehu Natnael A Abebe Nancy Larco Gideon Ayodo Peter Mokaya Jones Masiye Evelyn Chibwe Noel Kasomekera Nicole M Salipa Riaze Rafik Lucy Ramirez Shiva Adhikary Krishna Aryal Phanindra Baral Biraj Karmachaya Abhinav Vaidhya Ann Akiteng Frank Mugabe Sarah Asio Eragu Bernard Bukar Namasiku Siyumbwa Wibroad Mutale Kudakwashe Madzeke Alaisa Mbiriri Nyamayaro Wencelas Porika Nyawai Abaden Svisva Laura Ruckstuhl |
| author_sort | Archana Shrestha |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-992bdf24e8ec4d74866d7214d725d384 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2024-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-992bdf24e8ec4d74866d7214d725d3842025-08-20T02:13:35ZengBMJ Publishing GroupBMJ Open2044-60552024-01-0114110.1136/bmjopen-2023-074182Protocol 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 countriesArchana Shrestha0Biraj Man Karmacharya1Robert Kalyesubula2Isaac Ssinabulya3Zipporah AliAlma J Adler4Ana Olga Mocumbi5Neil Gupta6Meghnath DhimalBhagawan Koirala7Gedeon Ngoga8Symaque Dusabeyezu9Gene KwanGene Bukhman10Lilian MbauBeatriz Manuel11Giovanni Putoto12Santigie Sesay13Emily B Wroe14Yogeshwar Kalkonde15Sergio ChicumbeLauren BrownAbha Shrestha16Lucia GonzálezMatthew M Coates17Jones K Masiye18Mary Theodory Mayige19Wubaye Walelgne Dagnaw20Chiyembekezo KachimangaAna MocumbiRyan McBain21Apoorva GomberFabio Manenti22Roma ChilengiYogesh Jain23Sam PatelGladwell GathechaJulie Makani24Amy McLaughlin25Celina TrujilloLaura Drown26Reuben Mutagaywa27Todd Ruderman28Gina FerrariChantelle Boudreaux29Humberto MuquingueMary MayigeJonathan Chiwanda Banda30Andrea Atzori31Neusa Bay32Wondu Bekele33Victoria M Bhambhani34Remy Bitwayiki Nkwiro35Dawson Calixte36Katia Domingues37Darius Fenelon38Innocent Kamali39Catherine Karekezi40Alexio Mangwiro41Fastone Mathew Goma42Emmanuel Mensah43Nicole Mocumbi Salipa44Alvern Mutengerere45Marta Patiño46Devashri Salvi47Fameti Taero48Emílio Tostão49Sterman Toussaint50Abhijit GadewarSunil JadhaoChetanya MalikAlma AdlerVictoria BhambhaniSusan DonnellanKaita DominguesSheila KlassenAndrew MarxMaia OlsenCatherine PlayerRamon RuizAda ThapaLeslie WentworthAllison WesterveltAriana WolginEmily YaleMichael AbiyuLemma AyeleZelalem MengistuTemesgen SileshiNatnael AlemayehuNatnael A AbebeNancy LarcoGideon AyodoPeter MokayaJones MasiyeEvelyn ChibweNoel KasomekeraNicole M SalipaRiaze RafikLucy RamirezShiva AdhikaryKrishna AryalPhanindra BaralBiraj KarmachayaAbhinav VaidhyaAnn AkitengFrank MugabeSarah Asio EraguBernard BukarNamasiku SiyumbwaWibroad MutaleKudakwashe MadzekeAlaisa MbiririNyamayaro WencelasPorika NyawaiAbaden SvisvaLaura Ruckstuhl4 Dhulikhel Hospital, Dhulikhel, NepalKathmandu University, Dhulikhel, NepalNon-communicable Diseases Program, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, UgandaUganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, UgandaCenter for Integration Science, Brigham and Women`s Hospital, Boston, Massachusetts, USAUniversidade Eduardo Mondlane, Maputo, MozambiqueCenter for Integration Science, Brigham and Women`s Hospital, Boston, Massachusetts, USAKathmandu Institute of Child Health, Kathmandu, NepalPartners In Health/Inshuti Mu Buzima, Rwinkwavu, RwandaPartners In Health/Inshuti Mu Buzima, Rwinkwavu, RwandaCenter for Integration Science, Brigham and Women`s Hospital, Boston, Massachusetts, USADepartment of Community Health, Universidade Eduardo Mondlane, Maputo, MozambiqueDoctors with Africa CUAMM, Padua, ItalyNoncommunicable Diseases and Mental Health, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra LeonePartners In Health, Neno, MalawiChhattisgarh NCD Plus Initiative, Ambikapur, Chhattisgarh, IndiaDepartment of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Province 3, NepalDepartment of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USANoncommunicable Diseases and Mental Health Clinical Services, Malawi Ministry of Health, Lilongwe, MalawiNational Institute for Medical Research, Dar es Salaam, TanzaniaNCDI Poverty Network, Addis Ababa, EthiopiaPartners In Health, Boston, Massachusetts, USADoctors with Africa CUAMM, Padua, ItalyNCDI Poverty Network, Surguja, Chhattisgarh, IndiaSickle Cell Programme, Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, TanzaniaPartners In Health, Boston, Massachusetts, USACenter for Integration Science, Brigham and Women`s Hospital, Boston, Massachusetts, USAMuhimbili University of Health and Allied Sciences, Dar es Salaam, TanzaniaPartners In Health, Neno, MalawiCenter for Integration Science, Brigham and Women`s Hospital, Boston, Massachusetts, USACurative and Medical Rehabilitation Services, Ministry of Health, lilongwe, MalawiDoctors with Africa CUAMM, Padova, ItalyUniversidade Eduardo Mondlane, Maputo, MozambiqueMathiwos Wondu-Ye Ethiopia Cancer Society, Addis Ababa, EthiopiaCenter for Integration Science, Brigham and Women`s Hospital, Boston, Massachusetts, USAPartners In Health Sierra Leone, Kono, Sierra LeoneZamni Lasante, Croix-des-Bouquets, HaitiCenter for Integration Science, Brigham and Women`s Hospital, Boston, Massachusetts, USAZamni Lasante, Croix-des-Bouquets, HaitiPartners In Health/Inshuti Mu Buzima, Rwinkwavu, RwandaNon-Communicable Diseases Alliance Kenya, Nairobi, KenyaClinton Health Access Initiative, Harare, ZimbabweCentre for Infectious Diseases Research in Zambia, Lusaka, ZambiaCenter for Integration Science, Brigham and Women`s Hospital, Boston, Massachusetts, USAUniversidade Eduardo Mondlane, Maputo, MozambiqueSolidarMed, Harare, ZimbabwePartners In Health Sierra Leone, Kono, Sierra LeoneCenter for Integration Science, Brigham and Women`s Hospital, Boston, Massachusetts, USAMozambique Institute for Health Education and Research, Maputo, MozambiqueDepartment of Agricultural Economics and Development, Universidade Eduardo Mondlane, Maputo, MozambiquePartners In Health, Maryland County, LiberiaIntroduction 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.https://bmjopen.bmj.com/content/14/1/e074182.full |
| spellingShingle | Archana Shrestha Biraj Man Karmacharya Robert Kalyesubula Isaac Ssinabulya Zipporah Ali Alma J Adler Ana Olga Mocumbi Neil Gupta Meghnath Dhimal Bhagawan Koirala Gedeon Ngoga Symaque Dusabeyezu Gene Kwan Gene Bukhman Lilian Mbau Beatriz Manuel Giovanni Putoto Santigie Sesay Emily B Wroe Yogeshwar Kalkonde Sergio Chicumbe Lauren Brown Abha Shrestha Lucia González Matthew M Coates Jones K Masiye Mary Theodory Mayige Wubaye Walelgne Dagnaw Chiyembekezo Kachimanga Ana Mocumbi Ryan McBain Apoorva Gomber Fabio Manenti Roma Chilengi Yogesh Jain Sam Patel Gladwell Gathecha Julie Makani Amy McLaughlin Celina Trujillo Laura Drown Reuben Mutagaywa Todd Ruderman Gina Ferrari Chantelle Boudreaux Humberto Muquingue Mary Mayige Jonathan Chiwanda Banda Andrea Atzori Neusa Bay Wondu Bekele Victoria M Bhambhani Remy Bitwayiki Nkwiro Dawson Calixte Katia Domingues Darius Fenelon Innocent Kamali Catherine Karekezi Alexio Mangwiro Fastone Mathew Goma Emmanuel Mensah Nicole Mocumbi Salipa Alvern Mutengerere Marta Patiño Devashri Salvi Fameti Taero Emílio Tostão Sterman Toussaint Abhijit Gadewar Sunil Jadhao Chetanya Malik Alma Adler Victoria Bhambhani Susan Donnellan Kaita Domingues Sheila Klassen Andrew Marx Maia Olsen Catherine Player Ramon Ruiz Ada Thapa Leslie Wentworth Allison Westervelt Ariana Wolgin Emily Yale Michael Abiyu Lemma Ayele Zelalem Mengistu Temesgen Sileshi Natnael Alemayehu Natnael A Abebe Nancy Larco Gideon Ayodo Peter Mokaya Jones Masiye Evelyn Chibwe Noel Kasomekera Nicole M Salipa Riaze Rafik Lucy Ramirez Shiva Adhikary Krishna Aryal Phanindra Baral Biraj Karmachaya Abhinav Vaidhya Ann Akiteng Frank Mugabe Sarah Asio Eragu Bernard Bukar Namasiku Siyumbwa Wibroad Mutale Kudakwashe Madzeke Alaisa Mbiriri Nyamayaro Wencelas Porika Nyawai Abaden Svisva Laura Ruckstuhl 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 BMJ Open |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| url | https://bmjopen.bmj.com/content/14/1/e074182.full |
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protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT neusabay protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT wondubekele protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT victoriambhambhani protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT remybitwayikinkwiro protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT dawsoncalixte protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT katiadomingues protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT dariusfenelon protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT innocentkamali protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT catherinekarekezi protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT alexiomangwiro protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT fastonemathewgoma protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT emmanuelmensah protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT nicolemocumbisalipa protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT alvernmutengerere protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT martapatino protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT devashrisalvi protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT fametitaero protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT emiliotostao protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT stermantoussaint protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT abhijitgadewar protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT suniljadhao protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT chetanyamalik protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT almaadler protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT victoriabhambhani protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT susandonnellan protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT kaitadomingues protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT sheilaklassen protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT andrewmarx protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT maiaolsen protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT catherineplayer protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT ramonruiz protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT adathapa protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT lesliewentworth protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT allisonwestervelt protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT arianawolgin protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT emilyyale protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT michaelabiyu protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT lemmaayele protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT zelalemmengistu protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT temesgensileshi protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT natnaelalemayehu protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT natnaelaabebe protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT nancylarco protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT gideonayodo protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT petermokaya protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT jonesmasiye protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT evelynchibwe protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT noelkasomekera protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT nicolemsalipa protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT riazerafik protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT lucyramirez protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT shivaadhikary protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT krishnaaryal protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT phanindrabaral protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT birajkarmachaya protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT abhinavvaidhya protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT annakiteng protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT frankmugabe protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT sarahasioeragu protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT bernardbukar protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT namasikusiyumbwa protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT wibroadmutale protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT kudakwashemadzeke protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT alaisambiriri protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT nyamayarowencelas protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT porikanyawai protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT abadensvisva protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries AT lauraruckstuhl protocolforanevaluationoftheinitiationofanintegratedlongitudinaloutpatientcaremodelforseverechronicnoncommunicablediseasespenplusatsecondarycarefacilitiesdistricthospitalsin10lowerincomecountries |