Integrated Care Cascade Toolkit: an implementation guide to screening, treatment & follow-up for HIV & NCDs

Lemie Banda, Elizabeth Dunbar, Tafwirapo Chihana, Arnold Jumbe, Chiyembekezo Kachimanga, Lila Kerr, Joseph Lusaka, Bright Mailosi, Lawrence Nazimera, Basimenye Nhlema, Charles Phiri, and Emily Wroe

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The Integrated Care Cascade was developed in Neno District, Malawi over two years of collaboration between Partners In Health and the Ministry of Health (MOH).

PIH began working in Neno in 2007, and the HIV care program quickly blossomed, with active screening initiatives, treatment decentralized to all health facilities, and a robust system for tracking patients with missed appointments.3 At the end of 2014, 7,100 clients were enrolled in HIV care, representing an estimated 75% of HIV cases in the district.

Meanwhile, care for non-communicable disease (NCD) patients remained limited: case-finding was low, treatment was only available at the two hospitals, and there was no system to follow-up with missing patients. At the end of 2014, just 1% of estimated hypertension and diabetes cases were enrolled in care.

The Neno solution was to integrate care across screening, treatment and follow-up systems, leveraging the success of the HIV program to improve NCD outcomes. Through strategic leveraging of the strong HIV platform, including staff, space, and other resources, Neno was able to fully integrate NCD care. This toolkit highlight this success, including screening, treatment, and follow-up systems for our Integrated Chronic Care Clinic.

PEN-Plus Policy Brief – Decentralizing lifesaving care for severe NCDs

8-page policy brief presents PEN-Plus as a proven model for decentralizing care and treatment for type 1 diabetes, sickle cell diseases, rheumatic and congenital heart disease, and other severe NCDs that cause hundreds of thousands of avoidable deaths every year among the world’s poorest children and young adults.

Experience of living with type 1 diabetes in a low-income country: a qualitative study from Liberia

Alma J Adler, Celina Trujillo, Leah Schwartz, Laura Drown, Jacquelin Pierre, Christopher Noble, Theophilus Allison, Rebecca Cook, Cyrus Randolph, Gene Bukhman

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Despite the severe nature of T1D and growing burden in sub- Saharan Africa, little is currently known about the impact of T1D on patients and caregivers in the region. We conducted a qualitative study consisting of interviews with patients with T1D, caregivers, providers, civil society members and a policy-maker in Liberia to better understand the psychosocial and economic impact of living with T1D, knowledge of T1D and self-management, and barriers and facilitators for accessing T1D care.

T1D was found to have a significant impact on patients and caregivers, and informants identified several key individual and systems-level barriers to effective T1D care in Liberia. Addressing these concerns is vital for designing sustainable and effective programmes for treating patients living with T1D.