Background: In the light of the increasing burden of non-communicable diseases (NCDs) on health systems in low-and middle-income countries, particularly in Sub-Saharan Africa, context-adapted, cost-effective service delivery models are now required as a matter of urgency. We describe the experience of setting up and organising a nurseled Diabetes Mellitus (DM) and Hypertension (HTN) model of care in rural Zimbabwe, a low-income country with unique socioeconomic challenges and a dual disease burden of HIV and NCDs. Methods: Mirroring the HIV experience, we designed a conceptual framework with 9 key enablers: decentralization of services, integration of care, simplification of management guidelines, mentoring and task-sharing, provision of affordable medicines, quality assured laboratory support, patient empowerment, a dedicated monitoring and evaluation system, and a robust referral system. We selected 9 primary health care clinics (PHC) and two hospitals in Chipinge district and integrated DM and HTN either into the general outpatient department, pre-existing HIV clinics, or an integrated chronic care clinic (ICCC). We provided structured intensive mentoring for staff, using simplified protocols, and disease-specific education for patients. Free medication with differentiated periodic refills and regular monitoring with point of care (POC) glycosylated haemoglobin (HbA1c) were provided. Results: Nurses in 7 PHC facilities and one hospital developed sufficient knowledge and skills to diagnose, initiate treatment and monitor DM and HTN patients, and 3094 patients were registered in the programme (188 with DM only, 2473 with HTN only, 433 with both DM and HTN). Major lessons learned from our experience include: the value of POC devices in the management of diabetes; the pressure on services of the added caseload, exacerbated by the availability of free medications in supported health facilities; and the importance of leadership in the successful implementation of care in health facilities. Conclusion: Our experience demonstrates a model for nurse-led decentralized integrated DM and HTN care in a high HIV prevalence rural, low-income context. Developing a context-adapted efficient model of care is a dynamic process. We present our lessons learned with the intention of sharing experience which may be of value to other public health programme managers.

Background In light of the increasing burden of non-communicable diseases on health systems in low- and middle-income countries, particularly in Sub-Saharan Africa, context adapted cost effective service delivery models are now required as a matter of urgency. Multiple models have thus been trialled across Africa with varying degrees of success. Zimbabwe is a low-income country with unique socio-economic challenges but similar dual disease burden of infectious chronic diseases such as HIV and non-communicable diseases. We aim to describe the experience of setting up and organising a nurse-led Diabetes Mellitus (DM) and Hypertension (HTN) model of care in a rural context of a low-income country from July 2016 to June 2019.Methods A descriptive study based on a conceptual framework successfully applied in the roll-out of antiretroviral therapy in Manicaland Province, Zimbabwe. Attempting to mirror the HIV experience, we describe the key enablers in the design and implementation of the model: decentralization of services, integration of care, simplification of management guidelines, mentoring and task-sharing, provision of affordable medicines, quality assured laboratory support, patient empowerment, a dedicated monitoring and evaluation system, and a robust referral system.Results 11 out of 51 health facilities were selected in Chipinge district, of which nine were primary health care (PHC) clinics and two were hospitals. DM/HTN services were set up and integrated into the general out-patient department or pre-existing HIV clinics. In one hospital, an integrated chronic care clinic was established. Through structured intensive mentoring, including simplified protocols, nurses in seven PHC facilities and one hospital developed sufficient knowledge and skills to diagnose, initiate treatment and monitor DM/HTN patients. Overall, more than 3000 patients were registered in a dedicated recording system and offered education. Free medication with differentiated periodic refills and regular monitoring of blood pressure and/or blood glucose with the use of glycosylated haemoglobin were provided.Conclusion Our experience shows that it is feasible to implement nurse-led decentralized integrated DM/HTN care in a high HIV prevalence rural, low-income context. Developing a context-adapted efficient model of care is a dynamic process.

Background: In the light of the increasing burden of non-communicable diseases (NCDs) on health systems in low- and middle-income countries, particularly in Sub-Saharan Africa, context-adapted, cost-effective service delivery models are now required as a matter of urgency. We describe the experience of setting up and organising a nurse-led Diabetes Mellitus (DM) and Hypertension (HTN) model of care in rural Zimbabwe, a low-income country with unique socio-economic challenges and a dual disease burden of HIV and NCDs. Methods: Mirroring the HIV experience, we designed a conceptual framework with 9 key enablers: decentralization of services, integration of care, simplification of management guidelines, mentoring and task-sharing, provision of affordable medicines, quality assured laboratory support, patient empowerment, a dedicated monitoring and evaluation system, and a robust referral system. We selected 9 primary health care clinics (PHC) and two hospitals in Chipinge district and integrated DM and HTN either into the general out-patient department, pre-existing HIV clinics, or an integrated chronic care clinic (ICCC). We provided structured intensive mentoring for staff, using simplified protocols, and disease-specific education for patients. Free medication with differentiated periodic refills and regular monitoring with point of care (POC) glycosylated haemoglobin (HbA1c) were provided. Results: Nurses in 7 PHC facilities and one hospital developed sufficient knowledge and skills to diagnose, initiate treatment and monitor DM and HTN patients, and 3094 patients were registered in the programme (188 with DM only, 2473 with HTN only, 433 with both DM and HTN). Major lessons learned from our experience include: the value of POC devices in the management of diabetes; the pressure on services of the added caseload, exacerbated by the availability of free medications in supported health facilities; and the importance of leadership in the successful implementation of care in health facilities.Conclusion: Our experience demonstrates a model for nurse-led decentralized integrated DM and HTN care in a high HIV prevalence rural, low-income context. Developing a context-adapted efficient model of care is a dynamic process. We present our lessons learned with the intention of sharing experience which may be of value to other public health programme managers.

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Background In the light of the increasing burden of non-communicable diseases on health systems in low- and middle-income countries, particularly in Sub-Saharan Africa, context-adapted, cost-effective service delivery models are required urgently. Multiple models have been trialled across Africa with varying degrees of success. Zimbabwe is a low-income country with unique socio-economic challenges and a dual disease burden of infectious chronic diseases such as HIV and non-communicable diseases. We describe the experience of setting up and organising a nurse-led Diabetes Mellitus (DM) and Hypertension (HTN) model of care in rural Zimbabwe from July 2016 to June 2019. Programme design and implementation We used a conceptual framework successfully applied in the roll-out of antiretroviral therapy in Zimbabwe. Mirroring the HIV experience, we describe key enablers in the design and implementation of the model: decentralization of services, integration of care, simplification of guidelines, mentoring and task-sharing, provision of affordable medicines, quality assured laboratory support, patient empowerment, a dedicated monitoring and evaluation system, and a robust referral system. DM and HTN services were set up in 9 primary health care (PHC) facilities and two hospitals in Chipinge district, and integrated into the general out-patient department or pre-existing HIV clinics. In one hospital, an integrated chronic care clinic (ICCC) emerged. We provided mentoring for staff using simplified protocols, and patient education. Free medication and monitoring with point of care (POC) glycosylated haemoglobin (HbA1c) were provided. Nurses in 7 PHC facilities and one hospital developed sufficient knowledge and skills to diagnose and manage DM and HTN patients, and 3094 patients were registered. Major lessons learned include: the value of POC devices in the management of diabetes; the pressure on services due to added caseload, exacerbated by the availability of free medications; and the importance of leadership in successful programme implementation. Conclusion Our experience demonstrates a model for nurse-led decentralized integrated DM and HTN care in a high HIV prevalence rural, low-income context. Developing a context-adapted model of care is a dynamic process. We present our lessons learned with the intention of sharing experience which may be of value to other public health programme managers.