The PEN-Plus Partnership: addressing severe chronic non-communicable diseases among the poorest billion

Bukhman, Gene; Mocumbi, Ana Olga; Wroe, Emily; Gupta, Neil; Pearson, Luwei; Bermejo, Raoul; Dangou, J. M.; Moeti, Matshidiso

doi:10.1016/s2213-8587(23)00118-3

Cited by 14 publications

(9 citation statements)

References 2 publications

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“…In addition, fear of medical procedures, lack of awareness about cardiac disease progression, and minimal community education on the value of seeking medical care pose additional barriers. PEN-Plus is a strategy of integrated care delivery for severe NCDs, acting as a response to the urgent need for decentralization [51]. It complements the World Health Organization (WHO) Package of Essential Noncommunicable Interventions for Primary Care (PEN) adopted in 2010. WHO PEN is a primary care model and set of cost-effective interventions meant to be delivered in low-income settings for common NCDs such as uncomplicated hypertension.…”

Section: Development Of Decentralized Cardiac Care In Low-income Coun...mentioning

confidence: 99%

Decentralization and Integration of Advanced Cardiac Care for the World’s Poorest Billion Through the PEN-Plus Strategy for Severe Chronic Non-Communicable Disease

Klassen,

Okello,

Ferrer

et al. 2024

Global Heart

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Rheumatic and congenital heart disease, cardiomyopathies, and hypertensive heart disease are major causes of suffering and death in low- and lower middle-income countries (LLMICs), where the world’s poorest billion people reside. Advanced cardiac care in these counties is still predominantly provided by specialists at urban tertiary centers, and is largely inaccessible to the rural poor. This situation is due to critical shortages in diagnostics, medications, and trained healthcare workers. The Package of Essential NCD Interventions – Plus (PEN-Plus) is an integrated care model for severe chronic noncommunicable diseases (NCDs) that aims to decentralize services and increase access. PEN-Plus strategies are being initiated by a growing number of LLMICs. We describe how PEN-Plus addresses the need for advanced cardiac care and discuss how a global group of cardiac organizations are working through the PEN-Plus Cardiac expert group to promote a shared operational strategy for management of severe cardiac disease in high-poverty settings.

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Section: Development Of Decentralized Cardiac Care In Low-income Coun...mentioning

confidence: 99%

Decentralization and Integration of Advanced Cardiac Care for the World’s Poorest Billion Through the PEN-Plus Strategy for Severe Chronic Non-Communicable Disease

Klassen,

Okello,

Ferrer

et al. 2024

Global Heart

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“…All PEN-Plus programmes involve training of midlevel providers and ensuring access to appropriate devices and medications for appropriate diagnosis and treatment of SC-NCDs. 2 …”

Section: Introductionmentioning

confidence: 99%

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

Adler,

Wroe,

Atzori

et al. 2024

BMJ Open

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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 analysisGuided 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 disseminationThis 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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“…These include efforts from the Cardiac Surgery Intersociety Alliance to improve access to open-heart surgery by supporting workforce training and complementing national government efforts to disseminate cardiac surgery programs in LMICs; the Pulmonary Vascular Research Institute to increase access to medicines for pulmonary vascular disease worldwide; the World Heart Federation to support national roadmaps to address CVD and advocacy programs; and the NCDI (noncommunicable disease and injuries) Poverty Network's PEN-Plus Partnership to improve care for CVD among the most under-resourced populations, including children and younger adults. 5 The PEN-Plus strategy decentralizes specialized cardiovascular care to district hospitals through task-shifting to multidisciplinary teams of midlevel professionals and attempts to ensure sustainability by improving health literacy to promote self-management, using community health workers for retention in care, involving peer-support groups, and establishing referral or counterreferral paths for patients with CVD.…”

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confidence: 99%

Cardiovascular Health Care in Low- and Middle-Income Countries

Mocumbi

2024

Circulation

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The PEN-Plus Partnership: addressing severe chronic non-communicable diseases among the poorest billion

Cited by 14 publications

References 2 publications

Decentralization and Integration of Advanced Cardiac Care for the World’s Poorest Billion Through the PEN-Plus Strategy for Severe Chronic Non-Communicable Disease

Decentralization and Integration of Advanced Cardiac Care for the World’s Poorest Billion Through the PEN-Plus Strategy for Severe Chronic Non-Communicable Disease

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

Cardiovascular Health Care in Low- and Middle-Income Countries

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