Figure 1
Theory of change, highlighting three mechanisms of action.
Table 1
List of severe NCDs treated at PEN-Plus clinic in Neno, Malawi.
| CONDITIONS TREATED | |
|---|---|
| Cardiovascular | Rheumatic Heart Disease; Heart Failure; complicated Hypertension; Congenital heart disease; Stroke; Deep Venous Thrombosis, Pulmonary Embolism, Myocardial Infarction |
| Renal | Chronic kidney disease |
| Gastrointestinal | Liver cirrhosis |
| Endocrine | Type 1 DM Type 2 DM on insulin |
| Pulmonary | Severe chronic respiratory disease |
| Hematology | Sickle cell disease |
| Neurology | Severe epilepsy |
Table 2
Improvements in care for type 1 diabetes, kidney disease, and heart disease following training.
| TYPE 1 DIABETES | KIDNEY DISEASE | HEART DISEASE | |||||
|---|---|---|---|---|---|---|---|
| HBA1C DRAWN | BLOOD SUGAR DRAWN | CREATININE DOCUMENTED | URINE PROTEIN DOCUMENTED | ENALAPRIL GIVEN | BETA BLOCKER GIVEN | FUROSEMIDE GIVEN | |
| Average Baseline Coverage (Jan 2017–Oct 2020) | 0.04 | 0.24 | 0.08 | 0.05 | 0.28 | 0.08 | 0.09 |
| Predicted increase in coverage after the launch of PEN-Plus | 0.03*** | 0.22*** | 0.18*** | 0.33*** | 0.24*** | 0.41*** | 0.26*** |
| (0.01) | (0.02) | (0.03) | (0.03) | (0.03) | (0.03) | (0.02) | |
[i] Standard errors are in parentheses. * p < 0.05, ** p < 0.01, *** p < 0.001.
This table presents the predicted increase in probability that a clinical service will be provided at an eligible visit. For example, 24% of patients with type 1 diabetes had their blood sugar drawn at an eligible visits at baseline. The training is associated with a 22% point increase in the predicted probabiliy that this service would occur at a visit. Results reflect the results for the mean patient after a multivariable logistic regression models that control for patient age, HIV status, and gender (results from these underlying models can be found in the supplementary materials).
Figure 2
Improvements in Care Provision: Distribution of selected medical tests and medication for NCDs, before and after the launch of the advanced NCD clinic.
This figure shows temporal trends in care provision to highlight the increase at the time of the training. On the right is blood sugar testing and on the left is provision of beta blockers. Data indicates the proportion of eligible encounters in which the services was provided for the period January 2017–January 2020. Dates before the initiation of the training are indicated in blue. Dates after the initiation of training are in red. Trend lines before and after the training are also shown.
Table 3
List of didactic lecture topics by category. Pre-tests, post-tests, and case reviews were also conducted. Full materials are available upon request.
| TRAINING CURRICULUM | |
|---|---|
| Diabetes Mellitus | Epidemiology and Pathology Diagnosis Medications Insulin Management Complications Foot care, diet, lifestyle |
| Cardiovascular | Epidemiology and Pathology Hypertension and Preeclampsia DVT, PE and anticoagulation Chronic Heart Failure Rheumatic Heart Disease Counseling in Cardiovascular Disease |
| Pulmonology | Epidemiology and Pathology Asthma COPD, Bronchiectasis, Cough |
| Renal | Epidemiology and Pathology Chronic Kidney Disease Electrolytes |
| Gastroenterology | Hepatitis Ascites and Cirrhosis |
| Hematology | Sickle cell disease |
| Neurology | Epilepsy |