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dc.contributor.authorFrieden, M
dc.contributor.authorZamba, B
dc.contributor.authorMukumbi, N
dc.contributor.authorMafaune, PT
dc.contributor.authorMakumbe, B
dc.contributor.authorIrungu, E
dc.contributor.authorMoneti, V
dc.contributor.authorIsaakidis, P
dc.contributor.authorGarone, D
dc.contributor.authorPrasai, M
dc.date.accessioned2020-07-26T00:40:21Z
dc.date.available2020-07-26T00:40:21Z
dc.date.issued2020-06-01
dc.date.submitted2020-07-25
dc.identifier.pmid32487095
dc.identifier.doi10.1186/s12913-020-05351-x
dc.identifier.urihttp://hdl.handle.net/10144/619708
dc.description.abstractBackground 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.en_US
dc.language.isoenen_US
dc.publisherBMCen_US
dc.rightsWith thanks to BMC.en_US
dc.subjectDiabetes mellitus
dc.subjectHypertension
dc.subjectMentoring
dc.subjectNon-communicable diseases
dc.subjectNurse-led
dc.subjectPrimary-health-care
dc.titleSetting up a nurse-led model of care for management of hypertension and diabetes mellitus in a high HIV prevalence context in rural Zimbabwe: a descriptive studyen_US
dc.typeArticle
dc.identifier.eissn1472-6963
dc.identifier.journalBMC Health Services Researchen_US
dc.source.journaltitleBMC health services research
dc.source.volume20
dc.source.issue1
dc.source.beginpage486
dc.source.endpage
refterms.dateFOA2020-07-26T00:40:22Z
dc.source.countryEngland


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