Applying systems thinking to identify enablers and challenges to scale-up interventions for hypertension and diabetes in low-income and middle-income countries: protocol for a longitudinal mixed-methods study.

INTRODUCTION: There is an urgent need to reduce the burden of non-communicable diseases (NCDs), particularly in low-and middle-income countries, where the greatest burden lies. Yet, there is little research concerning the specific issues involved in scaling up NCD interventions targeting low-resource settings. We propose to examine this gap in up to 27 collaborative projects, which were funded by the Global Alliance for Chronic Diseases (GACD) 2019 Scale Up Call, reflecting a total funding investment of approximately US$50 million. These projects represent diverse countries, contexts and adopt varied approaches and study designs to scale-up complex, evidence-based interventions to improve hypertension and diabetes outcomes. A systematic inquiry of these projects will provide necessary scientific insights into the enablers and challenges in the scale up of complex NCD interventions. METHODS AND ANALYSIS: We will apply systems thinking (a holistic approach to analyse the inter-relationship between constituent parts of scaleup interventions and the context in which the interventions are implemented) and adopt a longitudinal mixed-methods study design to explore the planning and early implementation phases of scale up projects. Data will be gathered at three time periods, namely, at planning (TP), initiation of implementation (T0) and 1-year postinitiation (T1). We will extract project-related data from secondary documents at TP and conduct multistakeholder qualitative interviews to gather data at T0 and T1. We will undertake descriptive statistical analysis of TP data and analyse T0 and T1 data using inductive thematic coding. The data extraction tool and interview guides were developed based on a literature review of scale-up frameworks. ETHICS AND DISSEMINATION: The current protocol was approved by the Monash University Human Research Ethics Committee (HREC number 23482). Informed consent will be obtained from all participants. The study findings will be disseminated through peer-reviewed publications and more broadly through the GACD network.

Manual para el cuidado de personas con enfermedades crónicas no transmisibles manejo integral en el primer nivel de atención / Procedures for the care of people with chronic noncommunicable diseases integral management in the first level of care

Las enfermedades crónicas no transmisibles (ECNT) son patologías de larga duración cuya evolución es generalmente lenta. Las principales ECNT son las enfermedades vasculares (cardio y cerebrovasculares), la diabetes, el cáncer, las enfermedades respiratorias crónicas y la obesidad. Todas se caracterizan por compartir los mismos factores de riesgo: el tabaquismo, la alimentación inadecuada y la falta de actividad física La Estrategia Nacional de Prevención y Control de las Enfermedades no Transmisibles tiene como objetivo reducir la prevalencia de factores de riesgo y la morbimortalidad por ECNT en la población en general. Las acciones desarrolladas están focalizadas en la promoción de la salud, la reorientación de los servicios de salud y la vigilancia epidemiológica. Este Manual fue desarrollado considerando las guías de práctica clínica (GPC) elaboradas por la Dirección y otras guías y documentos técnicos de otras áreas del Ministerio de Salud de la Nación, fundamentalmente en lo referente a las recomendaciones del control periódico de salud. En aquellos casos en los que no se contaba con una guía de práctica clínica, como es el caso de hipertensión arterial, se realizó una revisión de las recomendaciones actuales, consolidadas en un capítulo y se actualizaron las recomendaciones pertinentes en el resto de los capítulos. El conjunto de recomendaciones que se presentan, no ambiciona establecer normativas sino otorgar una herramienta que favorezca la atención de la población independientemente del profesional que lo asista

Use of m-Health Technology for Preventive Interventions to Tackle Cardiometabolic Conditions and Other Non-Communicable Diseases in Latin America- Challenges and Opportunities.

In Latin America, cardiovascular disease (CVD) mortality rates will increase by an estimated 145% from 1990 to 2020. Several challenges related to social strains, inadequate public health infrastructure, and underfinanced healthcare systems make cardiometabolic conditions and non-communicable diseases (NCDs) difficult to prevent and control. On the other hand, the region has high mobile phone coverage, making mobile health (mHealth) particularly attractive to complement and improve strategies toward prevention and control of these conditions in low- and middle-income countries. In this article, we describe the experiences of three Centers of Excellence for prevention and control of NCDs sponsored by the National Heart, Lung, and Blood Institute with mHealth interventions to address cardiometabolic conditions and other NCDs in Argentina, Guatemala, and Peru. The nine studies described involved the design and implementation of complex interventions targeting providers, patients and the public. The rationale, design of the interventions, and evaluation of processes and outcomes of each of these studies are described, together with barriers and enabling factors associated with their implementation.