Adapting and Implementing the WHO PEN-Plus Model for Managing Severe Chronic Non-Communicable Diseases at First-Level Hospitals in Zambia

What this Trial Is About

Researchers are working to adapt and pilot the WHO Package of Essential Non-communicable Diseases PEN Plus intervention in Zambia to address the growing burden of complex chronic diseases such as diabetes, hypertension, and cancer. The study focuses on improving management of these diseases at first-level hospitals using an implementation framework designed to tailor interventions locally and prepare for national scale-up. This effort responds to increasing cases and insufficient primary care capacity in Zambia. The study involves adapting the PEN-Plus model through stakeholder engagement, training of frontline health workers, and establishing PEN-Plus clinics at selected peri-urban and rural hospitals. These clinics will provide care led by mid-level providers supported by specialists. The intervention includes supportive treatment, provision of necessary drugs and equipment, and integration with existing health information systems. The project will also develop national policies and operational plans to enable wider implementation. Participants are patients with chronic non-communicable diseases receiving care at first-level hospitals. Researchers will monitor implementation outcomes such as patient enrollment, care quality, and cost, as well as training outcomes for healthcare providers. Data collection includes routine visits and patient records integrated with national systems. The primary outcome measures the increase in patients diagnosed and managed according to WHO PEN-Plus guidelines over six years, with ongoing monitoring and evaluation of the program impact.

Domestication and Implementation of the PEN-Plus Clinical Model in the Zambian Health System