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Background: Amid the rising number of people with NCDs, Kenya has invested in strengthening primary care and in efforts to expand existing service delivery platforms to integrate care for managing chronic disease. One such approach is the AMPATH model, established in 2001 in western Kenya to provide HIV treatment and control services. The model was progressively adapted and developed further to provide care for people with other chronic conditions. Building on this experience, the Primary Health Integrated Care Project for Chronic Conditions (PIC4C) was launched in 2018 to further strengthen primary care services for the prevention and control of hypertension, diabetes, breast and cervical cancer. This study seeks to understand how well PIC4C delivers on its intended aims and to inform and support scale up of the PIC4C model for integrated care for people with selected chronic conditions in Kenya. Methods: The study is guided by a conceptual framework on implementing, sustaining and spreading innovation in health service delivery. We use a multimethod design combining qualitative and quantitative approaches, involving: (1) in-depth interviews with health workers and decision-makers to explore experiences of delivering PIC4C; (2) a cross-sectional survey of patients newly diagnosed with diabetes or hypertension and in-depth interviews to understand how well PIC4C meets patients’ needs; (3) a cohort study with an interrupted time series analysis to evaluate the degree to which PIC4C leads to health benefits such as improved management of hypertension or diabetes; and (4) a cohort study of households to examine the extent to which the national hospital insurance chronic care package provides financial risk protection to people with hypertension or diabetes within PIC4C.Workshops with decision-makers and other key people at local, county, national and international levels will ensure early and wide dissemination of the findings of the work to allow for the wider scale up of this model of care. Discussion: Our study will generate new knowledge about the key mechanisms and factors that shape the successful implementation of novel ways of delivering more integrated services to better manage and support people with chronic conditions in low resource settings. It will expand understanding of intended and unintended consequences of integrating NCD management into existing care programmes. This knowledge can be leveraged to inform and improve the design and implementation of similar programmes elsewhere in Kenya and beyond.

Original publication

DOI

10.21203/rs.3.rs-387629/v1

Type

Publication Date

06/04/2021