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| Name | Class |
|---|---|
| Amsterdam Institute for Global Health and Development | OTHER |
| Swiss Tropical & Public Health Institute | OTHER |
| Clinton Health Access Initiative, Eswatini | UNKNOWN |
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The WHO-PEN@Scale project is a three-arm cluster-randomized trial that is investigating the population-level effects of a healthcare reform in Eswatini, which aims to strengthen primary care for diabetes and hypertension. Prior to the reform, healthcare for diabetes and hypertension was mostly provided through physician-led teams in hospital outpatient departments. The healthcare reform aims to strengthen the provision of nurse-led care for diabetes and hypertension in primary healthcare facilities and community health worker-led care for these conditions in the facilities' catchment areas. The reform will broadly be guided by the World Health Organization's "Package of Essential Noncommunicable Disease Interventions for Primary Health Care in Low-Resource Settings" (WHO-PEN). The trial will take place at 84 clusters (a primary healthcare facility and its catchment area) across the country.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Standard of Care | No Intervention | Health services for diabetes and hypertension are provided as was the standard of care prior to the healthcare reform after the emergency decentralization motivated by the COVID-19 outbreak. Healthcare for diabetes and hypertension for complicated cases is provided through physician-led teams at hospitals and health centers. Healthcare for diabetes and hypertension for uncomplicated cases is provided at primary care clinics through nurses. | |
| DSD | Experimental | Clients are invited to participate in one of three Differentiated Service Delivery models tailored to their needs. |
|
| CDP | Experimental | Health services for diabetes and hypertension are provided in the scope of outreach activities set up on a monthly basis in communities. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| DSD | Other | This intervention consist of three Differentiated Service Delivery Models in which stable clients can be enrolled. The fast-track model gives preferential treatment to enrolled clients. Clients arrive at clinics, usually early in the morning, and can see the nurse as well as collect their medication without queuing. This model mainly targets the working population. The facility-based treatment clubs consist of bimonthly meetings where clients meet in groups of approximately 20 members. They receive health counselling, risk factor screening and medication prescription. This model mainly targets clients living close to the facility. The community advisory groups consist of groups of up to six clients. Groups are equipped with a point of care blood pressure and blood glucose measurement devices. They take turns in collecting the medication for the entire group and meet on a monthly basis. This model targets clients in hard-to-reach areas. |
| Measure | Description | Time Frame |
|---|---|---|
| Glycemic control (continuous) among adults with diabetes | Mean glycated haemoglobin (HbA1c) among adults aged 40 years and older with diabetes | 12 months |
| Systolic blood pressure among adults with hypertension | Mean systolic blood pressure among adults aged 40 years and older with hypertension | 12 months |
| Measure | Description | Time Frame |
|---|---|---|
| HbA1c among adults with diabetes or prediabetes | Mean glycated haemoglobin (HbA1c) among adults aged 40 years and older with diabetes or prediabetes | 12 months |
| Glycemic control (binary) among adults with diabetes |
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Inclusion criteria for the outcome assessment (household survey):
Exclusion criteria for the outcome assessment (household survey):
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| Name | Affiliation | Role |
|---|---|---|
| Pascal Geldsetzer, MD ScD MPH | Stanford University | Principal Investigator |
| Jan-Walter De Neve, MD ScD MPH | Heidelberg Institute of Global Health, Heidelberg University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Clinton Health Access Initiative | Mbabane | Eswatini |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 41888803 | Derived | Harkare HV, Ginindza N, Stehr L, Osetinsky B, Theilmann M, Marowa LR, Ntshalintshali N, Barnighausen T, Tediosi F. Implementation of WHO-PEN interventions in Eswatini: an assessment of health equity and out-of-pocket expenditure for diabetes and hypertension care. Int J Equity Health. 2026 Mar 26;25(1):119. doi: 10.1186/s12939-026-02829-8. | |
| 38802811 |
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No detailed IPD sharing plan has been developed yet.
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| SAP | No | Yes | No | Statistical Analysis Plan | Nov 10, 2019 | Nov 10, 2019 | SAP_000.pdf |
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| ID | Term |
|---|---|
| D003920 | Diabetes Mellitus |
| D006973 | Hypertension |
| D000073296 | Noncommunicable Diseases |
| ID | Term |
|---|---|
| D044882 | Glucose Metabolism Disorders |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
| D004700 | Endocrine System Diseases |
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| ID | Term |
|---|---|
| D003565 | Cytidine Diphosphate |
| ID | Term |
|---|---|
| D003597 | Cytosine Nucleotides |
| D011742 | Pyrimidine Nucleotides |
| D011743 | Pyrimidines |
| D006573 | Heterocyclic Compounds, 1-Ring |
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| University of Göttingen |
| OTHER |
| University of Eswatini | UNKNOWN |
| SWABCHA, Eswatini | UNKNOWN |
| Diabetes Swaziland | UNKNOWN |
This is a parallel three-arm cluster-randomized trial without a baseline assessment.
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|
| CDP | Other | Community Distribution Points are set up on a monthly basis in communities linked to the clinic. Healthcare staff sets up a temporary point of contact where clients can obtain screening for diabetes and hypertension, health counselling, referral to primary or tertiary facilities, and medication. |
|
The proportion of adults aged 40 years and older with diabetes who have an HbA1c less than 7.0%
| 12 months |
| Glycemic control (binary) among adults with diabetes or prediabetes | The proportion of adults aged 40 years and older with diabetes or prediabetes who have an HbA1c less than 7.0% | 12 months |
| Awareness of one's diabetes diagnosis | The proportion of adults aged 40 years and older with diabetes who report to have been diagnosed with diabetes prior to the household survey | 12 months |
| Awareness of one's diabetes or prediabetes diagnosis | The proportion of adults aged 40 years and older with diabetes or prediabetes who report to have been diagnosed with diabetes or prediabetes prior to the household survey | 12 months |
| Probability of being treated for diabetes among adults with diabetes | The proportion of adults aged 40 years and older with diabetes who report to be taking medication for their diabetes | 12 months |
| Probability of having been tested for diabetes among adults with diabetes | The proportion of adults aged 40 years and older with diabetes who report to have ever been tested for diabetes | 12 months |
| Probability of having been tested for diabetes among adults with diabetes or prediabetes | The proportion of adults aged 40 years and older with diabetes or prediabetes who report to have ever been tested for diabetes | 12 months |
| Probability of smoking among adults with diabetes, prediabetes, or hypertension | The proportion of adults aged 40 years and older with diabetes, prediabetes, or hypertension who report to be a current smoker | 12 months |
| Time spent doing moderate- or vigorous-intensity exercise among adults with diabetes, prediabetes, or hypertension | The mean number of minutes in a typical week spent doing moderate- or vigorous-intensity exercise among adults aged 40 years and older with diabetes | 12 months |
| Systolic blood pressure among adults with diabetes | Mean systolic blood pressure among adults aged 40 years and older with diabetes | 12 months |
| Systolic blood pressure among adults with diabetes or prediabetes | Mean systolic blood pressure among adults aged 40 years and older with diabetes or prediabetes | 12 months |
| Diastolic blood pressure among adults with diabetes | Mean diastolic blood pressure among adults aged 40 years and older with diabetes | 12 months |
| Diastolic blood pressure among adults with diabetes or prediabetes | Mean diastolic blood pressure among adults aged 40 years and older with diabetes or prediabetes | 12 months |
| Hypertension control (binary) among adults with hypertension | The proportion of adults aged 40 years and older with hypertension who have a systolic blood pressure <140 mm Hg and a diastolic blood pressure <90 mm Hg | 12 months |
| Diastolic blood pressure among adults with hypertension | Mean diastolic blood pressure among adults aged 40 years and older with hypertension | 12 months |
| Awareness of one's hypertension diagnosis | The proportion of adults aged 40 years and older with hypertension who report to have been diagnosed with hypertension prior to the household survey | 12 months |
| Probability of being treated for hypertension among adults with hypertension | The proportion of adults aged 40 years and older with hypertension who report to be taking blood-pressure-lowering medication | 12 months |
| Probability of having been tested for hypertension among adults with hypertension | The proportion of adults aged 40 years and older with hypertension who report to have ever had their blood pressure measured | 12 months |
| Frequency of drinking alcohol in the past 12 months among adults with diabetes, prediabetes, or hypertension | The proportion of adults aged 40 years and older with diabetes, prediabetes, or hypertension who report to having drunk daily, 5-6 days per week, 3-4 days per week, 1-2 days per week, 1-3 days per month, less than once a month, or never over the past 12 months. | 12 months |
| 21. Knowledge on diabetes and hypertension among adults with diabetes, prediabetes, or hypertension | The proportion of adults aged 40 years and older with diabetes, prediabetes, or hypertension who correctly responded to each individual question on diabetes and hypertension related knowledge. | 12 months |
| Harkare HV, Osetinsky B, Ginindza N, Cindzi BT, Mncina N, Akomolafe B, Marowa LR, Ntshalintshali N, Tediosi F. Human and financial resource needs for universal access to WHO-PEN interventions for diabetes and hypertension care in Eswatini: results from a time-and-motion and bottom-up costing study. Hum Resour Health. 2024 May 27;22(1):32. doi: 10.1186/s12960-024-00913-0. |
| 36949485 | Derived | Theilmann M, Ginindza N, Myeni J, Dlamini S, Cindzi BT, Dlamini D, Dlamini TL, Greve M, Harkare HV, Hleta M, Khumalo P, Kolbe LM, Lewin S, Marowa LR, Masuku S, Mavuso D, Molemans M, Ntshalintshali N, Nxumalo N, Osetinsky B, Pell C, Reis R, Shabalala F, Simelane BR, Stehr L, Tediosi F, van Leth F, De Neve JW, Barnighausen T, Geldsetzer P. Strengthening primary care for diabetes and hypertension in Eswatini: study protocol for a nationwide cluster-randomized controlled trial. Trials. 2023 Mar 22;24(1):210. doi: 10.1186/s13063-023-07096-4. |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D006571 |
| Heterocyclic Compounds |
| D009711 | Nucleotides |
| D009706 | Nucleic Acids, Nucleotides, and Nucleosides |
| D012265 | Ribonucleotides |