Optimizing care pathways and quality of care for moderate-to-severe hypertension, diabetes and common mental health multimorbidity in Mozambique (PEN-CONNECT)
1
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
2
School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
3
Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
4
Pettenkofer School of Public Health, Ludwig Maximilian University Munich, Munich, Germany
5
Prinses Maxima Center, Utrecht, Netherlands
6
Universidade Eduardo Mondlane, Maputo, Mozambique
7
Instituto Nacional de Saúde, Marracuene, Mozambique
8
Hospital Central do Maputo, Maputo, Mozambique
Popul. Med. 2026;8(Supplement Supplement 1):A3057
ABSTRACT
BACKGROUND:
Non-communicable diseases (NCDs) like hypertension (HT), diabetes mellitus (DM), and mental health conditions (MH) are a growing crisis in low resource settings. Individuals with multiple long-term conditions (MLTC) face fragmented, poorly coordinated care, highlighting the urgent need for integrated solutions.
OBJECTIVES:
To reduce the burden of MLTC NCDs by co-creating and evaluating a multi-level package of intervention components and implementation strategies to improve pathways for screening, diagnosis, management, and continuity of care for individuals affected by HTN, DM and MH.
METHODS:
Development of an intervention package based on the evidence-based strategies WHO PEN and PEN-Plus and guided by the EPIS (Exploration, Preparation, Implementation and Sustainment) framework. Mixed methods research is undertaken to conduct a patient-centered health systems appraisal, obtain insight into care path journeys of working-age adults with HT, DM and MH and co-develop the PEN-CONNECT intervention package. A stepped-wedge type 2 effectiveness-implementation hybrid study evaluates the effect of the intervention package on implementation fidelity for guideline-recommended management of HT, DM and MH and its impact on cardiovascular risk and quality of life in two districts in Mozambique. An accompanying mixed-methods process evaluation assesses the (1) reach, effectiveness, adoption, implementation and maintenance of the intervention, (2) fidelity of the intervention protocol and explore adaptations made during implementation, (3) organisational readiness for change, (4) economic impact and evaluates (5) real-world adaptions to the implementation strategies. Development of a roadmap and implementation toolkit supports scaling and integration of the PEN-CONNECT package within WHO Pen and PEN-PLUS across multiple regions in Mozambique.
CONCLUSIONS:
Building on the premise that strengthening the integration of PEN and PEN-Plus will be more effective than when addressed in isolation the PEN-CONNECT project generates robust clinical, implementation, and economic evidence to inform global policy and practice to improve care and health outcomes for patients with MLTC NCDs.
Non-communicable diseases (NCDs) like hypertension (HT), diabetes mellitus (DM), and mental health conditions (MH) are a growing crisis in low resource settings. Individuals with multiple long-term conditions (MLTC) face fragmented, poorly coordinated care, highlighting the urgent need for integrated solutions.
OBJECTIVES:
To reduce the burden of MLTC NCDs by co-creating and evaluating a multi-level package of intervention components and implementation strategies to improve pathways for screening, diagnosis, management, and continuity of care for individuals affected by HTN, DM and MH.
METHODS:
Development of an intervention package based on the evidence-based strategies WHO PEN and PEN-Plus and guided by the EPIS (Exploration, Preparation, Implementation and Sustainment) framework. Mixed methods research is undertaken to conduct a patient-centered health systems appraisal, obtain insight into care path journeys of working-age adults with HT, DM and MH and co-develop the PEN-CONNECT intervention package. A stepped-wedge type 2 effectiveness-implementation hybrid study evaluates the effect of the intervention package on implementation fidelity for guideline-recommended management of HT, DM and MH and its impact on cardiovascular risk and quality of life in two districts in Mozambique. An accompanying mixed-methods process evaluation assesses the (1) reach, effectiveness, adoption, implementation and maintenance of the intervention, (2) fidelity of the intervention protocol and explore adaptations made during implementation, (3) organisational readiness for change, (4) economic impact and evaluates (5) real-world adaptions to the implementation strategies. Development of a roadmap and implementation toolkit supports scaling and integration of the PEN-CONNECT package within WHO Pen and PEN-PLUS across multiple regions in Mozambique.
CONCLUSIONS:
Building on the premise that strengthening the integration of PEN and PEN-Plus will be more effective than when addressed in isolation the PEN-CONNECT project generates robust clinical, implementation, and economic evidence to inform global policy and practice to improve care and health outcomes for patients with MLTC NCDs.
| eISSN: | 2654-1459 |
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