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Objective: There is insufficient evidence on the role of self‐financing patient support groups in the control of blood pressure (BP) and/or diabetes in low‐ and middle‐income countries (LMICs). We conducted a systematic review to investigate the effectiveness of these groups in BP and glycaemic control. Methods: We searched PubMed, Embase, SCOPUS, Web of Science, Global Health, African Journals Online, CINAHL and African Index Medicus for published peer‐reviewed articles from inception up to November 2021. Grey literature was obtained from OpenGrey. Studies on patient support groups for hypertension and/or diabetes with a component of pooling financial resources, conducted in LMICs, were included. Narrative reviews, commentaries, editorials and articles published in languages other than English and French were excluded. Study quality and risk of bias were assessed using the National Institutes of Health Quality assessment tool and the revised Cochrane risk‐of‐bias tool. Results are reported according to PRISMA guidelines. Results: Of 724 records screened, three studies met the criteria: two trials conducted in Kenya and a retrospective cohort study conducted in Cambodia. All studies reported improvement in BP control after 12 months follow‐up with reductions in systolic BP of 23, 14.8, and 16.9 mmHg, respectively. Two studies reported diabetes parameters. The first reported improvement in HbA1c (reduction from baseline 10.8%, to 10.6% at 6 months) and random blood sugar (baseline 8.9 mmol/L, to 8.5 mmol/L at 6 months) but these changes did not achieve statistical significance. The second reported a reduction in fasting blood glucose (baseline—216 mg/dl, 12 months—159 mg/dl) in diabetic patients on medication. Conclusion: Self‐financing patient support groups for diabetes and hypertension are potentially effective in the control of BP and diabetes in LMICs. More studies are needed to add to the scarce evidence base on the role of self‐financing patient support groups. [ABSTRACT FROM AUTHOR]

Health systems worldwide struggle to manage the growing burden of type 2 diabetes and hypertension. Many patients receive suboptimal care, especially those most vulnerable. An evidence-based Integrated Care Package (ICP) with primary care-based diagnosis, treatment, education and self-management support and collaboration, leads to better health outcomes, but there is little knowledge of how to scale-up. The Scale-up integrated care for diabetes and hypertension project (SCUBY) aims to address this problem by roadmaps for scaling-up ICP in different types of health systems: a developing health system in a lower middle-income country (Cambodia); a centrally steered health system in a high-income country (Slovenia); and a publicly funded highly privatised health-care health system in a high-income country (Belgium). In a quasi-experimental multi-case design, country-specific scale-up strategies are developed, implemented and evaluated. A three-dimensional framework assesses scale-up along three axes: (1) increase in population coverage; (2) expansion of the ICP package; and (3) integration into the health system. The study includes a formative, intervention and evaluation phase. The intervention entails the development and implementation of an improved scale-up strategy through a roadmap with a minimum dataset to monitor proximal and distal outcomes. The SCUBY project is expected to result in three different roadmaps, tailored to the specific health system and country context, to progress scale-up of the ICP along three dimensions. These roadmaps can be adapted to other health systems with similar typology. Implementation is expected to increase the number of well-controlled patients with type 2 diabetes and hypertension in Cambodia, to reduce inequities in care and increase patient empowerment in Belgium and Slovenia. [ABSTRACT FROM AUTHOR]

Introduction: To address the increasing burden of non-communicable diseases (NCDs), global commitments have been made towards an integrated care (IC) approach. The 'SCale-Up diaBetes and hYpertension' (SCUBY) project aims to provide implementation science-based solutions through co-creation, implementation and evaluation of roadmaps for scale-up of IC for diabetes and hypertension. We analysed macro-level barriers and facilitators to IC in: a developing health system in a lower middle-income country (Cambodia); a centrally-steered health system in a highincome country (Slovenia); and a publicly-funded highly privatised healthcare health system in a high-income country (Belgium). The results of this study will provide input in roadmap-strategies for scaling up IC in these contexts. Methods: To identify macro-level bottlenecks, documents review (scientific publications, policy documents and grey literature); practice observations; focus groups with patients, health workers and community-based actors; and in-depth stakeholder interviews with health facility managers, policy makers, civil servants (Ministry of Health and health insurance), representatives of professional associations, non-governmental organisations, implementers, academics, and patient platforms were conducted. Thematic analysis utilising the WHO global strategy on integrated people-centred health services, was conducted as a cyclical process including a deductive and inductive analysis approach. Country-specific codes were discussed and complementary literature review performed to get a comprehensive picture of the missing links. Results: We identified differences and similarities in macro-level barriers across the three contexts. The lack of political commitment regarding NCD investment in Cambodia and the limited policy coherence due to the fragmented political structure in Belgium weaken governance for IC. In Slovenia, a change in political leadership has interfered with IC implementation. In Cambodia, the limited financial resources and allocation mechanisms for NCDs at the primary care level and a weak health information system hinder IC implementation, while in Belgium and Slovenia, the financial models are outdated, care integration is not incentivized and data sharing between different health workers is limited. Shortages in human resources for health are common challenges in Slovenia and Cambodia; however, task shifting is being addressed in all country-sites: introducing nurses in primary care in Belgium, involving peers in support groups in Slovenia to strengthen patient empowerment and self-management, and engaging community health workers for support at the primary care level in Cambodia. Conclusions: Common IC challenges in the three contexts are political leadership, the health financing system, health information systems and health workforce. This macro-level barriers analysis stimulates reciprocal learning. Specifically with regards to task shifting, Slovenia can learn from Cambodia on community health and peer support workers and Belgium from Slovenia on integrating nurses into primary care. Understanding the link between macro-level, contextual factors and specific health system challenges and opportunities are key to improve the implementation of IC. Implications for transferability and limitations: Strategies to integrate care include actions to reorient care models and coordinate services towards empowering and engaging people, and to create enabling environments in systems with proper accountability and governance at the micromeso- and macro-levels. Mechanisms to address macro-level barriers can be replicated, considering country/health system contextual factors. [ABSTRACT FROM AUTHOR]

Introduction: Integrated care interventions for type 2 diabetes (T2D) and hypertension (HT) are effective, yet challenges exist with regard to their implementation and scale-up. The 'SCale-Up diaBetes and hYpertension care' (SCUBY) Project aims to facilitate the scale-up of integrated care for T2D and HT through the co-creation and implementation of contextualised scale-up roadmaps in Belgium, Cambodia and Slovenia. We hereby describe the plan for the process and scale-up evaluation of the SCUBY Project. The specific goals of the process and scale-up evaluation are to (1) analyse how, and to what extent, the roadmap has been implemented, (2) assess how the differing contexts can influence the implementation process of the scale-up strategies and (3) assess the progress of the scale-up., Methods and Analysis: A comprehensive framework was developed to include process and scale-up evaluation embedded in implementation science theory. Key implementation outcomes include acceptability, feasibility, relevance, adaptation, adoption and cost of roadmap activities. A diverse range of predominantly qualitative tools-including a policy dialogue reporting form, a stakeholder follow-up interview and survey, project diaries and policy mapping-were developed to assess how stakeholders perceive the scale-up implementation process and adaptations to the roadmap. The role of context is considered relevant, and barriers and facilitators to scale-up will be continuously assessed., Ethics and Dissemination: Ethical approval has been obtained from the Institutional Review Board (ref. 1323/19) at the Institute of Tropical Medicine (Antwerp, Belgium). The SCUBY Project presents a comprehensive framework to guide the process and scale-up evaluation of complex interventions in different health systems. We describe how implementation outcomes, mechanisms of impact and scale-up outcomes can be a basis to monitor adaptations through a co-creation process and to guide other scale-up interventions making use of knowledge translation and co-creation activities., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)