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Strengthening Health Systems for Chronic Care and NCDs: Leveraging HIV Programs to Support Diabetes Services in Ethiopia Zenebe Melaku, ICAP Ethiopia Ahmed Reja, Ethiopian Diabetes Association Miriam Rabkin, ICAP Columbia University Making the HIV-NCD connection • In many resource-limited countries, HIV scale-up has created the first national chronic disease program. • In these same countries, the burden of other chronic diseases, including NCDs such as diabetes, is high and growing rapidly. • We conducted a rapid proof-of-concept study to explore the feasibility of adapting HIV-specific resources for use in a DM program at Adama Hospital in Ethiopia. • Following a baseline assessment, we adapted key strategies, systems, and tools originally developed for the Adama HIV clinic, and introduced them into the OPD for use with adult DM patients. A follow-up assessment was conducted after six months. Intervention Package: Strategies Systems Tools Introduction of an “essential package” of key services, supplies, and equipment Appointment and defaulter tracking systems Appointment books Use of step-by-step protocols to guide care Training, clinical mentorship and supportive supervision systems Charting tools, forms and flow sheets Emphasis on family-focused care Peer educator programs Job aids Identification of a limited number of M&E indicators Chart review/quality assessment conducted and used by clinic staff Patient education materials • No new or experimental services were introduced • No new clinic was created – DM patients were seen within OPD as before • No additional support was provided for medications, laboratory testing or transportation, and no new staff were engaged for implementation • No changes were made to service delivery or staffing at the HIV clinic % of charts with service documented Services offered and documented at least once in the past 3 visits (n = 260 patients) 100% 90% 82% 80% 82% 81% 80% 81% 77% 74% 70% 60% 45% 50% 56% 50% 49% 40% 30% 17% 20% 10% 2% 1% 3% 3% 6% 4% 5% 2% 0% Weight Blood pressure Fundoscopic Foot exam Neurologic Oral/dental Assessment DM Next Medication exam exam exam of visual education appointment adherence acuity provided documented assessed Baseline Follow up Six-month outcomes included: • Marked increase in documented service delivery with no added staff; • Expansion of services to include peer education and point-of-service DM screening for patient family members; • Rapid improvement in standards of care.