P-51: Expanding access to care for type 1 diabetes in Africa: early experience in case-finding from pen-plus
C Whelley, A Adler, C Pfaff, N Abebe, R Bitwayiki, G Ngoga, S Sridhar, M Patino, N Gupta, K Domingues, G Bukhman, A Mocumbi, E Wroe, , PEN-Plus Working GroupAbstract
Introduction
PEN-Plus clinics decentralize type 1 diabetes (T1D) care in resource-constrained settings by integrating care for severe, chronic non-communicable diseases at rural hospitals. In 2022, the NCDI Poverty Network supported the expansion of PEN-Plus clinics from an initial 4 to 10 additional countries across Africa and south Asia.
Objectives
This study investigates the enrolment and referral sources over time for patients with T1D enrolled to a subset of new PEN-Plus clinics.
Methods
Routine patient data was collected from 16 newly operational PEN-Plus clinics in district hospitals in predominantly rural areas in 8 countries from 2022 to 2024: Ethiopia (2), Kenya (2), Mozambique (1), Sierra Leone (2), Tanzania (2), Uganda (2), Zambia (2), and Zimbabwe (3). All care was provided at no cost. Data was collected from paper or electronic records and entered into Redcap. Descriptive results are reported.
Results
A total of 1,009 patients with T1D were enrolled across 16 clinics from May 2022 to December 2024. New enrolment peaked in the first 3 months (range 55-94) and stabilized over the first year (mean 35/month; range 17-64). Referrals came from outpatient clinics (52%), inpatient or emergency rooms (17%), primary care (10%), community (9%), and self-referral (8%). Over the first year, the proportion of emergency or inpatient referrals increased from 7% in the first quarter to 16% thereafter; however, absolute numbers stayed consistent while other sources declined.
Conclusions
We describe T1D enrolment at PEN-Plus clinics in Africa. The early peak suggests some may know their diagnosis but need a medical home. The ongoing steady enrolment indicates that people are living undiagnosed with T1D. Multi-pronged case-finding approaches are needed to target different referral sources. In our experience, connecting PEN-Plus teams to these efforts is paramount. The high proportion of continued acute referrals may represent diabetic ketoacidosis (DKA), which has important implications for training, mentorship, and supplies.