Decentralized care in Punjab

Decentralized care delivery and linkages for enhanced diagnosis and
treatment of Hepatitis C in six selected districts of Punjab

DURATION: 18 months The Hepatitis Fund
GEOGRAPHIC REACH: Punjab, Pakistan
STARTING DATE: 1st September 2020
PARTNER: Association for Social Development (ASD)



This project aims to develop, pilot and evaluate integrated hepatitis C care-package at 51 rural health centers (RHCs) in six high burden districts of Punjab. The project aims to achieve universal coverage of hepatitis C care in the entire region of Punjab by catalyzing evidence based scale-up in the remaining 30 districts of Punjab.

Punjab province has 36 districts and a population of around 110 million. The sero-prevalence of hepatitis C infection is exceptionally high at 8.9%. The project will pilot and evaluate integrated hepatitis C care at RHCs in the six highest-prevalence districts of Punjab. 12.5 million people live in these six districts, of which around 75% are living in rural areas. All 22 district and sub-district hospitals are in urban settings, so program-supported hepatitis care at these hospitals is relatively inaccessible to most rural inhabitants, especially women and disadvantaged groups. In these districts 51 RHCs are the main source of general health care for more than 9.5 million rural inhabitants.

The project will contextualize and evaluate an existing hospital based integrated and scalable intervention for delivering hepatitis C testing and treatment across all public primary care RHCs in six selected high-prevalence districts of Punjab, Pakistan.

A care package will be adapted for managing integrated hepatitis care at RHCs.

All 51 RHCs in the six selected districts will be enabled for delivering integrated hepatitis-C care in a region where 9.5 million people live.

At least 40,000 individuals will be screened with a rapid diagnostic test
10,000 of those reactive on rapid testing will receive PCR complementary testing at a designated laboratory.

4,000 confirmed cases will be registered and treated for hepatitis.

Treated cases will be re-tested after 12 weeks of completed treatment and 85% or more will be cured.

Process evaluation and costing studies will be conducted with data from the 51 project RHCs. Evidence of effectiveness and feasibility of the integrated care-package will be generated to inform the scaling-up of decentralized integrated care delivery package.

The results and the products will be shared with potential stakeholders within and outside Pakistan for potential application of the pilot model to other settings.

This intervention will achieve universal coverage of hepatitis C care in the whole of Punjab and possibly three other provinces within the country. The proposed project will not only develop a contextualized hepatitis care intervention but also generate evidence to inform program planning and decision-making for scaling hepatitis care in all RHCs of Punjab.

The continued engagement of the Punjab Hepatitis Control Program and the district health authorities will ensure that the intervention design remains sensitive to contextual realities and that the evidence is owned and used by the local public health authorities.

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