Chronic Disease Conditions Research Articles

Disease Burden Affects Aging Brain Function.

Most older adults live with multiple chronic disease conditions, yet the effect of multiple diseases on brain function remains unclear. We examine the relationship between disease multimorbidity and brain activity using regional cerebral blood flow (rCBF) 15O-water PET scans from 97 cognitively normal participants (mean baseline age 76.5) in the Baltimore Longitudinal Study of Aging (BLSA). Multimorbidity index scores, generated from the presence of 13 health conditions, were correlated with PET data at baseline and in longitudinal change (n = 74) over 5.05 (2.74 SD) years. At baseline, voxel-based analysis showed that higher multimorbidity scores were associated with lower relative activity in orbitofrontal, superior frontal, temporal pole and parahippocampal regions, and greater activity in lateral temporal, occipital, and cerebellar regions. Examination of the individual health conditions comprising the index score showed hypertension and chronic kidney disease individually contributed to the overall multimorbidity pattern of altered activity. Longitudinally, both increases and decreases in activity were seen in relation to increasing multimorbidity over time. These associations were identified in orbitofrontal, lateral temporal, brainstem, and cerebellar areas. Together, these results show that greater multimorbidity is associated with widespread areas of altered brain activity, supporting a link between health and changes in aging brain function.

AN OPEN-LABEL CLINICAL TRIAL TO PROVE THE EFFICACY OF HIRUDOTHERAPY IN REDUCING THE INCREASED INTRA-OCULAR PRESSURE IN GLAUCOMA

Glaucoma is a chronic disease condition prevalent globally leading to blindness. It results in optic neuropathy which is very difficult to manage. An increase in intraocular pressure is a cardinal feature in most cases. This study aims at lowering the intraocular pressure by leech therapy, which is a conventional treatment method described in Ayur- veda. Leech therapy was conducted in the selected patients and intraocular pressure before and after treatment were recorded. The study showed clinically and statistically significant changes in the intraocular pressure. Keywords: Leech therapy, glaucoma, intraocular pressure

Chronic Kidney Disease Prediction using Machine Learning Algorithms

Kidney diseases are increasing day by day among people. It is becoming a major health issue around the world. Not maintaining proper food habits and drinking less amount of water are one of the major reasons that contribute this condition. With this, it has become necessary to build up a system to foresee Chronic Kidney Diseases precisely. Here, we have proposed an approach for real time kidney disease prediction. Our aim is to find the best and efficient machine learning (ML) application that can effectively recognize and predict the condition of chronic kidney disease. We have used the data from UCI machine learning repository. In this work, five important machine learning classification techniques were considered for predicting chronic kidney disease which are KNN, Logistic Regression, Random Forest Classifier, SVM and Decision Tree Classifier. In this process, the data has been divided into two sections. In one section train dataset got trained and another section got evaluated by test dataset. The analysis results show that Decision Tree Classifier and Logistic Regression algorithms achieved highest performance than the other classifiers, obtaining the accuracy of 98.75% followed by random Forest, which stands at 97.5%.

Chronic Kidney Disease Prediction using Machine Learning Algorithms

Kidney diseases are increasing day by day among people. It is becoming a major health issue around the world. Not maintaining proper food habits and drinking less amount of water are one of the major reasons that contribute this condition. With this, it has become necessary to build up a system to foresee Chronic Kidney Diseases precisely. Here, we have proposed an approach for real time kidney disease prediction. Our aim is to find the best and efficient machine learning (ML) application that can effectively recognize and predict the condition of chronic kidney disease. We have used the data from UCI machine learning repository. In this work, five important machine learning classification techniques were considered for predicting chronic kidney disease which are KNN, Logistic Regression, Random Forest Classifier, SVM and Decision Tree Classifier. In this process, the data has been divided into two sections. In one section train dataset got trained and another section got evaluated by test dataset. The analysis results show that Decision Tree Classifier and Logistic Regression algorithms achieved highest performance than the other classifiers, obtaining the accuracy of 98.75% followed by random Forest, which stands at 97.5%.

Significance of hyperuricemia on the early diagnosis of disease severity in sepsis

Serum uric acid levels are an ideal marker in sepsis cases to assess oxidative stress and to predict disease prognosis. Elevated serum uric acid levels are associated with chronic disease conditions such as chronic kidney disease (CKD), cardiovascular disease (CVD). The present study was designed to assess the correlation between Hyperuricemia and mortality and morbidity in cases with clinically diagnosed sepsis. A total of 94 cases with a working diagnosis of sepsis above 18 years of age were recruited. The duration of hospital stay, mechanical ventilation, acute respiratory syndrome and acute kidney injury was noted. Patient discharge or death was considered an outcome of the sepsis. The most prevalent comorbidity was type 2 diabetes (44.68%), followed by type 1 diabetes (8.5%), type 2 diabetes with systemic hypertension (4.25%), chronic kidney disease (3.19%), cerebrovascular accident (3.19%), severe pulmonary disease (2.12%) and malignancy (2.12%). 59% cases had uric acid levels 7mg/dl. The comparison of uric acid levels with comorbidities (p=0.022), duration of hospital stay (p=0.003) and associated complications (p=0.003) was statistically significant. Hyperuricemia on patient arrival to the MICU with sepsis was associated with poor clinical outcome. High mortality rate was associated in cases with elevated uric acid levels.

Role of Pharmacists in the Interprofessional Care Team for Patients with Chronic Diseases.

Chronic diseases are a major health problem and cause of death worldwide. Patients with chronic diseases should be managed by an interprofessional care team consisting of general practitioners, medical specialists, nurses, and pharmacists. However, the roles of pharmacists in this interprofessional care team have not been fully explored. This study, therefore, examined their roles as members of the interprofessional care team in managing patients with chronic diseases. A search in PubMed, Google Scholar, EBSCO, Scopus, and Cochrane Library databases was conducted for research articles that discussed pharmacists, interprofessional healthcare, and chronic diseases. From initial 420 identified articles, a total of 27 articles were included in this study. The interprofessional healthcare team should have a sense of tolerance and belonging among its members, which is reflected in five dimensions: partnership, coordination, cooperation, decision-making, and therapeutic outcomes. The five dimensions are closely related because they support each other in the success of the therapy. The presence of pharmacists in an interprofessional healthcare team has been proven to help facilitate access to primary care and improve patient outcomes. Pharmacists can assist in managing chronic disease conditions by providing drug information to patients and other healthcare providers and by acting as a consultant for treatment-related issues. The pharmacist’s role as part of an interprofessional care team reinforces the importance of a collaborative healthcare team in providing clinical services to patients with chronic diseases.

The Relationship between Fulfilling Privacy Needs and Service Satisfaction in Adolescents with Chronic Illness Conditions in the Inpatient Room

Privacy needs for adolescents with chronic disease conditions are important, including secure information, psychological information, and social privacy. Violations against privacy will bring discomfort, stress, and dissatisfaction. Patients' satisfaction is one of the most important indicators that show the quality of ward services that include the dimensions of tangibility, reliability, responsiveness, assurance, and empathy. This study was conducted to analyze the relationship between the fulfillment of privacy needs and service satisfaction in adolescents with hospitalized chronic conditions. This correlational study was conducted using a cross-sectional approach. Samples were 72 adolescents aged 12-21 years with chronic disease conditions were selected using the consecutive sampling method. Data of this study were collected using questionnaires. Bivariate data analysis was performed using chi-square analysis. The results showed that the most unfulfilled need for privacy security was information privacy (70.8%), followed by psychological privacy (63.9%), physical privacy (58.3%), and the least unfulfilled one was social privacy (51.4%). Respondents were most dissatisfied with the dimension of empathy (87.5%), followed by assurance (84.7%), reliability (83.3%), tangibility (80.6%), and responsiveness (76.4%). This study also confirmed a meaningful relationship between service satisfaction with information privacy (p-value 0.001) and physical privacy (p-value 0.021 0.05). Whereas service satisfaction is associated with neither psychological privacy nor social privacy. The role of nurses is very important in carrying out patient-centered care, especially in meeting the privacy needs to achieve service satisfaction for adolescents with chronic disease conditions.

Health Related Quality of life of Diabetic and Non-Diabetic Elderly in a Municipality of Central Nepal

Background: Quality of life (QoL) is the perception of an individual about their position in life. Chronic diseases such as diabetes are said to have influence on QoL. Health condition changes with increased age and chronic disease condition. This study aimed to assess Health-Related QoL of diabetic and non-diabetic elderly.
 Method: A community based cross-sectional study was conducted among 167 elderly in Gaindakot municipality of Nawalpur, Nepal. Health related QoL was assessed using World Health Organization QoL Instrument scale. Data was analyzed using descriptive as well as inferential statistics.
 Results: Among the diabetic respondents, highest mean score was obtained in social relationship (68.76), whereas environmental health (69.02) holds highest mean score among non-diabetic. Non-diabetics were in better position in terms of both psychological (63.23 vs 55.77) and physical health (62.23 vs 57.15) than diabetics. Overall QoL and overall health perception were found to be significantly correlated with all domains of QoL at (p<0.05) and (p<0.01) respectively among diabetics. Age group, gender, educational status, marital status and employment status were found to be statistically associated with different domains of QoL in both groups but caste, family type smoking and alcohol intake didn’t show any association with any of the domain of QoL in both groups.
 Conclusion: Three domains of Health Related QoL (physical, psychological and environmental health) except social relationship were better among non-diabetic compared to that of diabetic respondents. Preventing diabetes and focusing on physical, psychological and environmental health of diabetics are required for a healthy elderly life.

Design and Development of Mechanical Ventilator

Respiratory diseases and injury-induced respiratory failure constitute a significant public healthiness in both developed and fewer developed countries. Asthma, chronic obstructive pulmonary disease and other chronic respiratory conditions are spread globally. These conditions are exacerbated by pollution , smoking, and burning of biomass for fuel, all of which are on the rise in developing countries1,2 Patients with underlying lung disease may develop respiratory failure under a selection of challenges and should be supported mechanical ventilation. These are machines which mechanically assist patients inspire and exhale, allowing the exchange of oxygen and CO2 to occur within the lungs, a process mentioned as procedure. Design and prototyping of a inexpensive portable mechanical ventilator to be utilized in mass casualty cases and resource-poor environments. The ventilator delivers breaths by compressing a typical bag-valve mask (BVM) with a pivoting cam arm, eliminating the need for an individual's operator for the BVM. Now a days, COVID-19 is one among the main issue goes on, and during this disease ventilator is plays the important role. during this project report, we've focused on to style and development of semi-automatic low cost mechanical ventilator.

Recent trends in stem cell-based therapies and applications of artificial intelligence in regenerative medicine.

Stem cells are undifferentiated cells that can self-renew and differentiate into diverse types of mature and functional cells while maintaining their original identity. This profound potential of stem cells has been thoroughly investigated for its significance in regenerative medicine and has laid the foundation for cell-based therapies. Regenerative medicine is rapidly progressing in healthcare with the prospect of repair and restoration of specific organs or tissue injuries or chronic disease conditions where the body’s regenerative process is not sufficient to heal. In this review, the recent advances in stem cell-based therapies in regenerative medicine are discussed, emphasizing mesenchymal stem cell-based therapies as these cells have been extensively studied for clinical use. Recent applications of artificial intelligence algorithms in stem cell-based therapies, their limitation, and future prospects are highlighted.

Comorbid conditions at chronic obstructive pulmonary disease: the questions under investigation and discussion

The second part of the review examines in detail the questions of diagnostics and peculiarities of the metabolic syndrome manifestations, which presents the link between most comorbid conditions at patients with chronic obstructive pulmonary disease. The metabolic syndrome is based on the insulin resistance and compensatory hyperinsulinemia, caused by both chronic low‑intensity inflammation and increased adipose tissue, often against the background of aggravated heredity at diabetes mellitus. The authors elucidate aspects of the effects of obesity, cachexia and some endocrine disorders on the disease course. The deficiency of researches on endocrine status, especially thyroid function and related metabolic disorders was emphasized. Possible pathogenetic mechanisms of osteoporosis development in this contingent of patients are considered. The need for further research of the pathogenetic role of vitamin D is discussed. Data on the role of the functional state of kidneys in the development of metabolic disorders in an organism have been presented, though kidney pathology in patients with chronic obstructive pulmonary disease is not currently considered as a comorbid condition. The contradictory literature data on the development of anemia in these patients were analysed. The authors presented data on the development of oncological processes as a systemic manifestation at COPD and performed analysis of common and mutually aggravating mechanisms of the development of these pathological conditions. Attention has been paid to the relationship between gastroesophageal reflux disease, bronchiectasis and obstructive sleep apnea with chronic obstructive pulmonary disease. The prospects of modern genetic research in chronic obstructive pulmonary disease and comorbid conditions have been determined.

Prevalence and Types of Sexual Dysfunction Among Female Medical Students

Background: Sexuality is a complex phenomenon that is being influenced by psychological, nutritional as well as physiological factors. Its dysfunction includes desire, arousal, orgasmic and sex pain disorders. The present study aimed to assess the prevalence of sexual dysfunction (SD) and risk factors in a cohort of both married and unmarried female students in UDS-Tamale. Methods: The Golombok Rust Inventory of Sexual Satisfaction (GRISS) was administered to 150 female students independent of age (mean±SD: single (24.1 ± 2.0) and married (29.6 ± 5.2)) domiciled in UDS-Tamale campus. Results: Out of a total of 150 questionnaires administered. 93 (62.0%) females returned the questionnaires, and 79 were complete and evaluable questionnaires. This represents 52.7% response rate. From this study, the age ranges as well as the mean (SD) of the age of the participants are 20 to 42 and 27.0 ± 4.8 years respectively. The mean duration of marriage is 4.6 ± 3.4 years. Majority of the studied participants are non-smokers (97.5%), do not consumed alcoholic beverages (67.1%), do not have any chronic disease (69.6%) and do not also have any family history of any chronic disease condition (55.7%). The mean income level, BMI as well as WHR are Ghc 590.1 ±406.9, 25.6 ± 3.5 kg m-2 and 0.8 ± 0.1 respectively. The prevalence of sexual dysfunction among the single respondent was 67.6%. The most prevalent areas of difficulties were: infrequency 81.1%, Avoidance 64.9%, non-communication 64.9%, dissatisfaction 64.9%, anorgasmia 62.2%, non-sensuality 56.8% and vaginismus 56.8%. The prevalence of sexual dysfunction among the married respondent was 54.8%. Sexual dysfunction is high in both single female (67.9%) and married female (54.8%) medical students in the study. Conclusion: Married females in the study were more obese than single females, and the married-obese group was associated with high sexual dysfunction. Notwithstanding this however, the single-normal females had more sexual dysfunction compared to the married-normal females. The SD in the females appear to be contributed mostly by infrequency and avoidance in the single female group, whereas by dissatisfaction and infrequency in the married female group.

Multimodality imaging of myocardial viability: an expert consensus document from the European Association of Cardiovascular Imaging (EACVI).

In clinical decision making, myocardial viability is defined as myocardium in acute or chronic coronary artery disease and other conditions with contractile dysfunction but maintained metabolic and electrical function, having the potential to improve dysfunction upon revascularization or other therapy. Several pathophysiological conditions may coexist to explain this phenomenon. Cardiac imaging may allow identification of myocardial viability through different principles, with the purpose of prediction of therapeutic response and selection for treatment. This expert consensus document reviews current insight into the underlying pathophysiology and available methods for assessing viability. In particular the document reviews contemporary viability imaging techniques, including stress echocardiography, single photon emission computed tomography, positron emission tomography, cardiovascular magnetic resonance, and computed tomography and provides clinical recommendations for how to standardize these methods in terms of acquisition and interpretation. Finally, it presents clinical scenarios where viability assessment is clinically useful.

Objectively measured chronic disease risk among food pantry patrons.

This cross-sectional, observational study examined the prevalence of objectively measured chronic disease risk factors among a diverse group of food pantry patrons. Public health nurses performed biometric screenings in community settings for 1,685 unduplicated adults attending food pantries. Over three fourths of participants (81.1%) were overweight or obese. High cholesterol and high blood pressure were detected in 38.4% and 37.7% of participants, respectively. Over half (58%) of the participants were referred to a local community health clinic for follow-up services. Interventions should target food pantry patrons to reduce the prevalence of chronic disease conditions among this vulnerable population.

Decreasing perceived risk associated with regular cannabis use among older adults in the United States from 2015 to 2019.

Cannabis use among older adults is increasing sharply in the United States. While the risks and benefits of cannabis use remain unclear, it is important to monitor risk factors for use, including low perception of harm. The objective of this study was to estimate recent national trends in perceived risk associated with cannabis use among older adults. Trend analysis. A total of 18,794 adults aged 65 and older participating in the 2015-2019 National Survey on Drug Use and Health, a cross-sectional nationally representative survey of non-institutionalized individuals in the United States. We estimated the prevalence of older adults who believe that people who smoke cannabis once or twice a week are at great risk of harming themselves physically and in other ways. This was examined across cohort years and stratified by demographic characteristics, diagnosis of chronic disease, past-month tobacco and binge alcohol use, and all-cause emergency department use. Between 2015 and 2019, perceived risk associated with regular use decreased from 52.6% to 42.7%, an 18.8% relative decrease (p < 0.001). Decreases in perceived risk were detected in particular among those never married (a 32.6% relative decrease), those who binge drink (a 31.3% relative decrease), use tobacco (a 26.8% relative decrease), have kidney disease (a 32.1% relative decrease), asthma (a 31.7% relative decrease), heart disease (a 16.5% relative decrease), chronic obstructive pulmonary disease (a 21.5% relative decrease), two or more chronic conditions (a 20.2% relative decrease), and among those reporting past-year emergency department use (a 21.0% relative decrease) (ps < 0.05). The perceived risk of regular cannabis use is decreasing among older adults. We detected sharp decreases in risk perception among those with chronic disease and high-risk behaviors, including tobacco and binge alcohol use. As the number of older adults who use cannabis increases, efforts are needed to raise awareness of the possible adverse effects with special emphasis on vulnerable groups.

Personalized intervention cardiology with transcatheter aortic valve replacement made possible with a non-invasive monitoring and diagnostic framework

One of the most common acute and chronic cardiovascular disease conditions is aortic stenosis, a disease in which the aortic valve is damaged and can no longer function properly. Moreover, aortic stenosis commonly exists in combination with other conditions causing so many patients suffer from the most general and fundamentally challenging condition: complex valvular, ventricular and vascular disease (C3VD). Transcatheter aortic valve replacement (TAVR) is a new less invasive intervention and is a growing alternative for patients with aortic stenosis. Although blood flow quantification is critical for accurate and early diagnosis of C3VD in both pre and post-TAVR, proper diagnostic methods are still lacking because the fluid-dynamics methods that can be used as engines of new diagnostic tools are not well developed yet. Despite remarkable advances in medical imaging, imaging on its own is not enough to quantify the blood flow effectively. Moreover, understanding of C3VD in both pre and post-TAVR and its progression has been hindered by the absence of a proper non-invasive tool for the assessment of the cardiovascular function. To enable the development of new non-invasive diagnostic methods, we developed an innovative image-based patient-specific computational fluid dynamics framework for patients with C3VD who undergo TAVR to quantify metrics of: (1) global circulatory function; (2) global cardiac function as well as (3) local cardiac fluid dynamics. This framework is based on an innovative non-invasive Doppler-based patient-specific lumped-parameter algorithm and a 3-D strongly-coupled fluid-solid interaction. We validated the framework against clinical cardiac catheterization and Doppler echocardiographic measurements and demonstrated its diagnostic utility by providing novel analyses and interpretations of clinical data in eleven C3VD patients in pre and post-TAVR status. Our findings position this framework as a promising new non-invasive diagnostic tool that can provide blood flow metrics while posing no risk to the patient. The diagnostic information, that the framework can provide, is vitally needed to improve clinical outcomes, to assess patient risk and to plan treatment.

Clinical trial of autologous adipose tissue-derived regenerative (stem) cells therapy for exploration of its safety and efficacy.

IntroductionLiver cirrhosis is the ultimate condition of chronic liver diseases. Non-alcoholic steatohepatitis and fatty liver diseases are emerging in association with metabolic syndrome largely due to excess nutrition. Stromal cells of adipose tissue are enriched mesenchymal stem cells which are pluripotent and immunomodulatory, which are expected to be applied for repairing/regenerative therapy of the impaired organs.MethodsWe conducted the multi-institutional clinical trial (Japanese UMIN Clinical Trial Registry: UMIN000022601) of cell therapy using freshly isolated autologous adipose tissue-derived regenerative (stem) cells (ADRCs), which are obtained by the investigational trial device, adipose tissue dissociation device, for liver cirrhosis patients due to non-alcoholic steatohepatitis or fatty liver disease, to exploratory assess efficacy as well as safety of this trial. We completed treatment and 24 weeks follow-up for 7 patients.ResultsWe observed that 6 out of 7 patients' serum albumin concentration was improved. As for prothrombin activity, 5 out of 7 patients showed improvement. No trial-related adverse events, which were serious or non-serious, was observed. Besides, no malfunction of the investigational trial device was encountered.ConclusionThus, treatment with autologous ADRCs obtained with the investigational trial device in steatohepatitis-related cirrhosis was confirmed to be safely conductible and potentially promising for the retaining or improving the impaired hepatic reserve.

Gene Cascade Shift and Pathway Enrichment in Rat Kidney Induced by Acarbose Through Comparative Analysis.

Acarbose is an effective anti-diabetic drug to treat type 2 diabetes mellitus (T2DM), a chronic degenerative metabolic disease caused by insulin resistance. The beneficial effects of acarbose on blood sugar control in T2DM patients have been confirmed by many studies. However, the effect of acarbose on patient kidney has yet to be fully elucidated. In this study, we report in detail the gene expression cascade shift, pathway and module enrichment, and interrelation network in acarbose-treated Rattus norvegicus kidneys based on the in-depth analysis of the GSE59913 microarray dataset. The significantly differentially expressed genes (DEGs) in the kidneys of acarbose-treated rats were initially screened out by comparative analysis. The enriched pathways for Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were further identified. The protein-protein interaction (PPI) analysis for DEGs was achieved through the STRING database mining. Pathway interrelation and hub genes for enriched pathways were further examined to uncover key biological effects of acarbose. Results revealed 44 significantly up-regulated genes and 86 significantly down-regulated genes (130 significant differential genes in total) in acarbose-treated rat kidneys. Lipid metabolism pathways were considerably improved by acarbose, and the physical conditions in chronic kidney disease (CKD) patients were improved possibly through the increase of the level of high-density lipoprotein (HDL) by lecithin-cholesterol acyl-transferase (LCAT). These findings suggested that acarbose may serve as an ideal drug for CKD patients, since it not only protects the kidney, but also may relieve the complications caused by CKD.

Clinical Picture, Outcome, and Risk of Serious Bacterial Infections in Immunocompetent Previously Healthy Neutropenic Children

Abstract Objective In childhood, the cause of neutropenia is a challenging diagnosis with a spectrum of underlying etiologies. This study was performed to investigate the clinical picture and the outcomes associated with the new onset neutropenia in previously healthy children, and to determine the risk of serious bacterial infection (SBI) in those patients. Methods Patients presenting between January 2018 and September 2018 with an absolute neutrophil count (ANC) &lt;1,500/μL were retrospectively evaluated. Patients with known underlying chronic disease or immunosuppressive conditions were excluded. Neutropenia was categorized into three groups: mild, 1,000–1,500/μL; moderate, 500 to &lt;1,000/μL; and severe &lt;500/μL. Results A total of 423 patients were investigated. There were 156 (36.9%), 193 (45.6%), and 74 (17.5%) patients in the mild, moderate, and severe groups, respectively. Bacteremia was detected in one (0.02%) patient and SBI in 21 (4.9%) patients. No significant correlation was found between the incidence of SBI and bacterial infection rate among different age groups (p &gt; 0.05). The incidence of SBI varied significantly according to the severity of the neutropenia (p = 0.012) and as the neutropenia became more severe, the incidence of SBI increased (p = 0.015). Conclusion The clinical outcome of neutropenia in previously healthy and immunocompetent children is generally good with a relatively low incidence of SBI. We suggest that aggressive therapy and frequent follow-up should be reserved for previously healthy neutropenic children with SBI.

Expansion of a national differentiated service delivery model to support people living with HIV and other chronic conditions in South Africa: a descriptive analysis

BackgroundSouth Africa is home to 7.7 million people living with HIV and supports the largest antiretroviral therapy (ART) program worldwide. Despite global investment in HIV service delivery and the parallel challenge of non-communicable diseases (NCDs), there are few examples of integrated programs addressing both HIV and NCDs through differentiated service delivery. In 2014, the National Department of Health (NDoH) of South Africa launched the Central Chronic Medicines Dispensing and Distribution (CCMDD) program to provide patients who have chronic diseases, including HIV, with alternative access to medications via community-based pick-up points. This study describes the expansion of CCMDD toward national scale.MethodsYale monitors CCMDD expansion as part of its mixed methods evaluation of Project Last Mile, a national technical support partner for CCMDD since 2016. From March 2016 through October 2019, cumulative weekly data on CCMDD uptake [patients enrolled, facilities registered, pick-up points contracted], type of medication provided [ART only; NCD only; and ART-NCD] and collection sites preferred by patients [external pick-up points; adherence/outreach clubs; or facility-based fast lanes], were extracted for descriptive, longitudinal analysis.ResultsAs of October 2019, 3,436 health facilities were registered with CCMDD across 46 health districts (88 % of South Africa’s districts), and 2,037 external pick-up points had been contracted by the NDoH. A total of 2,069,039 patients were actively serviced through CCMDD, a significant increase since 2018 (p < 0.001), including 76 % collecting ART [64 % ART only, 12 % ART plus NCD/comorbidities] and 479,120 [24 %] collecting medications for chronic diseases only. Further, 734,005 (35 %) of patients were collecting from contracted, external pick-up points, a 73 % increase in patient volume from 2018.DiscussionThis longitudinal description of CCMDD provides an example of growth of a national differentiated service delivery model that integrates management of HIV and noncommunicable diseases. This study demonstrates the success of the program in engaging patients irrespective of their chronic condition, which bodes well for the potential of the program to address the rising burden of both HIV and NCDs in South Africa.ConclusionsThe CCMDD program expansion signals the potential for a differentiated service delivery strategy in resource-limited settings that can be agnostic of the patients chronic disease condition.