Implementing noncommunicable disease clinics to improve control of hypertension in Somaliland: an observational study

Introduction: noncommunicable diseases (NCDs) are rising in Somaliland, yet evidence on implementing effective prevention and control in resource-limited settings remains scarce. In 2022, Somaliland launched its first pilot NCD clinic at Hargeisa Group Hospital, modelled after package of essential noncommunicable (PEN-plus) in Rwanda, treating heart failure, hypertension, diabetes, chronic obstructive pulmonary disease (COPD), and asthma. It is staffed by nurses and general practitioners under the supervision of an Internal Medicine specialist and has enrolled over 2000 patients. We evaluate the clinic´s impact on hypertension control to inform improvements and national scale-up. Methods: a quasi-experimental pre-post design with mixed-effect models was used, analyzing data from 2022-2024. The outcome was a change in systolic blood pressure (SBP) and diastolic blood pressure (DBP) from initial to follow-up visits among hypertensive patients with at least one follow-up. Results: three hundred and forty-eight (348) patients (56.6 years and 60% female) were included and had a median follow-up of 3 visits (IQR 3) over 114 days (IQR 185). Baseline mean BP was 148.6/96.0 mmHg (95% CI: 139.0-158.3 / 91.9-100.9). Clinic attendance was associated with a significant reduction in SBP, ranging from 10.3 mmHg (95% CI: -12.8, -7.7) at first follow-up to 17.3 mmHg (95% CI: -23.4, -11.1) at last follow-up; DBP dropped 5.6 mmHg (95% CI: -7.1, -4.1) to 8.0 mmHg (95% CI: -11.6, -4.3). Conclusion: the NCD clinic markedly improved hypertension control. Sustaining this reduction in BP could contribute to reducing the risk of major cardiovascular disease events and overall NCD-related mortality in Somaliland. Lessons from this pilot will guide the national scale-up of NCD clinics in Somaliland.