Accelerating Delivery of rheumatic heart disease preventive iNterventions in Uganda (ADUNU)

乌干达加速实施风湿性心脏病预防干预措施 (ADUNU)

• 批准号: 10500950
• 负责人: Andrea Zawacki Beaton
• 金额: $ 68.03万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10500950
• 关键词: 15 year old; Adherence; Adopted; Adoption; Antibiotic Prophylaxis; Awareness; Benzathine Penicillin; Cardiac; Cardiovascular Diseases; Cardiovascular system; Caring; Charge; Child; Clinical; Communities; Country; Data; Decentralization; Detection; Diagnosis; Dimensions; Echocardiography; Effectiveness; Endemic Diseases; Enrollment; Evaluation; Evidence based practice; Failure; Foundations; Funding; Goals; Government; Guidelines; HIV; Health; Health Personnel; Health Services Accessibility; Health care facility; Healthcare; Healthcare Systems; Heart; Heart Diseases; Hospital Referrals; Hospitals; Individual; Injections; Institutes; Intervention; Interview; Intramuscular; Investments; Light; Maintenance; Maps; Measures; Methods; Modeling; Nurses; Observational Study; Outcome; Outcomes Research; Patient-Focused Outcomes; Patients; Penicillin G; Persons; Population; Prevalence; Primary Health Care; Prophylactic treatment; Protocols documentation; Provider; Reach Effectiveness Adoption Implementation and Maintenance; Registries; Research; Research Infrastructure; Resolution; Resource-limited setting; Resources; Rheumatic Heart Disease; Running; Secondary Prevention; Service delivery model; Subgroup; System; Technology; Testing; Time; Training; Travel; Uganda; Work; World Health; aged; base; budget impact; community center; community engaged research; community setting; cost; cost effective; cost effectiveness; cost estimate; cost-effectiveness evaluation; design; disease registry; disorder control; evidence base; experience; experimental study; health care delivery; implementation determinants; implementation strategy; improved; innovation; insight; low and middle-income countries; low income country; marginalized population; mathematical model; microcosting; neglect; novel; prevent; prevention service; preventive intervention; program costs; programs; prospective; routine practice; scale up; success; tool; uptake; young adult

Project Summary Abstract Rheumatic heart disease (RHD) is the most commonly acquired heart disease among children and young adults worldwide. Continuous antibiotic prophylaxis (secondary prevention) with monthly intramuscular benzathine penicillin G (BPG) is a cornerstone of RHD control programs and has been used successfully for decades in wealthy countries. Unfortunately, because of neglect in the global and national health agendas, most RHD- endemic countries (like Uganda) have no RHD programs, so most of the estimated 40 million people living with RHD worldwide remain undiagnosed and unprotected from further valvular damage. Considering these challenges, our objective is to partner with the Ugandan government to test a novel community-based program, ADUNU (Acholi for “heart”) that aims to find individuals with RHD and provide secondary prevention close to where they live. The program will be tested in two districts (one demonstration, one replication), building a foundation for national scale-up beyond the proposed research. ADUNU is based on two core, evidence-based technologies, (1) RHD testing using handheld echocardiography in community settings and (2) nurse-led, registry-based delivery of secondary prevention. ADUNU is a non-randomized experiment that will set up a new system in settings where RHD-related healthcare currently does not exist, with the goal of finding new cases and enrolling them in local registries that provide secondary prevention. ADUNU will be integrated with general primary healthcare and track outcomes over time, key factors in sustainability and scalability. In Aim 1, we will evaluate ADUNU using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, mapped to the RHD Care Cascade (an adaptation of the cascade used for HIV). Primary quantitative outcomes in each of RE-AIM’s five dimensions will be supplemented with qualitative data from in-depth interviews and administrative data. In Aim 2, we will evaluate the cost-effectiveness and budget impact of ADUNU in these two districts in order to justify investment and plan for scale-up of the program nationally in Uganda, beyond the proposed study. ADUNU will provide much-needed evidence to government stakeholders in RHD-endemic countries, demonstrating how a pragmatic, community-based strategy can deliver guideline-based care to people living with RHD. It will also provide critical, and currently absent, evidence on the cost-effectiveness, affordability, and sustainability of RHD programs in resource-limited settings.

项目摘要摘要 风湿性心脏病（RHD）是儿童和年轻人中最常见的心脏病 全世界。连续的抗生素预防（二次预防），每月肌内苯甲胺 青霉素G（BPG）是RHD控制程序的基石，数十年来已成功使用 富裕国家。不幸的是，由于全球和国家卫生议程的忽视，大多数RHD- 内在国家（如乌干达）没有RHD计划，因此大多数享受的人中有4000万人 全球RHD在进一步的瓣膜损伤中仍然没有被诊断为未经诊断和未受保护。考虑这些 挑战，我们的目标是与乌干达政府合作，以测试一个基于社区的新型计划， 旨在找到患有RHD的人的Adunu（Acholi） 他们住的地方。该计划将在两个地区进行测试（一个演示，一个复制），建造一个 国家规模扩大的基金会超出了拟议的研究。 Adunu基于两个核心，基于证据的 技术，（1）在社区环境中使用手持超声心动图和（2）护士领导的RHD测试， 基于注册表的二级预防交付。 Adunu是一个非随机实验，将建立一个新的 当前与RHD相关的医疗保健的设置中，系统的目标是寻找新病例和 将它们纳入提供二级预防的当地注册表。 Adunu将与一般整合 随着时间的流逝，主要医疗保健和跟踪结果，可持续性和可扩展性的关键因素。在AIM 1中，我们将 使用覆盖范围，有效性，采用，实施和维护（RE-AIM）评估Adunu 框架，映射到RHD Care Cascade（用于HIV使用的级联反应）。原始定量 Re-Aim的五个维度中的每一个中的结果都将添加到深入的定性数据 访谈和行政数据。在AIM 2中，我们将评估成本效益和预算的影响 为了证明投资并计划在这两个地区的ADUNU，并计划在全国范围内扩大计划的规模 乌干达，超越了拟议的研究。 Adunu将为政府提供急需的证据 RHD式国家的利益相关者，展示了务实的，基于社区的战略 可以为拥有RHD的人提供基于指南的护理。它还将提供关键，目前 缺少RHD计划的成本效益，负担能力和可持续性的证据 资源有限的设置。