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.

项目概要 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。每月肌注苄星霉素进行持续抗生素预防（二级预防） 青霉素 G (BPG) 是 RHD 控制计划的基石，已在以下领域成功使用了数十年： 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- 流行国家（如乌干达）没有 RHD 计划，因此估计有 4000 万患有该病的人中的大多数 世界范围内的 RHD 仍未得到诊断，也未受到进一步瓣膜损伤的保护。考虑到这些 挑战，我们的目标是与乌干达政府合作测试一项新颖的基于社区的计划， ADUNU（Acholi 意为“心脏”）旨在寻找 RHD 患者并在附近提供二级预防 他们住的地方。该计划将在两个地区进行测试（一个示范，一个复制），建立一个 为超出拟议研究范围的国家推广奠定基础。 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式超声心动图进行 RHD 测试，以及 (2) 由护士主导， 基于登记的二级预防。 ADUNU 是一项非随机实验，将建立一个新的 在目前不存在 RHD 相关医疗保健的环境中建立系统，目的是发现新病例并 将他们登记到提供二级预防的当地登记处。 ADUNU 将与通用集成 初级医疗保健并跟踪一段时间内的结果，这是可持续性和可扩展性的关键因素。在目标 1 中，我们将 使用范围、有效性、采用、实施和维护 (RE-AIM) 评估 ADUNU 框架，映射到 RHD 护理级联（针对 HIV 的级联的改编）。初级定量 RE-AIM 五个维度中每个维度的结果都将得到来自深入研究的定性数据的补充 访谈和行政数据。在目标 2 中，我们将评估成本效益和预算影响 ADUNU 在这两个地区进行投资，并计划在全国范围内扩大该计划 乌干达，超出了拟议的研究范围。 ADUNU 将向政府提供急需的证据 RHD 流行国家的利益相关者展示了务实的、基于社区的战略如何 可以为 RHD 患者提供基于指南的护理。它还将提供关键的、当前的 缺乏有关 RHD 计划的成本效益、可负担性和可持续性的证据 资源有限的设置。