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

项目摘要 风湿性心脏病（RHD）是儿童和年轻人中最常见的心脏病 国际吧持续抗生素预防（二级预防），每月肌肉注射苄星青霉素 青霉素G（BPG）是风湿性心脏病控制计划的基石，几十年来已成功地用于 富裕的国家。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4000万人中的大多数人生活在 全球范围内的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，测试一个新的基于社区的计划， ADUNU（Acholi，意为“心脏”），旨在发现RHD患者，并提供接近 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 为国家扩大拟议研究范围奠定基础。ADUNU基于两个核心，以证据为基础 技术，（1）在社区环境中使用手持式超声心动图进行RHD测试，（2）护士引导， 以登记册为基础提供二级预防。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， 将他们登记在提供二级预防的当地登记处。ADUNU将与一般 初级保健和跟踪结果随着时间的推移，可持续性和可扩展性的关键因素。在目标1中，我们 使用覆盖、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（用于艾滋病毒的级联的适应）。初级定量 RE-AIM的五个维度中的每一个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，我们将评估以下方面的成本效益和预算影响： 为了证明投资的合理性，并计划在全国范围内扩大该方案的规模， 乌干达，超出拟议的研究。ADUNU将向政府提供急需的证据 在RHD流行国家的利益相关者，展示了一个务实的，基于社区的战略， 可以为RHD患者提供基于指南的护理。它还将提供关键的，目前 缺乏关于RHD计划的成本效益、可负担性和可持续性的证据， 资源有限的环境。

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.