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)是儿童和年轻人最常见的获得性心脏病 全世界。持续抗生素预防(二级预防)，每月肌肉注射苯扎辛 青霉素G(BPG)是风湿性心脏病控制程序的基石，几十年来一直在风湿性心脏病的治疗中成功应用 富裕国家。不幸的是，由于全球和国家卫生议程中的忽视，大多数风湿性心脏病- 地方性疾病流行国家(如乌干达)没有风湿性心脏病项目，因此估计有4000万人患有风湿性心脏病 风湿性心脏病在世界范围内仍未得到诊断，也没有针对进一步的瓣膜损伤提供保护。考虑到这些 挑战，我们的目标是与乌干达政府合作，测试一项以社区为基础的新计划， ADUNU(心脏的Acholi)，旨在发现风湿性心脏病患者，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，一个推广)，建立一个 除了拟议的研究之外，还为国家扩大规模提供了基础。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超声心动图进行RHD测试，(2)由护士领导， 以登记为基础提供二级预防。ADUNU是一项非随机实验，它将建立一个新的 目前不存在与风湿性心脏病相关的医疗保健的环境中的系统，目标是发现新病例和 将他们登记在提供二级预防的地方登记处。ADUNU将与General 初级医疗保健并跟踪随时间推移的结果，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REACH、有效性、采用、实施和维护(RE-AIM)评估ADUNU 框架，映射到风湿性心脏病护理级联(用于艾滋病毒的级联的改编)。初级定量 在RE-AIM的五个维度中的每一个方面的结果都将得到来自深入的定性数据的补充 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 在这两个地区的ADUNU，以证明投资的合理性，并计划在#年在全国范围内扩大该计划 乌干达，除了拟议的研究之外。ADUNU将向政府提供急需的证据 风湿病流行国家的利益攸关方，展示了务实的、以社区为基础的战略 可以为风湿性心脏病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 资源受限设置。