Rheumatic Heart Disease Research and Screening in Nepal: A Feasibility Study

尼泊尔风湿性心脏病研究和筛查：可行性研究

• 批准号: 9766434
• 负责人: Rajendra Koju
• 金额: $ 14.53万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-15 至 2021-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9766434
• 关键词: Accounting; Acute; Address; Adherence; Affect; Age; Antigen Mimicry; Area; Attitude; Benzathine Penicillin; Blood Vessels; Cardiac; Cardiovascular Diseases; Cessation of life; Characteristics; Child; Childhood; Clinical; Clinical Services; Country; Data; Disease; Education; Enrollment; Epidemiology; Ethnic Origin; Family; Feasibility Studies; First Degree Relative; Foundations; General Population; Genetic; Health Services; Heart Valves; Heart failure; Hospitals; Immigration; Immune response; Improve Access; Incidence; Income; Individual; Inflammation; Intervention; Intramuscular Injections; Knowledge; Lead; Longevity; Low income; Measures; Mitral Valve; Morbidity - disease rate; Nepal; Outcome; Parents; Participant; Pathogenesis; Patients; Penicillin G; Population; Poverty; Prevalence; Prevention; Prophylactic treatment; Provider; Public Health; Publishing; Recording of previous events; Registries; Research; Resources; Rheumatic Fever; Rheumatic Heart Disease; Risk; Risk Factors; Secondary Prevention; Severities; Siblings; Site; Solid; Streptococcal Infections; Streptococcus pyogenes; System; Time; Uganda; United States; Universities; Washington; Woman; cohort; cost; cost effectiveness; design; disease diagnosis; disease registry; disorder control; experience; heart damage; heart disease risk; improved; low and middle-income countries; mortality; patient registry; prevent; programs; prospective; scale up; screening; screening program; sex; side effect; sociodemographics; transplant centers

PROJECT SUMMARY/ABSTRACT Rheumatic Heart Disease (RHD) remains a significant public health problem in lower and middle-income countries (LMIC), accounting for over 300,000 deaths world-wide. RHD is a sequela of Acute Rheumatic Fever (ARF) caused by Group A Streptococcus (GAS). The Benzathine Penicillin Prophylaxis (BPP), through tri- weekly intramuscular injection of benzathine penicillin G, remains the mainstay of intervention to delay and prevent the sequelae among ARF and RHD patients by preventing repeat GAS infections. Two major obstacles exist to the optimal utilization of this effort. First, despite proven benefits, BPP adherence remains low. Unfortunately, there is very little knowledge on the factors associated with BPP adherence. Even in countries, like Nepal, which has a nation-wide free BPP program serving about 6000 patients, there is absence of a robust system to prospectively track and study these patients. Second, largely because RHD is initially asymptomatic, only a fraction of those who would benefit are enrolled in BPP programs. There is a dearth of information and evidence on potentially high-yield approaches like the screening of first-degree relatives of RHD patients to identify asymptomatic, early-stage RHD patients who may benefit from BPP. We will combine the resources and expertise at the University of Washington with those from our existing partners at two leading Nepali hospitals (Manmohan Cardiothoracic, Vascular and Transplant Center and Dhulikhel Hospital) to first create an easy to use, scalable, comprehensive electronic RHD registry and enroll BPP patients (n=1000) from these sites. In Aim 1, we will examine whether patient socio-demographic, clinical, and health services-related characteristics are associated with BPP adherence. We will use the BPP registry to collect important covariate information and adherence outcomes to address this aim. In Aim 2, we will determine the feasibility of screening first-degree relatives of known RHD patients. We will invite first- degree relatives (n=150) of 50 known RHD patients (enrolled in the BPP registry) for echocardiographic screening for RHD. We will assess the participation rate; time and cost required to complete the screening of each participant; and estimate the prevalence of RHD in these first degree relatives. These are vital preliminary data needed to design a study to determine the efficacy and cost-effectiveness of a screening approach that focuses on first-degree relatives. Our proposal harnesses one of the largest RHD patient pools in the world for establishing a robust RHD-related quality improvement and research platform that serves as a solid foundation for conducting larger epidemiologic, interventional, and implementation studies on RHD risk, prevention, and treatment.

项目总结/摘要 风湿性心脏病（RHD）仍然是中低收入国家的一个重大公共卫生问题。 在低收入国家（LMIC），全世界有30多万人死亡。风湿性心脏病是急性风湿热的后遗症 (ARF)A组链球菌（GAS）。苄星青霉素预防（BPP），通过三- 每周肌肉注射苄星青霉素G，仍然是干预的主要手段， 通过预防反复GAS感染，预防ARF和RHD患者的后遗症。两大 在最佳利用这一努力方面存在障碍。首先，尽管已经证明了BPP的好处， 低不幸的是，有很少的知识与BPP遵守的相关因素。即使在 在一些国家，比如尼泊尔，有一个全国范围的免费BPP项目，为大约6000名患者提供服务， 一个强大的系统来前瞻性地跟踪和研究这些患者。其次，主要是因为RHD最初是 无症状，只有一小部分受益者参加了BPP计划。有一个缺乏 关于潜在的高收益方法的信息和证据，如筛选一级亲属， RHD患者，以确定可能从BPP中获益的无症状早期RHD患者。我们将联合收割机 华盛顿大学的资源和专业知识与我们现有的合作伙伴在两个 尼泊尔主要医院（Manmohan心胸、血管和移植中心以及Dhulikhel医院） 首先创建一个易于使用、可扩展、全面的RHD电子登记系统，并招募BPP患者 （n=1000）。在目标1中，我们将检查患者的社会人口统计学、临床和 健康服务相关特征与BPP依从性相关。我们将使用BPP注册表 收集重要的协变量信息和依从性结果以实现这一目标。在目标2中，我们将 确定筛查已知RHD患者一级亲属的可行性。我们会先邀请- 50例已知RHD患者（入组BPP登记研究）的一级亲属（n=150）进行超声心动图检查 筛查风湿性心脏病我们会评估参与率、完成筛选所需的时间和费用， 每个参与者;并估计RHD在这些一级亲属中的患病率。这些都是至关重要的 设计研究所需的数据，以确定筛选方法的有效性和成本效益， 重点是一级亲属我们的建议利用世界上最大的RHD患者库之一， 建立一个强大的RHD相关质量改进和研究平台，作为坚实的基础 进行更大规模的流行病学、干预性和实施性研究，研究风湿性心脏病的风险、预防和 治疗