mAnaging siCkle CELl disease through incReased AdopTion of hydroxyurEa in Nigeria (ACCELERATE)

在尼日利亚通过增加羟基脲的使用来控制镰状细胞病（加速）

• 批准号: 10638598
• 负责人: Obiageli Eunice Nnodu
• 金额: $ 70.84万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-15 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10638598
• 关键词: Address; Adopted; Adoption; Africa; African; Algorithms; Birth; Blood Transfusion; Caring; Cephalic; Clinical; Clinical Trials; Consultations; Counseling; Country; Disease; Disease Management; Education; Educational workshop; Effectiveness; Ensure; Exploration, Preparation, Implementation, and Sustainment; Feedback; Focus Groups; Funding; Ghana; Government; Guidelines; Health; Health Personnel; Health education; Healthcare; Hematologist; Hemoglobinopathies; Hydration status; Infection; Infrastructure; Intervention; Interview; Ions; Knowledge; Mediator; Medicine; Methods; Neonatal Screening; Nigeria; Nigerian; Nurses; Patient-Focused Outcomes; Patients; Persons; Phase; Physicians; Policies; Preparation; Prophylactic treatment; Protocols documentation; Provider; Public Health; Published Comment; Randomized; Research Design; Resource-limited setting; Sickle Cell Anemia; Specialist; Structure; System; Time; Training; United States National Institutes of Health; adverse outcome; clinical research site; clinical training; control trial; dosage; effectiveness evaluation; evidence base; follow-up; health care service organization; health training; hydroxyurea; hypertension control; implementation barriers; implementation design; implementation facilitation; implementation fidelity; implementation process; implementation strategy; improved; low and middle-income countries; mortality; nutrition; patient oriented; patient screening; primary outcome; provider adoption; provider-level barriers; scale up; screening; secondary outcome; systematic review; tailored health care; tool

Project Summary/Abstract Large knowledge gaps remain regarding strategies to promote the adoption of hydroxyurea (HU), particularly in sub-Saharan African countries including Nigeria, where more than 75% of annual sickle cell anemia births occur. The vast majority of people with SCD in Africa do not receive evidenced-based health care (e.g., newborn screening, health education, prophylaxis for infection, optimal nutrition and hydration, blood transfusion, transcranial Doppler screening, and HU therapy), despite its effectiveness in reducing SCD-related adverse outcomes and mortality. The use of HU in SSA is <1% among SCD patients. Our preliminary findings indicate that provider-level barriers are significant and must be addressed to improve HU adoption. To address HU adoption we will use the NIH-funded study (e.g., Realizing Effectiveness Across Continents with Hydroxyurea (REACH) Clinical Trial (NCT01966731)) that developed an evidence-informed, clinical, practical, and easy-to- follow algorithm to 1) Screen patients for sickle cell disease (SCD), 2) Initiate HU treatment, and 3) Maintain HU dosage over time (SIM) for the improved management of SCD as our intervention. The Nigerian government released guidelines supporting the SIM intervention for HU adoption for improved SCD management, and HU is on the list of essential medicines for Nigeria. Our implementation strategy for improving SCD management in Nigeria uses a practical and replicable evidence-based task-sharing strategy, TAsk-Strengthening Strategy for Hemoglobinopathies (TASSH), adopted from our TAsk-Strengthening Strategy for Hypertension control (TASSH) trials in Ghana and Nigeria containing the essential components of i) Training healthcare workers/providers to be more patient-centered in clinical consultations, ii) Clinical reminders, and iii) Practice facilitation (TCP) known as (TASSH TCP) for SCD management. Using a sequential exploratory mixed-methods study design, we will conduct this study using the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework in four sequential phases to assess the effectiveness of SIM adoption by providers in the context of the TASSH TCP implementation strategy in Nigeria.

项目摘要/摘要 在促进采用羟基尿素的战略方面仍然存在巨大的知识差距，特别是在#年。 撒哈拉以南非洲国家，包括尼日利亚，每年75%以上的镰状细胞性贫血出生发生在尼日利亚。 在非洲，绝大多数患有SCD的人没有得到基于证据的医疗保健(例如，新生儿 筛查、健康教育、感染预防、最佳营养和补水、输血、 经颅多普勒筛查和HU疗法)，尽管它在减少SCD相关的不良反应方面有效 结果和死亡率。在SCD患者中，SSA中HU的使用率为1%。我们的初步调查结果表明 提供商级别的障碍非常严重，必须加以解决才能提高HU的采用率。向胡主席致词 采用我们将使用NIH资助的研究(例如，使用羟基尿素实现跨大陆的有效性 (REACH)临床试验(NCT01966731)，开发了一种循证、临床、实用和易于- 遵循算法1)筛查镰状细胞病(SCD)患者，2)启动HU治疗，3)维持HU 剂量随时间(SIM)的改善管理的SCD作为我们的干预。尼日利亚政府 发布了支持SIM干预HU采用以改进SCD管理的指南，HU是 在尼日利亚的基本药物清单上。我们改善SCD管理的实施策略 尼日利亚使用一种实用和可复制的循证任务分担战略，即任务加强战略，用于 从我们的高血压控制任务强化策略中采纳的血红蛋白病(TASSH) (TASSH)在加纳和尼日利亚的试验，包含i)培训医疗保健的基本组成部分 工作人员/提供者在临床咨询中更加以患者为中心，ii)临床提醒，iii)实践 用于SCD管理的便利化(TCP)，称为(TASSH TCP)。使用序贯探索性混合方法 研究设计，我们将通过探索、准备、实施和维持来进行这项研究 (EPIS)框架，分四个顺序阶段，以评估供应商在 在尼日利亚实施TASSH技术合作伙伴关系战略的背景。