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 关于促进采用羟基脲（HU）的策略，仍然存在很大的知识差距，特别是 撒哈拉以南非洲国家在内，包括尼日利亚，每年有75％的镰状细胞性贫血出生发生。 非洲SCD的绝大多数人都没有获得基于证据的医疗保健（例如，新生儿 筛查，健康教育，预防感染，最佳营养和补水，输血， 尽管具有颅内多普勒筛查和HU疗法），尽管它有效减少了SCD相关的不良反应 结果和死亡率。在SCD患者中，在SSA中使用HU <1％。我们的初步发现表明 提供者级别的障碍很大，必须解决以改善HU采用。解决Hu 采用我们将使用NIH资助的研究（例如，实现羟基脲的有效性 （触及）临床试验（NCT01966731）），该试验开发了证据，临床，实用且易于 - 遵循算法至1）筛查患者镰状细胞疾病（SCD），2）启动HU治疗，3）维持HU 随着时间的推移（SIM）剂量改善了SCD的管理作为我们的干预。尼日利亚政府 已发布了支持HU采用的SIM DYSERION的指南，以改善SCD管理，Hu是 在尼日利亚必需药物的清单上。我们改善SCD管理的实施策略 尼日利亚使用实用且可复制的基于证据的任务共享策略，完成任务加密策略 血红蛋白病（TASSH），从我们的任务强度加长进行高血压控制中采用 （TASSH）在加纳和尼日利亚的试验，其中包含I）培训医疗保健的基本组成部分 工人/提供者在临床咨询中以患者为中心，ii）临床提醒和iii）实践 SCD管理的促进（TCP）称为（TASSH TCP）。使用顺序探索性混合方法 研究设计，我们将使用探索，准备，实施和维持来进行这项研究 （EPIP）在四个顺序阶段中的框架，以评估提供商在 尼日利亚TASSH TCP实施战略的背景。