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

项目总结/摘要 在促进采用羟基脲（HU）的战略方面，特别是在以下方面，仍然存在巨大的知识差距： 包括尼日利亚在内的撒哈拉以南非洲国家每年有超过75%的新生儿发生镰状细胞性贫血。 非洲绝大多数SCD患者没有接受循证医疗保健（例如，新生儿 筛查、健康教育、预防感染、最佳营养和水合作用、输血， 经颅多普勒筛查和HU治疗），尽管其在减少SCD相关不良反应方面有效 结果和死亡率。在SCD患者中，SSA中HU的使用<1%。我们的初步调查结果显示 供应商层面的障碍是重要的，必须加以解决，以提高HU的采用。解决HU 我们将使用NIH资助的研究（例如，通过羟基脲实现跨洲有效性 （REACH）临床试验（NCT 01966731）），开发了一种循证、临床、实用和易于操作的 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 剂量随时间变化（SIM），以改善SCD的管理作为我们的干预措施。尼日利亚政府 发布了指导方针，支持采用SIM干预HU，以改善SCD管理， 列入尼日利亚基本药物清单。我们在香港推行的改善学生宿舍管理策略 尼日利亚采用了一项切实可行、可复制的循证任务分担战略，即加强艾滋病毒/艾滋病工作战略。 血红蛋白病（TASH），采用我们的TASk-高血压控制强化策略 在加纳和尼日利亚进行的TASSH试验，包含以下基本组成部分： 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，以及iii）实践 用于SCD管理的便利化（TCP），称为（TASHTCP）。采用序贯探索性混合方法 研究设计，我们将使用探索，准备，实施和维持 （EPIS）框架，以评估供应商在以下领域采用SIM的有效性： 在尼日利亚实施TASH TCP战略的背景下。

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.