[R01] Accelerating Delivery of rheumatic heart disease preventive iNterventions in Uganda (ADUNU)
Ente: National Heart Lung and Blood Institute
Scadenza: 2027-07-31
Importo max: $309,908
Paese: US
Descrizione
Modified Project Summary Abstract
Rheumatic heart disease (RHD) is the most commonly acquired heart disease among children and young adults worldwide, affecting an estimated 55 million people globally. Despite a 2018 World Health Assembly resolution calling for global reprioritization of RHD, no evidence-based implementation models exist to guide countries and communities on how to act—most RHD-endemic countries have no programs, leaving the majority of those affected undiagnosed and unprotected. This burden is not limited to low-income countries: approximately 400,000 Americans live with RHD, with disproportionate burden among Native American and Alaska Native populations and rising incidence in some states. Continuous antibiotic prophylaxis with monthly intramuscular benzathine penicillin G is a cornerstone of RHD control, yet uptake remains poor due to low case detection rates and inadequate access to care. Our objective is to test ADUNU (Accelerating Delivery of rheUmatic heart disease preventive iNterventions in Uganda), a community-based program that aims to find individuals with RHD and provide secondary prevention close to where they live. The program will be tested in two districts (Kitgum, demonstration; Oyam replication), building an evidence-base for national scale-up. 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 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). Quantitative data 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 to justify investment and plan for scale-up of the program nationally in Uganda, beyond the proposed study. ADUNU will generate significant, rigorous implementation evidence that cannot be efficiently produced in higher-income settings where RHD prevalence is insufficient for equivalent research. The resulting program template and community health worker-based care models have direct domestic applicability—our team's IN-STEP program is already translating Uganda-developed approaches to improve cardiac diagnosis among the White Mountain Apache Tribe, demonstrating a concrete and operational reciprocal innovation pathway.
Istituzione: CINCINNATI CHILDRENS HOSP MED CTR
PI: Andrea Zawacki Beaton, David A Watkins
Progetto: 5R01HL164615-05
Settori: National Heart Lung and Blood Institute
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