Accelerating Delivery of rheumatic heart disease preventive iNterventions in Uganda (ADUNU)

乌干达加速实施风湿性心脏病预防干预措施 (ADUNU)

基本信息

批准号：
10500950
负责人：
Andrea Zawacki Beaton
金额：
$ 68.03万
依托单位：
CINCINNATI CHILDRENS HOSP MED CTR
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-01 至 2027-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10500950
关键词：
15 year old Adherence Adopted Adoption Antibiotic Prophylaxis Awareness Benzathine Penicillin Cardiac Cardiovascular Diseases Cardiovascular system Caring Charge Child Clinical Communities Country Data Decentralization Detection Diagnosis Dimensions Echocardiography Effectiveness Endemic Diseases Enrollment Evaluation Evidence based practice Failure Foundations Funding Goals Government Guidelines HIV Health Health Personnel Health Services Accessibility Health care facility Healthcare Healthcare Systems Heart Heart Diseases Hospital Referrals Hospitals Individual Injections Institutes Intervention Interview Intramuscular Investments Light Maintenance Maps Measures Methods Modeling Nurses Observational Study Outcome Outcomes Research Patient-Focused Outcomes Patients Penicillin G Persons Population Prevalence Primary Health Care Prophylactic treatment Protocols documentation Provider Reach Effectiveness Adoption Implementation and Maintenance Registries Research Research Infrastructure Resolution Resource-limited setting Resources Rheumatic Heart Disease Running Secondary Prevention Service delivery model Subgroup System Technology Testing Time Training Travel Uganda Work World Health aged base budget impact community center community engaged research community setting cost cost effective cost effectiveness cost estimate cost-effectiveness evaluation design disease registry disorder control evidence base experience experimental study health care delivery implementation determinants implementation strategy improved innovation insight low and middle-income countries low income country marginalized population mathematical model microcosting neglect novel prevent prevention service preventive intervention program costs programs prospective routine practice scale up success tool uptake young adult

项目摘要

Project Summary Abstract Rheumatic heart disease (RHD) is the most commonly acquired heart disease among children and young adults worldwide. Continuous antibiotic prophylaxis (secondary prevention) with monthly intramuscular benzathine penicillin G (BPG) is a cornerstone of RHD control programs and has been used successfully for decades in wealthy countries. Unfortunately, because of neglect in the global and national health agendas, most RHD- endemic countries (like Uganda) have no RHD programs, so most of the estimated 40 million people living with RHD worldwide remain undiagnosed and unprotected from further valvular damage. Considering these challenges, our objective is to partner with the Ugandan government to test a novel community-based program, ADUNU (Acholi for “heart”) that aims to find individuals with RHD and provide secondary prevention close to where they live. The program will be tested in two districts (one demonstration, one replication), building a foundation for national scale-up beyond the proposed research. 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 is a non-randomized experiment that will set up a new system in settings where RHD-related healthcare currently does not exist, with the goal of finding new cases and enrolling them in local registries that provide 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). Primary quantitative outcomes in each of RE-AIM’s five dimensions 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 in these two districts in order to justify investment and plan for scale-up of the program nationally in Uganda, beyond the proposed study. ADUNU will provide much-needed evidence to government stakeholders in RHD-endemic countries, demonstrating how a pragmatic, community-based strategy can deliver guideline-based care to people living with RHD. It will also provide critical, and currently absent, evidence on the cost-effectiveness, affordability, and sustainability of RHD programs in resource-limited settings.

项目概要摘要风湿性心脏病（RHD）是儿童和年轻人中最常见的心脏病在世界范围内，每月肌注苄星霉素进行持续抗生素预防（二级预防）。青霉素 G (BPG) 是 RHD 控制计划的基石，已在以下领域成功使用了数十年：不幸的是，由于全球和国家卫生议程的忽视，大多数 RHD- 流行国家（如乌干达）没有 RHD 计划，因此估计有 4000 万患有该病的人中的大多数考虑到这些，全世界的 RHD 仍未得到诊断，也无法免受进一步的瓣膜损伤。挑战，我们的目标是与乌干达政府合作测试一项新颖的基于社区的计划， ADUNU（Acholi 意为“心脏”）旨在寻找 RHD 患者并在附近提供二级预防该计划将在两个地区进行测试（一个示范，一个复制），建立一个 ADUNU 超出拟议研究的国家规模扩大的基础是基于两个核心的、基于证据的。技术，(1) 在社区环境中使用手持式超声心动图进行 RHD 测试，以及 (2) 由护士主导， ADUNU 是一项基于登记的二级预防实验，它将建立一个新的机制。在目前不存在 RHD 相关医疗保健的环境中建立系统，目的是发现新病例并将他们纳入提供二级预防的当地登记处，并将其与一般预防相结合。初级医疗保健并随着时间的推移跟踪结果，这是可持续性和可扩展性的关键因素。在目标 1 中，我们将。使用范围、有效性、采用、实施和维护 (RE-AIM) 评估 ADUNU 框架，映射到 RHD 护理级联（用于 HIV 初级定量的级联的改编）。 RE-AIM 五个维度中每个维度的结果都将得到来自深入研究的定性数据的补充在目标 2 中，我们将评估成本效益和预算影响。 ADUNU 在这两个地区进行投资，并计划在全国范围内扩大该计划乌干达，除了拟议的研究之外，ADUNU 还将向政府提供急需的证据。 RHD 流行国家的利益相关者展示了务实的、基于社区的战略如何可以为 RHD 患者提供基于指南的护理，目前它还将提供关键的护理。缺乏有关 RHD 计划的成本效益、可负担性和可持续性的证据资源有限的设置。