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.

项目概要/摘要 关于促进羟基脲（HU）采用的策略仍然存在巨大的知识差距，特别是在 包括尼日利亚在内的撒哈拉以南非洲国家，每年 75% 以上的镰状细胞性贫血新生儿都发生在这些国家。 非洲绝大多数患有 SCD 的人没有接受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、 经颅多普勒筛查和 HU 治疗），尽管它可以有效减少 SCD 相关不良反应 结果和死亡率。在 SCD 患者中，SSA 中使用 HU 的比例<1%。我们的初步调查结果表明 提供商层面的障碍是巨大的，必须解决以提高 HU 的采用率。致胡 采用时，我们将使用 NIH 资助的研究（例如，利用羟基脲实现跨大陆的有效性 (REACH) 临床试验 (NCT01966731)) 开发了一种循证、临床、实用且易于使用的方法 按照算法进行 1) 筛查患者是否患有镰状细胞病 (SCD)，2) 开始 HU 治疗，以及 3) 维持 HU 随着时间的推移剂量（SIM）作为我们的干预措施，以改善 SCD 的管理。尼日利亚政府 发布了支持 HU 采用 SIM 干预以改善 SCD 管理的指南，并且 HU 正在 列入尼日利亚基本药物清单。我们改善 SCD 管理的实施策略 尼日利亚采用实用且可复制的基于证据的任务共享战略，即任务强化战略 血红蛋白病 (TASSH)，源自我们的高血压控制任务强化策略 (TASSH) 在加纳和尼日利亚进行的试验包含 i) 医疗保健培训的基本组成部分 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，以及 iii) 实践 用于 SCD 管理的便利 (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、实施和维持来进行本研究 (EPIS) 框架分四个连续阶段来评估提供商采用 SIM 的有效性 尼日利亚 TASSH TCP 实施战略的背景。