Background: Rheumatic heart disease (RHD) is a preventable, acquired cardiac condition caused by an abnormal immunological response to infection with Group A Streptococcus. RHD contributes to premature mortality and cardiovascular morbidity, often related to late diagnosis and missed opportunities for early treatment. The aim of the ‘Non-Expert Acquisition and Remote Expert Review of Screening echocardiography images from Child health and AnteNatal clinics’ (NEARER SCAN) study is to co-design, implement and evaluate a task-sharing echocardiographic active case finding program for RHD in Australia and Timor-Leste.
Methods: NEARER SCAN is a type II effectiveness-implementation hybrid study (2022-2025). Approximately 1500 children and pregnant women will be scanned across 11 communities in Australia and Timor-Leste over 18-months. A package of implementation strategies will be co-designed with communities. Data will include numbers of normal, abnormal, and uninterpretable echocardiograms obtained, progression through the cascade of care, and interviews and surveys with staff.
Results: After 12 months of co-design, 37 non-experts were trained including 22 (59%) Aboriginal health workers. Early analysis suggests: a) training needs are greater than anticipated with multiple additional site visits required; b) more success has been seen where there is explicit permission to scan; c) technological issues interfere with scanning requiring different troubleshooting pathways.
Conclusion: Task-sharing echocardiography for RHD may be able to be successfully integrated into routine care in Australia and Timor-Leste. However, early findings suggest that training requires more support than anticipated, scanning may be more consistent when occurring at designated times, and improved pathways to troubleshoot technological issues are required.