Oral Presentation Lancefield International Symposium for Streptococci and Streptococcal Diseases 2025

Implementation and Impact of a Novel Rheumatic Heart Disease Screening Program in Uganda: Results from the ADUNU Program  (118185)

Scott Wirth 1 , Paul Warren 1 , Jafesi Pulle 2 , Doreen Nakagaayi 2 , Evaline Ayaa 3 , Michaela Pardo 4 , Francis Odong 2 , Ronald Ogwanh 2 , Isaac Omara 2 , Craig Sable 5 , Alison Spaziani 6 , Nicholas J Ollberding 1 , David Watkins 4 , Kristen Danforth 4 , Emmy Okello 2 , Andrea Beaton 1
  1. Cincinnati Children's Hospital Medical Center / Rheumatic Heart Disease Research Collaborative in Uganda, Cincinnati, OHIO, United States
  2. Uganda Heart Institute, Kampala, Uganda
  3. Uganda Ministry of Health, Kampala, Uganda
  4. Department of Global Health, University of Washington, Seattle, Washington, United States
  5. Children's Heart Center, Ochsner Children's Hospital, New Orleans, Louisiana, United States
  6. Department of Cardiology, Children's National Medical Center / Rheumatic Heart Disease Research Collaborative in uganda, Washington, District of Columbia, United States

Background 

Rheumatic heart disease (RHD) screening remains challenging in resource-limited settings due to limited expertise. The ADUNU program aims to integrate RHD screening echocardiography into Uganda’s public health system through task-shifting to briefly trained healthcare workers (HCWs).  

Methods 

We conducted a mixed-methods appraisal of ADUNU’s impact since its May 2023 launch in Kitgum district, Uganda, using logic model evaluation and descriptive/regression analyses to assess training expenditures, screening outcomes, and diagnostic performance.  

Results 

Training required ~$65,000 to support personnel costs, including 990 trainer hours, 495 coordinator hours, and 202 cardiologist hours for remote overread and feedback. Among 61 HCWs working across 10 facilities, 17 (29%) completed training requirements and earned certification to independently conduct screening. Overall, ADUNU screened 11,793 individuals (median age 20 years, 70% female), generating 807 referrals into the public health system (6.8% positive screen rate). Certified HCWs demonstrated 55% sensitivity, 97% specificity, 52% PPV, and 98% NPV for RHD detection. In adjusted analysis, increasing age (OR 0.96 [95% CI 0.93-0.98]), female sex (OR 0.46 [0.22-0.91], and low HCW screening experience (OR 0.19 [0.09-0.40]) were associated with decreased screening accuracy.   

Discussion 

ADUNU demonstrates that RHD screening can be successfully integrated into a resource-limited public health system at scale. Program expenditures were predominantly allocated to HCW training, suggesting modifications to automate and streamline training protocols could reduce costs. ADUNU’s suboptimal HCW certification rate, limited screening sensitivity, and heterogeneous performance across high-risk populations identify other critical areas for program optimization in subsequent iterations and expansion efforts. 

  1. The ADUNU Program Nakagaayi, D., et al. “A Decentralized Delivery Program for Rheumatic Heart Disease Treatment and Prevention in Uganda.” Nat Med, vol. 30, no. 1, Jan. 2024, pp. 12–13, https://doi.org/10.1038/s41591-023-02646-4.
  2. Logic Model Kaplan S, Garrett K. The use of logic models by community-based initiatives. Evaluation and Program Planning 2005; (28): 167-72.
  3. Savaya R, Waysman M. The Logic Model: A Tool for Incorporating Theory in Development and Evaluation of Programs. Administration in Social Work 2005; 29(2): 85-103.
  4. ADUNU ClinicalTrials.gov record. Accelerating Delivery of rheUmatic Heart Disease Preventive iNterventions in Northern Uganda. ClinicalTrials.gov Identifier NCT05783375. Updated June 11, 22024. Accessed August 4, 2024. https://clinicaltrials.gov/study/NCT05783375?term=adunu$rank=1