Accelerating Delivery of rheUmatic Heart Disease Preventive iNterventions in Northern Uganda

Primary outcomes

1. Proportion of persons with RHD reached by the ADUNU program

   Time frame: 5 year endpoint

   This objective will involve only secondary analysis of de-identified data collected by districts using routine MOH data collection procedures supplemented by some routine program data during the Ministry's rollout of the ADUNU Programme Package. The number of individuals screened and screening positivity rates will be extracted from screening logs implemented and maintained by DHOs and assessed by modality (school fairs, health days, passive health center screening, and active outreach to family members of RHD diagnosed).

2. Proportion of persons with RHD enrolled in care, retained and adherent to treatment

   Time frame: 3 months

   Secondary analysis of data from the districts RHD registry will be used to assess the proportion of registrants enrolled, retained and adherent to secondary prophylaxis.

3. Proportion of persons with RHD enrolled in care, retained and adherent to treatment

   Time frame: 24 months

   Secondary analysis of data from the districts RHD registry will be used to assess the proportion of registrants enrolled, retained and adherent to secondary prophylaxis.

4. Adoption and implementation of the ADUNU program at the organization level surveys

   Time frame: Baseline

   Brief surveys will be filled out by providers who are acting as administrators of their health centre and will include questions on a range of logistic (e.g., availability of commodities and stockouts, basic infrastructure reliability) and organizational readiness topics (e.g., staffing levels and turnover, organization of patient scheduling, district support visits)

5. Adoption and implementation of the ADUNU program at the organization level surveys

   Time frame: 24 months

   Brief surveys will be filled out by providers who are acting as administrators of their health centre and will include questions on a range of logistic (e.g., availability of commodities and stockouts, basic infrastructure reliability) and organizational readiness topics (e.g., staffing levels and turnover, organization of patient scheduling, district support visits)

6. Adoption and implementation of the ADUNU program at the provider level

   Time frame: 6 months

   Two types of data collection activities from frontline providers will be used to understand individual provider-level adoption and maintenance over time: provider surveys and in-depth interviews of providers. A standardized survey instrument on Adoption and a standardized checklist on implementation fidelity that will be completed by the research staff via direct observation. Research staff will use a standardized checklist that will be developed from the core elements of RHD testing (e.g., ultrasound technique, saving of images) and secondary prevention (e.g., injection technique, adequate post-injection monitoring for anaphylaxis)

7. Adoption and implementation of the ADUNU program at the patient level interview

   Time frame: 24 months

   We will conduct a limited number of interviews of registry patients in each district stratified by adherence outcomes as well as age group (adult vs children).

8. Cost-analysis of the ADUNU program

   Time frame: 3 year endpoint

   To estimate program costs, we will use the standardized data collection instruments. Our instruments will measure fixed and capital costs, as well as variable or recurrent costs. Ingredients-based costing will be used for drugs and consumables, personnel costs, and equipment costs, whereas gross costing will be used for "indirect" costs such as facility rents and utilities and maintenance. Relevant data for ingredients-based costing include study data on participant healthcare utilization and price lists of drugs, consumables, and equipment. DHO budget sheets for health facilities and overall health service utilization will be used for gross costing. Both financial costs and economic costs will be measured. We will also estimate of out-of-pocket costs borne by registrants, which will allow us to estimate costs from the patient/household perspective.