Evaluating the implementation of a dynamic digital application to enable community-based decentralisation of rheumatic heart disease case management in Uganda: protocol for a hybrid type III effectiveness-implementation study
Introduction Rheumatic heart disease (RHD) affects over 39 million people worldwide, the majority in low-income and middle-income countries. Secondary antibiotic prophylaxis (SAP), given every 3–4 weeks can improve outcomes, provided more than 80% of doses are received. Poor adherence is strongly co...
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| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2023-10-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/10/e071540.full |
| _version_ | 1827122462817517568 |
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| author | Emmy Okello Craig Sable David A Watkins Chris T Longenecker Jessica Abrams Andrea Zawacki Beaton Joselyn Rwebembera Jenifer Atala Jafesi Pulle Rachel Sarnacki Nicholas Ollberding Ndate Fall Yanfang Su Linda Oyella Kristen Danforth Neema W Minja Sarah R de Loizaga Jenipher Kamarembo Francis Odong Haddy Nalubwama Doreen Nakagaayi Judith W Dexheimer |
| author_facet | Emmy Okello Craig Sable David A Watkins Chris T Longenecker Jessica Abrams Andrea Zawacki Beaton Joselyn Rwebembera Jenifer Atala Jafesi Pulle Rachel Sarnacki Nicholas Ollberding Ndate Fall Yanfang Su Linda Oyella Kristen Danforth Neema W Minja Sarah R de Loizaga Jenipher Kamarembo Francis Odong Haddy Nalubwama Doreen Nakagaayi Judith W Dexheimer |
| author_sort | Emmy Okello |
| collection | DOAJ |
| description | Introduction Rheumatic heart disease (RHD) affects over 39 million people worldwide, the majority in low-income and middle-income countries. Secondary antibiotic prophylaxis (SAP), given every 3–4 weeks can improve outcomes, provided more than 80% of doses are received. Poor adherence is strongly correlated with the distance travelled to receive prophylaxis. Decentralising RHD care has the potential to bridge these gaps and at least maintain or potentially increase RHD prophylaxis uptake. A package of implementation strategies was developed with the aim of reducing barriers to optimum SAP uptake.Methods and analysis A hybrid implementation-effectiveness study type III was designed to evaluate the effectiveness of a package of implementation strategies including a digital, cloud-based application to support decentralised RHD care, integrated into the public healthcare system in Uganda. Our overarching hypothesis is that secondary prophylaxis adherence can be maintained or improved via a decentralisation strategy, compared with the centralised delivery strategy, by increasing retention in care. To evaluate this, eligible patients with RHD irrespective of their age enrolled at Lira and Gulu hospital registry sites will be consented for decentralised care at their nearest participating health centre. We estimated a sample size of 150–200 registrants. The primary outcome will be adherence to secondary prophylaxis while detailed implementation measures will be collected to understand barriers and facilitators to decentralisation, digital application tool adoption and ultimately its use and scale-up in the public healthcare system.Ethics and dissemination This study was approved by the Institutional Review Board (IRB) at Cincinnati Children’s Hospital Medical Center (IRB 2021-0160) and Makerere University School of Medicine Research Ethics Committee (Mak-SOMREC-2021-61). Participation will be voluntary and informed consent or assent (>8 but <18) will be obtained prior to participation. At completion, study findings will be communicated to the public, key stakeholders and submitted for publication. |
| first_indexed | 2024-03-11T12:11:42Z |
| format | Article |
| id | doaj.art-63f9e7c340d44735b4f2fb900aec3b4e |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2025-03-20T14:09:25Z |
| publishDate | 2023-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-63f9e7c340d44735b4f2fb900aec3b4e2024-09-11T00:35:10ZengBMJ Publishing GroupBMJ Open2044-60552023-10-01131010.1136/bmjopen-2022-071540Evaluating the implementation of a dynamic digital application to enable community-based decentralisation of rheumatic heart disease case management in Uganda: protocol for a hybrid type III effectiveness-implementation studyEmmy Okello0Craig Sable1David A Watkins2Chris T Longenecker3Jessica Abrams4Andrea Zawacki Beaton5Joselyn Rwebembera6Jenifer Atala7Jafesi Pulle8Rachel Sarnacki9Nicholas Ollberding10Ndate Fall11Yanfang Su12Linda Oyella13Kristen Danforth14Neema W Minja15Sarah R de Loizaga16Jenipher Kamarembo17Francis Odong18Haddy Nalubwama19Doreen Nakagaayi20Judith W Dexheimer21Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda11 Department of Cardiology, Children’s National Medical Center, Washington, District of Columbia, USADepartment of Global Health, University of Washington, Seattle, Washington, USADivision of Cardiology, University of Washington School of Medicine, Seattle, Washington, USADivision of Paediatric Cardiology, Department of Paediatrics and Child Health, University of Cape Town Faculty of Health Sciences, Rondebosch, South Africa5 The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA4 Department of Adult Cardiology, Uganda Heart Institute Ltd, Kampala, Uganda3 Rheumatic Heart Disease Research Collaborative, Uganda Heart Institute, Kampala, Uganda3 Rheumatic Heart Disease Research Collaborative, Uganda Heart Institute, Kampala, Uganda11 Department of Cardiology, Children’s National Medical Center, Washington, District of Columbia, USA7 Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA2Cincinnati Children’s Hospital Medical Center, Rheumatology, Cincinnati, United States of AmericaDepartment of Global Health, University of Washington, Seattle, Washington, USA3 Rheumatic Heart Disease Research Collaborative, Uganda Heart Institute, Kampala, Uganda1 Department of Global Health, University of Washington, Seattle, Washington, USA2 Kilimanjaro Clinical Research Institute (KCRI), Moshi, Tanzania, United Republic of5 The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA3 Rheumatic Heart Disease Research Collaborative, Uganda Heart Institute, Kampala, Uganda3 Rheumatic Heart Disease Research Collaborative, Uganda Heart Institute, Kampala, Uganda10 Department is Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda4 Department of Adult Cardiology, Uganda Heart Institute Ltd, Kampala, Uganda12 Department of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USAIntroduction Rheumatic heart disease (RHD) affects over 39 million people worldwide, the majority in low-income and middle-income countries. Secondary antibiotic prophylaxis (SAP), given every 3–4 weeks can improve outcomes, provided more than 80% of doses are received. Poor adherence is strongly correlated with the distance travelled to receive prophylaxis. Decentralising RHD care has the potential to bridge these gaps and at least maintain or potentially increase RHD prophylaxis uptake. A package of implementation strategies was developed with the aim of reducing barriers to optimum SAP uptake.Methods and analysis A hybrid implementation-effectiveness study type III was designed to evaluate the effectiveness of a package of implementation strategies including a digital, cloud-based application to support decentralised RHD care, integrated into the public healthcare system in Uganda. Our overarching hypothesis is that secondary prophylaxis adherence can be maintained or improved via a decentralisation strategy, compared with the centralised delivery strategy, by increasing retention in care. To evaluate this, eligible patients with RHD irrespective of their age enrolled at Lira and Gulu hospital registry sites will be consented for decentralised care at their nearest participating health centre. We estimated a sample size of 150–200 registrants. The primary outcome will be adherence to secondary prophylaxis while detailed implementation measures will be collected to understand barriers and facilitators to decentralisation, digital application tool adoption and ultimately its use and scale-up in the public healthcare system.Ethics and dissemination This study was approved by the Institutional Review Board (IRB) at Cincinnati Children’s Hospital Medical Center (IRB 2021-0160) and Makerere University School of Medicine Research Ethics Committee (Mak-SOMREC-2021-61). Participation will be voluntary and informed consent or assent (>8 but <18) will be obtained prior to participation. At completion, study findings will be communicated to the public, key stakeholders and submitted for publication.https://bmjopen.bmj.com/content/13/10/e071540.full |
| spellingShingle | Emmy Okello Craig Sable David A Watkins Chris T Longenecker Jessica Abrams Andrea Zawacki Beaton Joselyn Rwebembera Jenifer Atala Jafesi Pulle Rachel Sarnacki Nicholas Ollberding Ndate Fall Yanfang Su Linda Oyella Kristen Danforth Neema W Minja Sarah R de Loizaga Jenipher Kamarembo Francis Odong Haddy Nalubwama Doreen Nakagaayi Judith W Dexheimer Evaluating the implementation of a dynamic digital application to enable community-based decentralisation of rheumatic heart disease case management in Uganda: protocol for a hybrid type III effectiveness-implementation study BMJ Open |
| title | Evaluating the implementation of a dynamic digital application to enable community-based decentralisation of rheumatic heart disease case management in Uganda: protocol for a hybrid type III effectiveness-implementation study |
| title_full | Evaluating the implementation of a dynamic digital application to enable community-based decentralisation of rheumatic heart disease case management in Uganda: protocol for a hybrid type III effectiveness-implementation study |
| title_fullStr | Evaluating the implementation of a dynamic digital application to enable community-based decentralisation of rheumatic heart disease case management in Uganda: protocol for a hybrid type III effectiveness-implementation study |
| title_full_unstemmed | Evaluating the implementation of a dynamic digital application to enable community-based decentralisation of rheumatic heart disease case management in Uganda: protocol for a hybrid type III effectiveness-implementation study |
| title_short | Evaluating the implementation of a dynamic digital application to enable community-based decentralisation of rheumatic heart disease case management in Uganda: protocol for a hybrid type III effectiveness-implementation study |
| title_sort | evaluating the implementation of a dynamic digital application to enable community based decentralisation of rheumatic heart disease case management in uganda protocol for a hybrid type iii effectiveness implementation study |
| url | https://bmjopen.bmj.com/content/13/10/e071540.full |
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