ADUNU

Accelerating Delivery of Rheumatic Heart Disease Prevention in Northern Uganda

Unfortunately, RHD is not on most national health agendas, so many RHD-endemic countries lack comprehensive RHD programs. This leaves many people living with RHD (about 55 million worldwide) undiagnosed and unprotected, even though penicillin can effectively control the disease for many patients.

Finding patients with RHD early and helping them stay on antibiotics could prevent many deaths. Can a Uganda Ministry of Health-led community-based RHD program sustainably diagnose and provide life-saving care for those living with RHD? 

ADUNU is a demonstration project piloting a comprehensive RHD program in two districts in Uganda. The project will assess and measure the feasibility, scalability, and cost-effectiveness of applying established RHD prevention and screening programs to find and diagnose community members with RHD with the aim of and linking and retaining them in care close to home.

ADUNU will provide information to governments and stakeholders in low-resource RHD-endemic countries to help them establish effective community-based RHD programs.

Nurse-Led Detection and Follow-Up: The ADUNU program will train nurses throughout the district to detect RHD cases using a simplified echocardiography approach, and to follow-up with patients via the national RHD Registry (The ACT Platform).

2,168

Clinics will be trained in RHD care

120,508

Persons will be screened for RHD

21

Persons to be linked to RHD care

Project Site: Kitgum and Oyam Districts

Project Dates: 2021-2024

Project Aims:

  1. Evaluate ADUNU using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, mapped to the RHD Care Cascade (an adoption of the cascade used for HIV).

  2. Evaluate the cost-effectiveness and budget impact of ADUNU in these two districts in order to justify investment and plan for scale-up of the program nationally in Uganda, beyond the proposed study.

Ministry of Health-Led Programming

The ADUNU program is overseen by the Ugandan Ministry of Health and is being deployed by the Kitgum and Oyam District of Health Offices.

Free Screening

Echo screening will be offered to all district residents 5-39 years at health centers and organized community- and school-based events.

Localized Care

RHD patients diagnosed through District Hospitals will be referred back to their local clinics for routine care, reducing the burden on patients (travel, time) and the health system (overbookings, supply stockouts), while bolstering long-term patient-health worker relations.