{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T04:15:09Z","timestamp":1781928909382,"version":"3.54.5"},"reference-count":40,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2023,10,27]],"date-time":"2023-10-27T00:00:00Z","timestamp":1698364800000},"content-version":"unspecified","delay-in-days":26,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Clinical and Translational Science Award","award":["UL1TR002548"],"award-info":[{"award-number":["UL1TR002548"]}]},{"name":"AHA","award":["20SFRN35380042"],"award-info":[{"award-number":["20SFRN35380042"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,9,19]]},"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Rheumatic heart disease (RHD) affects over 39\u2009million people worldwide, the majority in low-income and middle-income countries. Secondary antibiotic prophylaxis (SAP), given every 3\u20134 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>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\u2013200 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This study was approved by the Institutional Review Board (IRB) at Cincinnati Children\u2019s 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 (&gt;8\u2009but &lt;18) will be obtained prior to participation. At completion, study findings will be communicated to the public, key stakeholders and submitted for publication.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-071540","type":"journal-article","created":{"date-parts":[[2023,10,28]],"date-time":"2023-10-28T12:45:11Z","timestamp":1698497111000},"page":"e071540","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"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"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2272-9153","authenticated-orcid":false,"given":"Neema W","family":"Minja","sequence":"first","affiliation":[{"name":"Department of Global Health, University of Washington, Seattle, Washington, USA"},{"name":"Kilimanjaro Clinical Research Institute (KCRI), Moshi, Tanzania, United Republic of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7955-3481","authenticated-orcid":false,"given":"Jafesi","family":"Pulle","sequence":"additional","affiliation":[{"name":"Rheumatic Heart Disease Research Collaborative, Uganda Heart Institute, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joselyn","family":"Rwebembera","sequence":"additional","affiliation":[{"name":"Department of Adult Cardiology, Uganda Heart Institute Ltd, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah R","family":"de Loizaga","sequence":"additional","affiliation":[{"name":"The Heart Institute, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ndate","family":"Fall","sequence":"additional","affiliation":[{"name":"The Heart Institute, Cincinnati 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Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenipher","family":"Kamarembo","sequence":"additional","affiliation":[{"name":"Rheumatic Heart Disease Research Collaborative, Uganda Heart Institute, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Oyella","sequence":"additional","affiliation":[{"name":"Rheumatic Heart Disease Research Collaborative, Uganda Heart Institute, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis","family":"Odong","sequence":"additional","affiliation":[{"name":"Rheumatic Heart Disease Research Collaborative, Uganda Heart Institute, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haddy","family":"Nalubwama","sequence":"additional","affiliation":[{"name":"Department is Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, 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Children\u2019s Hospital Medical Center, Cincinnati, Ohio, USA"},{"name":"University of Cincinnati College of Medicine, Cincinnati, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig","family":"Sable","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Children\u2019s National Medical Center, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris T","family":"Longenecker","sequence":"additional","affiliation":[{"name":"Department of Global Health, University of Washington, Seattle, Washington, USA"},{"name":"Division of Cardiology, University of Washington, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen","family":"Danforth","sequence":"additional","affiliation":[{"name":"Department of Global Health, University of Washington, Seattle, Washington, 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