{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T21:28:15Z","timestamp":1777670895740,"version":"3.51.4"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>Rheumatic heart disease (RHD) is a leading cause of premature death and disability in low-income countries; however, few receive optimal benzathine penicillin G (BPG) therapy to prevent disease progression. We aimed to comprehensively describe the treatment cascade for RHD in Uganda to identify appropriate targets for intervention.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>Using data from the Uganda RHD Registry (n=1504), we identified the proportion of patients in the following care categories: (1) diagnosed and alive as of June 1, 2016; (2) retained in care; (3) appropriately prescribed BPG; and (4) optimally adherent to BPG (&gt;80% of prescribed doses). We used logistic regression to investigate factors associated with retention and optimal adherence. Overall, median (interquartile range) age was 23 (15\u201338) years, 69% were women, and 82% had clinical RHD. Median follow-up time was 2.4 (0.9\u20134.0) years. Retention in care was the most significant barrier to achieving optimal BPG adherence with only 56.9% (95% confidence interval, 54.1%\u201359.7%) of living subjects having attended clinic in the prior 56 weeks. Among those retained in care, however, we observed high rates of BPG prescription (91.6%; 95% confidence interval, 89.1%\u201393.5%) and optimal adherence (91.4%; 95% confidence interval, 88.7\u201393.5). Younger age, latent disease status, and access to care at a regional center were the strongest independent predictors of retention and optimal adherence.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>Our study suggests that improving retention in care\u2014possibly by decentralizing RHD services\u2014would have the greatest impact on uptake of antibiotic prophylaxis among patients with RHD in Uganda.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circoutcomes.117.004037","type":"journal-article","created":{"date-parts":[[2017,11,14]],"date-time":"2017-11-14T01:11:11Z","timestamp":1510621871000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":44,"title":["Rheumatic Heart Disease Treatment Cascade in Uganda"],"prefix":"10.1161","volume":"10","author":[{"given":"Chris T.","family":"Longenecker","sequence":"first","affiliation":[{"name":"From the Case Western Reserve University School of Medicine, Cleveland, OH (C.T.L., S.R.M., M.A.C., R.A.S., D.I.S.); Division of Cardiovascular Medicine (C.T.L., M.A.C., D.I.S.) and Department of Medicine, University Hospitals Cleveland Medical Center, OH (S.R.M., R.A.S.); Uganda Heart Institute, Kampala, Uganda (T.O.A., P.L., J.R., I.S., E.O.); Department of Pediatric Cardiology, Children\u2019s National Health System, Washington, DC (A.B., C.S., A.S.); Department of Medicine, Makerere University School..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen R.","family":"Morris","sequence":"additional","affiliation":[{"name":"From the Case Western Reserve University School of Medicine, Cleveland, OH (C.T.L., S.R.M., M.A.C., R.A.S., D.I.S.); Division of Cardiovascular Medicine (C.T.L., M.A.C., D.I.S.) and Department of Medicine, University Hospitals Cleveland Medical Center, OH (S.R.M., R.A.S.); Uganda Heart Institute, Kampala, Uganda (T.O.A., P.L., J.R., I.S., E.O.); Department of Pediatric Cardiology, Children\u2019s National Health System, Washington, DC (A.B., C.S., A.S.); Department of Medicine, Makerere University School..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Twalib O.","family":"Aliku","sequence":"additional","affiliation":[{"name":"From the Case Western Reserve University School of Medicine, Cleveland, OH (C.T.L., S.R.M., M.A.C., R.A.S., D.I.S.); Division of Cardiovascular Medicine (C.T.L., M.A.C., D.I.S.) and Department of Medicine, University Hospitals Cleveland Medical Center, OH (S.R.M., R.A.S.); Uganda Heart Institute, Kampala, Uganda (T.O.A., P.L., J.R., I.S., E.O.); Department of Pediatric Cardiology, Children\u2019s National Health System, Washington, DC (A.B., C.S., A.S.); Department of Medicine, Makerere University School..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Beaton","sequence":"additional","affiliation":[{"name":"From the Case Western Reserve University School of Medicine, Cleveland, OH (C.T.L., S.R.M., M.A.C., R.A.S., D.I.S.); Division of Cardiovascular Medicine (C.T.L., M.A.C., D.I.S.) and Department of Medicine, University Hospitals Cleveland Medical Center, OH (S.R.M., R.A.S.); Uganda Heart Institute, Kampala, Uganda (T.O.A., P.L., J.R., I.S., E.O.); Department of Pediatric Cardiology, Children\u2019s National Health System, Washington, DC (A.B., C.S., A.S.); Department of Medicine, Makerere University School..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco A.","family":"Costa","sequence":"additional","affiliation":[{"name":"From the Case Western Reserve University School of Medicine, Cleveland, OH (C.T.L., S.R.M., M.A.C., R.A.S., D.I.S.); Division of Cardiovascular Medicine (C.T.L., M.A.C., D.I.S.) and Department of Medicine, University Hospitals Cleveland Medical Center, OH (S.R.M., R.A.S.); Uganda Heart Institute, Kampala, Uganda (T.O.A., P.L., J.R., I.S., E.O.); Department of Pediatric Cardiology, Children\u2019s National Health System, Washington, DC (A.B., C.S., A.S.); Department of Medicine, Makerere University School..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moses R.","family":"Kamya","sequence":"additional","affiliation":[{"name":"From the Case Western Reserve University School of Medicine, Cleveland, OH (C.T.L., S.R.M., M.A.C., R.A.S., D.I.S.); Division of Cardiovascular Medicine (C.T.L., M.A.C., D.I.S.) and Department of Medicine, University Hospitals Cleveland Medical Center, OH (S.R.M., R.A.S.); Uganda Heart Institute, Kampala, Uganda (T.O.A., P.L., J.R., I.S., E.O.); Department of Pediatric Cardiology, Children\u2019s National Health System, Washington, DC (A.B., C.S., A.S.); Department of Medicine, Makerere University School..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cissy","family":"Kityo","sequence":"additional","affiliation":[{"name":"From the Case Western Reserve University School of Medicine, Cleveland, OH (C.T.L., S.R.M., M.A.C., R.A.S., D.I.S.); Division of Cardiovascular Medicine (C.T.L., M.A.C., D.I.S.) and Department of Medicine, University Hospitals Cleveland Medical Center, OH (S.R.M., R.A.S.); Uganda Heart Institute, Kampala, Uganda (T.O.A., P.L., J.R., I.S., E.O.); Department of Pediatric Cardiology, Children\u2019s National Health System, Washington, DC (A.B., C.S., A.S.); Department of Medicine, Makerere University School..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Lwabi","sequence":"additional","affiliation":[{"name":"From the Case Western Reserve University School of Medicine, Cleveland, OH (C.T.L., S.R.M., M.A.C., R.A.S., D.I.S.); Division of Cardiovascular Medicine (C.T.L., M.A.C., D.I.S.) and Department of Medicine, University Hospitals Cleveland Medical Center, OH (S.R.M., R.A.S.); Uganda Heart Institute, Kampala, Uganda (T.O.A., P.L., J.R., I.S., E.O.); Department of Pediatric Cardiology, Children\u2019s National Health System, Washington, DC (A.B., C.S., A.S.); Department of Medicine, Makerere University School..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grace","family":"Mirembe","sequence":"additional","affiliation":[{"name":"From the Case Western Reserve University School of Medicine, Cleveland, OH (C.T.L., S.R.M., M.A.C., R.A.S., D.I.S.); Division of Cardiovascular Medicine (C.T.L., M.A.C., D.I.S.) and Department of Medicine, University Hospitals Cleveland Medical Center, OH (S.R.M., R.A.S.); Uganda Heart Institute, Kampala, Uganda (T.O.A., P.L., J.R., I.S., E.O.); Department of Pediatric Cardiology, Children\u2019s National Health System, Washington, DC (A.B., C.S., A.S.); Department of Medicine, Makerere University School..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dorah","family":"Nampijja","sequence":"additional","affiliation":[{"name":"From the Case Western Reserve University School of Medicine, Cleveland, OH (C.T.L., S.R.M., M.A.C., R.A.S., D.I.S.); Division of Cardiovascular Medicine (C.T.L., M.A.C., D.I.S.) and Department of Medicine, University Hospitals Cleveland Medical Center, OH (S.R.M., R.A.S.); Uganda Heart Institute, Kampala, Uganda (T.O.A., P.L., J.R., I.S., E.O.); Department of Pediatric Cardiology, Children\u2019s National Health System, Washington, DC (A.B., C.S., A.S.); Department of Medicine, Makerere University School..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joselyn","family":"Rwebembera","sequence":"additional","affiliation":[{"name":"From the Case Western Reserve University School of Medicine, Cleveland, OH (C.T.L., S.R.M., M.A.C., R.A.S., D.I.S.); Division of Cardiovascular Medicine (C.T.L., M.A.C., D.I.S.) and Department of Medicine, University Hospitals Cleveland Medical Center, OH (S.R.M., R.A.S.); Uganda Heart Institute, Kampala, Uganda (T.O.A., P.L., J.R., I.S., E.O.); Department of Pediatric Cardiology, Children\u2019s National Health System, Washington, DC (A.B., C.S., A.S.); Department of Medicine, Makerere University School..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Craig","family":"Sable","sequence":"additional","affiliation":[{"name":"From the Case Western Reserve University School of Medicine, Cleveland, OH (C.T.L., S.R.M., M.A.C., R.A.S., D.I.S.); Division of Cardiovascular Medicine (C.T.L., M.A.C., D.I.S.) and Department of Medicine, University Hospitals Cleveland Medical Center, OH (S.R.M., R.A.S.); Uganda Heart Institute, Kampala, Uganda (T.O.A., P.L., J.R., I.S., E.O.); Department of Pediatric Cardiology, Children\u2019s National Health System, Washington, DC (A.B., C.S., A.S.); Department of Medicine, Makerere University School..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert A.","family":"Salata","sequence":"additional","affiliation":[{"name":"From the Case Western Reserve University School of Medicine, Cleveland, OH (C.T.L., S.R.M., M.A.C., R.A.S., D.I.S.); Division of Cardiovascular Medicine (C.T.L., M.A.C., D.I.S.) and Department of Medicine, University Hospitals Cleveland Medical Center, OH (S.R.M., R.A.S.); Uganda Heart Institute, Kampala, Uganda (T.O.A., P.L., J.R., I.S., E.O.); Department of Pediatric Cardiology, Children\u2019s National Health System, Washington, DC (A.B., C.S., A.S.); Department of Medicine, Makerere University School..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy","family":"Scheel","sequence":"additional","affiliation":[{"name":"From the Case Western Reserve University School of Medicine, Cleveland, OH (C.T.L., S.R.M., M.A.C., R.A.S., D.I.S.); Division of Cardiovascular Medicine (C.T.L., M.A.C., D.I.S.) and Department of Medicine, University Hospitals Cleveland Medical Center, OH (S.R.M., R.A.S.); Uganda Heart Institute, Kampala, Uganda (T.O.A., P.L., J.R., I.S., E.O.); Department of Pediatric Cardiology, Children\u2019s National Health System, Washington, DC (A.B., C.S., A.S.); Department of Medicine, Makerere University School..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel I.","family":"Simon","sequence":"additional","affiliation":[{"name":"From the Case Western Reserve University School of Medicine, Cleveland, OH (C.T.L., S.R.M., M.A.C., R.A.S., D.I.S.); Division of Cardiovascular Medicine (C.T.L., M.A.C., D.I.S.) and Department of Medicine, University Hospitals Cleveland Medical Center, OH (S.R.M., R.A.S.); Uganda Heart Institute, Kampala, Uganda (T.O.A., P.L., J.R., I.S., E.O.); Department of Pediatric Cardiology, Children\u2019s National Health System, Washington, DC (A.B., C.S., A.S.); Department of Medicine, Makerere University School..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isaac","family":"Ssinabulya","sequence":"additional","affiliation":[{"name":"From the Case Western Reserve University School of Medicine, Cleveland, OH (C.T.L., S.R.M., M.A.C., R.A.S., D.I.S.); Division of Cardiovascular Medicine (C.T.L., M.A.C., D.I.S.) and Department of Medicine, University Hospitals Cleveland Medical Center, OH (S.R.M., R.A.S.); Uganda Heart Institute, Kampala, Uganda (T.O.A., P.L., J.R., I.S., E.O.); Department of Pediatric Cardiology, Children\u2019s National Health System, Washington, DC (A.B., C.S., A.S.); Department of Medicine, Makerere University School..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emmy","family":"Okello","sequence":"additional","affiliation":[{"name":"From the Case Western Reserve University School of Medicine, Cleveland, OH (C.T.L., S.R.M., M.A.C., R.A.S., D.I.S.); 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