{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,21]],"date-time":"2026-06-21T18:47:38Z","timestamp":1782067658612,"version":"3.54.5"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Population Health and Outcomes"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>The World Health Organization recommends echocardiographic screening and secondary prophylaxis for rheumatic heart disease (RHD), but evidence on how to implement these interventions within healthcare systems is limited. We report early implementation and clinical outcomes of an RHD program in northern Uganda.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>\n                      From May 2023, the District Health Office in Kitgum trained primary healthcare workers in RHD screening and implemented registry-based secondary antibiotic prophylaxis in public facilities. We analyzed program and registry data through December 31, 2024. Data were obtained from aggregated program reports and individual-level records from the national RHD registry. We developed an RHD care cascade to examine screening uptake and outcomes, including adherence to secondary antibiotic prophylaxis. Adherence was categorized as perfect (100%), near perfect (90%\u201399%), acceptable (80%\u201389%), suboptimal (60% to 79%), or poor (&lt;60%). Differences in mean adherence across subgroups were evaluated using 1-way ANOVA and \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      tests. Time-to-event analysis was conducted to assess the probability of receiving an injection over time since enrollment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>Health workers screened about 1% of the district\u2019s target population each month. Over 18 months, 25\u2009358 people were screened, including 1213 (4.8%) positive screens and 333 (1.3%) confirmed RHD cases. Among those screened, 16\u2009406 (64%) were female, and 10\u2009746 (42%) and 7333 (28%) were children (aged 5 years\u201314 years) and adolescents (aged 15 years\u201324 years), respectively. Of those with positive screens, 972 (80%) received confirmatory echocardiograms. Confirmed cases were relatively young (mean age 28 years), and 224 (67%) were female. Overall, 220 (75%) individuals achieved at least acceptable adherence. Among those who defaulted, 79% did so within 6 months of enrollment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>An integrated RHD program in Uganda achieved successful delivery of echocardiographic screening within primary healthcare and acceptable early outcomes. The care cascade framework can be used to monitor similar RHD programs and identify opportunities for improvement.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circoutcomes.125.012831","type":"journal-article","created":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T09:00:21Z","timestamp":1777626021000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Early Implementation and Clinical Outcomes of an Integrated Rheumatic Heart Disease Screening and Treatment Program in Northern Uganda"],"prefix":"10.1161","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7955-3481","authenticated-orcid":true,"given":"Jafesi","family":"Pulle","sequence":"first","affiliation":[{"name":"Rheumatic Heart Disease Research Collaborative, Uganda Heart Institute, Kampala (J.P., J.K., D.N., F.O., I.O.O., J.R., M.A., R.O., E.O.)."},{"name":"Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda (J.P., J.K., D.N., J.R., N.K.S., E.O.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Kayima","sequence":"additional","affiliation":[{"name":"Rheumatic Heart Disease Research Collaborative, Uganda Heart Institute, Kampala (J.P., J.K., D.N., F.O., I.O.O., J.R., M.A., R.O., E.O.)."},{"name":"Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda (J.P., J.K., D.N., J.R., N.K.S., E.O.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5796-3404","authenticated-orcid":true,"given":"Nanhua","family":"Zhang","sequence":"additional","affiliation":[{"name":"Division of Biostatistics &amp; Epidemiology, Cincinnati Children\u2019s Hospital Medical Centre, OH (N.Z.)."},{"name":"Department of Pediatrics, University of Cincinnati, College of Medicine, OH (N.Z., S.L., S.H.W., A.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7409-6661","authenticated-orcid":true,"given":"Kristen","family":"Danforth","sequence":"additional","affiliation":[{"name":"Department of Global Health (K.D., C.T.L., K.S., M.P., D.W.), University of Washington, Seattle."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison R.","family":"Webel","sequence":"additional","affiliation":[{"name":"Department of Child, Family &amp; Population Health Nursing (A.R.W.), University of Washington, Seattle."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8515-0196","authenticated-orcid":true,"given":"Charles A.","family":"Oyoo","sequence":"additional","affiliation":[{"name":"Department of Non-Communicable Diseases, Ministry of Health, Kampala, Uganda (C.A.O.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9468-0179","authenticated-orcid":true,"given":"Chris T.","family":"Longenecker","sequence":"additional","affiliation":[{"name":"Department of Global Health (K.D., C.T.L., K.S., M.P., D.W.), University of Washington, Seattle."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6798-2737","authenticated-orcid":true,"given":"Craig","family":"Sable","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Ochsner Children\u2019s Hospital, New Orleans, LA (C.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4010-9951","authenticated-orcid":true,"given":"Doreen","family":"Nakagaayi","sequence":"additional","affiliation":[{"name":"Rheumatic Heart Disease Research Collaborative, Uganda Heart Institute, Kampala (J.P., J.K., D.N., F.O., I.O.O., J.R., M.A., R.O., E.O.)."},{"name":"Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda (J.P., J.K., D.N., J.R., N.K.S., E.O.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evaline","family":"Ayaa","sequence":"additional","affiliation":[{"name":"Department of Health, Kitgum District, Uganda (E.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis","family":"Odong","sequence":"additional","affiliation":[{"name":"Rheumatic Heart Disease Research Collaborative, Uganda Heart Institute, Kampala (J.P., J.K., D.N., F.O., I.O.O., J.R., M.A., R.O., E.O.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0524-0364","authenticated-orcid":true,"given":"Isaac O.","family":"Otim","sequence":"additional","affiliation":[{"name":"Rheumatic Heart Disease Research Collaborative, Uganda Heart Institute, Kampala (J.P., J.K., D.N., F.O., I.O.O., J.R., M.A., R.O., 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