{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T20:04:49Z","timestamp":1784923489784,"version":"3.55.0"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,3,3]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Early echocardiographic detection improves rheumatic heart disease (RHD) outcomes, but screening in endemic, resource\u2010limited settings remains a challenge. The Accelerating Delivery of Rheumatic Heart Disease Preventive Services in Northern Uganda program was developed to integrate task\u2010shifted RHD screening into the existing health system in Kitgum, Uganda. We evaluated the program\u2019s impact on RHD case detection and assessed screening performance during its first year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">We conducted a programmatic evaluation of all individuals screened via the program from May 2023 to April 2024, describing demographic and echocardiographic findings. We assessed sensitivity, specificity, predictive values, and accuracy of screenings performed by health care workers who had completed the full training, using expert\u2010confirmed diagnoses as the gold standard.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">Of 11\u2009793 individuals screened, 806 (6.8%) screened positive, with 544 receiving confirmatory testing. A total of 126 new RHD cases were diagnosed (74 mild, 52 moderate\/severe). Among 3243 screenings by fully trained health care workers, sensitivity was 55% (95% CI, 47%\u201363%), specificity 97% (95% CI, 97%\u201398%), positive predictive value 52% (95% CI, 45%\u201360%), negative predictive value 98% (95% CI, 97%\u201398%), and accuracy 95% (95% CI, 95%\u201396%). Accuracy varied with age, sex, and health care worker screening volume: older age (odds ratio [OR], 0.96 [95% CI, 0.93\u20130.98]) and female sex (OR, 0.46 [95% CI, 0.22\u20130.91]) were associated with decreased accuracy, whereas higher screening volume improved accuracy (OR, 5.24 [95% CI, 2.52\u201310.65]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Task\u2010shifted echocardiographic screening can be effectively integrated into low\u2010resource health systems. Accelerating Delivery of Rheumatic Heart Disease Preventive Services in Northern Uganda trained a local screening workforce and identified 126 new RHD cases in its first year. Moderate sensitivity and subgroup variability indicate opportunities for improvement through targeted training and supportive technologies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.043275","type":"journal-article","created":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T12:18:00Z","timestamp":1771589880000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Delivering Rheumatic Heart Disease Diagnosis at Scale: Performance of an Integrated Public Health Screening Program in Northern Uganda"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3901-2669","authenticated-orcid":false,"given":"Scott H.","family":"Wirth","sequence":"first","affiliation":[{"name":"Heart Institute, Cincinnati Children\u2019s Hospital Medical Center","place":["Cincinnati, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7955-3481","authenticated-orcid":false,"given":"Jafesi","family":"Pulle","sequence":"additional","affiliation":[{"name":"Uganda Heart Institute","place":["Kampala, Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles Oyoo","family":"Akiya","sequence":"additional","affiliation":[{"name":"Uganda Ministry of Health","place":["Kampala, Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evaline","family":"Ayaa","sequence":"additional","affiliation":[{"name":"Kitgum District","place":["Kitgum, Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michaela","family":"Pardo","sequence":"additional","affiliation":[{"name":"Heart Institute, Cincinnati Children\u2019s Hospital Medical Center","place":["Cincinnati, 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Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6798-2737","authenticated-orcid":false,"given":"Craig","family":"Sable","sequence":"additional","affiliation":[{"name":"Children\u2019s National Medical Center","place":["Washington, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9689-4998","authenticated-orcid":false,"given":"Alison","family":"Spaziani","sequence":"additional","affiliation":[{"name":"University of Washington","place":["Seattle, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3432-1430","authenticated-orcid":false,"given":"Paul W.","family":"Warren","sequence":"additional","affiliation":[{"name":"Heart Institute, Cincinnati Children\u2019s Hospital Medical Center","place":["Cincinnati, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9404-7368","authenticated-orcid":false,"given":"Nicholas J.","family":"Ollberding","sequence":"additional","affiliation":[{"name":"Heart Institute, Cincinnati Children\u2019s Hospital Medical Center","place":["Cincinnati, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry Otto","family":"Okello","sequence":"additional","affiliation":[{"name":"Kitgum District","place":["Kitgum, Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6341-9595","authenticated-orcid":false,"given":"David A.","family":"Watkins","sequence":"additional","affiliation":[{"name":"University of Washington","place":["Seattle, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7409-6661","authenticated-orcid":false,"given":"Kristen","family":"Danforth","sequence":"additional","affiliation":[{"name":"University of Washington","place":["Seattle, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6109-0092","authenticated-orcid":false,"given":"Emmy","family":"Okello","sequence":"additional","affiliation":[{"name":"Uganda Heart Institute","place":["Kampala, Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4963-355X","authenticated-orcid":false,"given":"Andrea","family":"Beaton","sequence":"additional","affiliation":[{"name":"Heart Institute, Cincinnati Children\u2019s Hospital Medical Center","place":["Cincinnati, 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