Rheumatic Heart Disease Treatment Cascade in Uganda

Area of Science:

• Cardiology
• Public Health
• Infectious Diseases

Background:

• Rheumatic Heart Disease (RHD) causes significant premature mortality and disability in low-income nations.
• Optimal benzathine penicillin G (BPG) therapy is underutilized for RHD prevention.
• Understanding the RHD treatment cascade in Uganda is vital for targeted interventions.

Purpose of the Study:

• To comprehensively describe the RHD treatment cascade in Uganda.
• To identify key barriers and facilitators for optimal BPG therapy.
• To inform strategies for improving RHD management and outcomes.

Main Methods:

• Analysis of data from the Uganda RHD Registry (n=1504).
• Assessment of patient categories: diagnosed/alive, retained in care, prescribed BPG, and optimally adherent to BPG.
• Logistic regression used to identify factors associated with retention and adherence.

Main Results:

• Retention in care (56.9%) was the primary barrier to optimal BPG adherence.
• Among retained patients, BPG prescription (91.6%) and adherence (91.4%) were high.
• Younger age, latent disease, and regional care access predicted better retention and adherence.

Conclusions:

• Improving retention in care is the most impactful strategy to increase antibiotic prophylaxis uptake in Ugandan RHD patients.
• Decentralizing RHD services may enhance patient retention and adherence to BPG therapy.
• Targeted interventions focusing on retention are recommended for RHD management in Uganda.