Delivering Rheumatic Heart Disease Diagnosis at Scale: Performance of an Integrated Public Health Screening Program...

Area of Science:

• Cardiology
• Public Health
• Global Health

Background:

• Early echocardiographic detection of rheumatic heart disease (RHD) is crucial for improving patient outcomes.
• Screening for RHD in endemic, resource-limited settings presents significant challenges.
• The Accelerating Delivery of Rheumatic Heart Disease Preventive Services in Northern Uganda program aimed to integrate task-shifted RHD screening into the local health system.

Purpose of the Study:

• To evaluate the impact of a task-shifted RHD screening program on case detection in Northern Uganda.
• To assess the performance of RHD screening conducted by healthcare workers in a resource-limited environment.

Main Methods:

• Programmatic evaluation of 11,793 individuals screened between May 2023 and April 2024.
• Assessment of screening performance metrics (sensitivity, specificity, predictive values, accuracy) using expert-confirmed diagnoses as the gold standard.
• Analysis of factors influencing screening accuracy, including age, sex, and healthcare worker screening volume.

Main Results:

• 126 new cases of RHD were diagnosed among 11,793 individuals screened (6.8% positive rate).
• Screenings by fully trained healthcare workers showed 55% sensitivity and 97% specificity.
• Screening accuracy was influenced by patient demographics and healthcare worker experience, with higher screening volumes correlating with improved accuracy.

Conclusions:

• Task-shifted echocardiographic screening is a viable strategy for integration into low-resource health systems.
• The program successfully trained a local workforce and identified a significant number of new RHD cases.
• Opportunities exist to enhance screening effectiveness through targeted training and advanced technologies to address moderate sensitivity and subgroup variability.