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Early Implementation and Clinical Outcomes of an Integrated Rheumatic Heart Disease Screening and Treatment Program
Jafesi Pulle1,2, James Kayima1,2, Nanhua Zhang3,4
1Rheumatic 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.).
Circulation. Population Health and Outcomes
|May 1, 2026
Summary
This study implemented rheumatic heart disease (RHD) screening and prophylaxis in Uganda, achieving acceptable adherence to treatment. The RHD care cascade effectively monitored program outcomes and identified areas for improvement.
Area of Science:
- Cardiology
- Public Health
- Implementation Science
Background:
- Rheumatic heart disease (RHD) screening and secondary prophylaxis are WHO-recommended but implementation evidence is limited.
- Northern Uganda initiated an RHD program integrating primary healthcare with echocardiographic screening and antibiotic prophylaxis.
Purpose of the Study:
- To report on the early implementation and clinical outcomes of an RHD program in northern Uganda.
- To evaluate the effectiveness of integrating RHD screening and prophylaxis into primary healthcare.
Main Methods:
- Primary healthcare workers were trained in RHD screening and registry-based secondary antibiotic prophylaxis.
- An RHD care cascade framework was used to analyze screening uptake, confirmatory echocardiograms, and adherence to prophylaxis.
- Data were collected from program reports and the national RHD registry over 18 months.
Main Results:
- Over 18 months, 25,358 individuals were screened, identifying 333 confirmed RHD cases.
- 80% of positive screens received confirmatory echocardiograms, and 75% of confirmed cases achieved acceptable adherence to prophylaxis.
- Most individuals who defaulted from prophylaxis did so within 6 months of enrollment.
Conclusions:
- An integrated RHD program in Uganda successfully delivered echocardiographic screening via primary healthcare.
- The program demonstrated acceptable early clinical outcomes for RHD management.
- The RHD care cascade is a valuable tool for monitoring and improving similar RHD programs.
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