Implementing a national acute rheumatic fever case-finding program and registry in Nepal: protocol for a multi-site...

Area of Science:

• Public Health
• Cardiovascular Disease Epidemiology
• Implementation Science

Background:

• Rheumatic heart disease (RHD) is a major cause of preventable death in children and young adults in low-income countries.
• Acute rheumatic fever (ARF), the precursor to RHD, is often undiagnosed, leading to delayed treatment and severe valvular disease.
• Nepal faces a significant RHD burden but lacks a systematic approach for ARF identification and follow-up.

Purpose of the Study:

• To describe the implementation of a standardized ARF case-finding program and integrated registry in Nepal.
• To evaluate the program's acceptability, feasibility, and adoption within existing healthcare infrastructure.
• To provide a model for strengthening ARF detection in other RHD-endemic regions.

Main Methods:

• Implementing a standardized ARF case-finding program using modified Jones criteria and echocardiography across 11 hospitals.
• Integrating the program into existing PEN-Plus chronic disease infrastructure.
• Utilizing REDCap for centralized training and registry-based follow-up, evaluating implementation via Proctor's taxonomy and CFIR.

Main Results:

• The study protocol outlines the implementation of a pragmatic ARF case-finding program.
• Care-process indicators like diagnostic patterns and follow-up completion will be summarized over the first 12 months.
• Implementation outcomes focus on acceptability, feasibility, and adoption, not clinical detection rates.

Conclusions:

• This protocol details a pragmatic approach to embedding ARF case-finding into routine district-level care in Nepal.
• Findings will guide future program evaluations, scale-up, and sustainability efforts.
• The model may be replicable for improving ARF detection in similar low-resource settings globally.