Testing a Registry-Based Strategy (ACT+) to Reduce Loss to Follow-Up in Rheumatic Heart Disease Screening in Uganda

Developing and Testing a Registry-Enabled Strategy (ACT+) to Reduce Loss to Follow-Up Between Screening and Confirmation of Rheumatic Heart Disease in Uganda

This study aims to improve follow-up care after positive rheumatic heart disease (RHD) screening in Northern Uganda. It will identify barriers and co-develop an enhanced ACT+ strategy, then evaluate its effectiveness in increasing linkage to confirmatory echocardiography, along with its adoption, acceptability, and feasibility. Secondary outcomes include time to diagnosis, initiation of treatment, and factors influencing implementation.

Inclusion Criteria: Community Members

• 18 years of age or older
• Received a positive ADUNU echocardiographic screening result within the past 24 months OR parent/legal guardian of a minor who received a positive ADUNU echocardiographic screening result within the past 24 months

Inclusion Criteria: Providers

• Employed at an ADUNU-participating facility or confirmatory echo facilities at the time of study
• Holds a designated ADUNU role (nurse screener, confirmatory provider, or referral support staff) or is involved in RHD screening, diagnosis or care
• Ability to provide informed consent in Acholi, Luo, or English

Inclusion Criteria: Regional RHT ACT Nurse Coordinator

• Employed as a Regional ACT Nurse at the time of study
• Has familiarity with ADUNU program
• Ability to provide informed consent in Acholi, Luo, or English

Inclusion Criteria: District Health Office Team Members and District RHD Focal Persons

• Employed at District Health Office within an ADUNU-participating district
• Has familiarity with ADUNU program
• Ability to provide informed consent in Acholi, Luo, or English

Exclusion Criteria:

• No formal exclusion criteria beyond inability to provide informed consent. Individuals with significant cognitive or communication impairment precluding interview participation will not be enrolled.