Abstract 18798: Application of the HIV/AIDS Treatment Cascade Model to Rheumatic Heart Disease in Uganda
Introduction: The treatment cascade model has been an effective tool to evaluate HIV/AIDS control programs throughout the world. Application of this model to rheumatic heart disease (RHD) may identify critical barriers to treatment across the entire continuum of care.
Methods: Data from three echocardiographic screening studies conducted from 2010-2013 and from an RHD registry in Kampala, Uganda were pooled together for this analysis. We describe the following categories of care: (1) total identified cases of definite subclinical and clinical RHD; (2) patients linked to care (at least one initial visit with an RHD provider); (3) patients retained in care (clinical follow-up within last 6 months); and (4) patients who are optimally adherent to benzathine penicillin G (BPG) prophylaxis (>80% of injections over prior 12 months).
Results: Excluding cases known to have died during follow-up, a total of 764 cases of definite RHD were identified, including 81 subclinical cases detected by echocardiographic screening. The treatment cascade is depicted in the Figure. Overall, linkage to care was excellent, although retention in care was poor. Retention was higher among patients identified through echocardiographic screening compared to those identified clinically (84% vs. 45%, p<0.001). Eighty-four percent of those who were retained in care were optimally adherent.
Conclusion: A national RHD control program is coalescing around a collaboration of governmental and non-governmental organizations in Uganda. The treatment cascade model, initially developed for HIV/AIDS care, may be an effective tool to evaluate the clinical and cost-effectiveness of national RHD controls programs.
- Health services research
- Acquired immunodeficiency syndrome
- Healthcare delivery systems
- Valvular heart disease
Author Disclosures: C. Longenecker: None. E. Okello: None. T. Aliku: None. A. Beaton: None. G. Mirembe: None. A. Webel: None. P. Lwabi: None. C. Kityo: None. V. Musiime: None. C. Sable: None. M. Kamya: None. M. Costa: None. R. Salata: None. D. Simon: None.
- © 2014 by American Heart Association, Inc.