{
  "abstract": "Introduction Detection and treatment of streptococcal pharyngitis in children reduces acute rheumatic fever by 70–80%. However, investment in primary prevention is limited in rheumatic heart disease (RHD) endemic countries due to lack of diagnostic capacity. We conducted a pragmatic public health trial ( Rheumatic Heart Disease Community Streptococcal Treatment Program (RESET)) to determine the effect of an integrated group A streptococcal (GAS) education and treatment programme on the echocardiographic burden of RHD among children aged 5–15 years in Uganda.Methods We implemented our interventions within the primary healthcare system of Tororo district, Eastern Uganda, over 2 years. The primary outcome was a reduction in RHD prevalence. Secondary outcomes included improved provider and community knowledge and increased health-seeking behaviour for sore throat. Interventions targeted three key barriers to primary prevention: limited provider expertise in diagnosing and treating GAS pharyngitis, poor uptake of guideline-based treatment and low public awareness of the link between sore throat and RHD.Results There was no significant change in RHD prevalence from baseline (0.66%, 95% CI 0.58% to 0.73%) to 2 years post-implementation (0.61%, 95% CI 0.51% to 0.71%). Primary training was completed by 101 healthcare workers with knowledge scores improving from 55% pre-training to 75% post-training. Secondary training reached 470 providers across 81 facilities. Facility assessments found only one-third met nearly all readiness metrics. Over 2000 community education events reached an estimated 380 000 people. Recognition of sore throat as a serious issue improved with 89% post-campaign identifying its link to heart disease. Health centre logs showed no increase in sore throat presentations over 22 months.Conclusion As the first large-scale integrated primary prevention programme for RHD in sub-Saharan Africa, RESET demonstrated both feasibility of scaling up patient and provider education and implementation challenges in translating education into action. Ongoing research aims to identify care-seeking barriers and co-design a sore throat treatment model tailored to the community’s cultural and contextual needs.Trial registration number NCT05276999.",
  "authors": [
    {
      "affiliations": [
        "Uganda Heart Institute, Kampala, Uganda"
      ],
      "name": "Emma Ndagire"
    },
    {
      "affiliations": [
        "Uganda Heart Institute, Kampala, Uganda"
      ],
      "name": "Joselyn Rwebembera"
    },
    {
      "affiliations": [
        "Uganda Heart Institute, Kampala, Uganda"
      ],
      "name": "Gloria Kaudha"
    },
    {
      "affiliations": [
        "Uganda Heart Institute, Kampala, Uganda"
      ],
      "name": "Jafesi Pulle"
    },
    {
      "affiliations": [
        "Uganda Heart Institute, Kampala, Uganda"
      ],
      "name": "Miriam Nakitto"
    },
    {
      "affiliations": [
        "Uganda Heart Institute, Kampala, Uganda"
      ],
      "name": "Juliet Alepere"
    },
    {
      "affiliations": [
        "Uganda Heart Institute, Kampala, Uganda"
      ],
      "name": "Jane-Liz Nambogo"
    },
    {
      "affiliations": [
        "Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA"
      ],
      "name": "Ndate Fall"
    },
    {
      "affiliations": [
        "Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Amy Scheel"
    },
    {
      "affiliations": [
        "Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA"
      ],
      "name": "Sarah de Loizaga"
    },
    {
      "affiliations": [
        "Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA"
      ],
      "name": "McCall Miller"
    },
    {
      "affiliations": [
        "Uganda Heart Institute, Kampala, Uganda"
      ],
      "name": "Mucunguzi Atukunda"
    },
    {
      "affiliations": [
        "Children's National Hospital, Washington, DC, USA"
      ],
      "name": "Rachel Sarnacki"
    },
    {
      "affiliations": [
        "Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA",
        "University of Cincinnati College of Medicine, Cincinnati, Ohio, USA"
      ],
      "name": "Nanhua Zhang"
    },
    {
      "affiliations": [
        "Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA",
        "University of Cincinnati College of Medicine, Cincinnati, Ohio, USA"
      ],
      "name": "Nicholas J Ollberding"
    },
    {
      "affiliations": [
        "Ochsner Children’s Hospital, New Orleans, Louisiana, USA"
      ],
      "name": "Craig Sable"
    },
    {
      "affiliations": [
        "All India Institute of Medical Sciences, Delhi, India",
        "Translational Health Science and Technology Institute, National Capital Region, Faridabad, Pali, Haryana, India"
      ],
      "name": "Ganesan Karthikeyan"
    },
    {
      "affiliations": [
        "Uganda Heart Institute, Kampala, Uganda"
      ],
      "name": "Emmy Okello"
    },
    {
      "affiliations": [
        "Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA",
        "University of Cincinnati College of Medicine, Cincinnati, Ohio, USA"
      ],
      "name": "Andrea Beaton"
    }
  ],
  "title": "Implementation and evaluation of a pragmatic community streptococcal treatment programme to improve rheumatic heart disease primary prevention in Uganda",
  "uid": "e49d486d-bcf7-5b2c-98a2-2b53022d3218"
}