NEARER SCAN (LENO BESIK) evaluation of a task-sharing echocardiographic active case finding programme for rheumatic heart disease in Australia and Timor-Leste: protocol for a hybrid type II effectiveness-implementation study
Mike English,
Alex Brown,
James Marangou,
Shobhana Nagraj,
Jonathan Carapetis,
Bo Remenyi,
Karla Canuto,
Jeffrey W Cannon,
Paul Burgess,
Peter Morris,
Alex Kaethner,
Anna Ralph,
Jennifer Yan,
Vicki Wade,
Daniel Engelman,
Andrew Steer,
Judith M Katzenellenbogen,
Bart J Currie,
Benjamin Jones,
Gavin Wheaton,
David Simon,
Holger Unger,
Graham Hillis,
Natasha J Howard,
Joshua R Francis,
Emma Haynes,
Maida Stewart,
Salvador Amaral,
Alice Mitchell,
Anferida Fernandes Monteiro,
Marisa Gilles,
Herculano Seixas,
Joaquina Maurays,
Jade Neave,
Chantelle Pears,
Meghan Bailey,
Maria Tanesi,
Helder Neto,
Jacqui Williamson,
Jessica de Dassel,
Simon Slota-Kan
Affiliations
Mike English
1 Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
Alex Brown
Indigenous Health, The Kids Research Institute Australia, Perth, WA, Australia
James Marangou
3 Department of Cardiology, Royal Darwin Hospital, Tiwi, Northern Territory, Australia
Shobhana Nagraj
assistant professor of primary and community care
Jonathan Carapetis
Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
Bo Remenyi
Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
Karla Canuto
Rural and Remote Health, Flinders University, Darwin, Northern Territory, Australia
Jeffrey W Cannon
Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
Paul Burgess
3UCL Institute of Cognitive Neuroscience, London, UK
Peter Morris
University Hospital Geelong, Geelong, VIC, Australia
Alex Kaethner
NT Cardiac, Darwin, Northern Territory, Australia
Anna Ralph
Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
Jennifer Yan
Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
Vicki Wade
RHD Australia, Menzies School of Health Research, Casuarina, New South Wales, Australia
Daniel Engelman
Centre for International Child Heath, The Royal Children`s Hospital Melbourne, Parkville, Victoria, Australia
Andrew Steer
Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
Judith M Katzenellenbogen
School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
Bart J Currie
4Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
Benjamin Jones
Imperial College Healthcare NHS Trust, London, UK
Gavin Wheaton
Division of Paediatric Medicine, Women`s and Children`s Health Network, South Australia, Australia
David Simon
Department of Internal Medicine 3—Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
Holger Unger
third year medical student
Graham Hillis
Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
Natasha J Howard
4 Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
Joshua R Francis
Centro Integrado de Gestao de Crises, Dili, Timor-Leste
Emma Haynes
Centre for Aboriginal Medical and Dental Health, The University of Western Australia, Perth, Western Australia, Australia
Maida Stewart
Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
Salvador Amaral
Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
Alice Mitchell
2 Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
Anferida Fernandes Monteiro
2 Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
Marisa Gilles
9 Western Australia Country Health Service, Perth, Western Australia, Australia
Herculano Seixas
11 Hospital Nacional Guido Valadares, Dili, Timor-Leste
Joaquina Maurays
12 Maluk Timor, Dili, Timor-Leste
Jade Neave
2 Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
Chantelle Pears
9 Western Australia Country Health Service, Perth, Western Australia, Australia
Meghan Bailey
2 Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
Maria Tanesi
2 Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
Helder Neto
16 Timor-Leste Ministerio da Saude, Dili, Timor-Leste
Jacqui Williamson
2 Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
Jessica de Dassel
2 Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
Simon Slota-Kan
9 Western Australia Country Health Service, Perth, Western Australia, Australia
Introduction Rheumatic heart disease (RHD) is underdiagnosed globally resulting in missed treatment opportunities and adverse clinical outcomes. We describe the protocol for a study which aims to co-design, implement and conduct an evaluation of a task-sharing approach to echocardiographic active case finding for early detection and management of RHD in high-risk settings in Australia and Timor-Leste.Methods and analysis Echocardiograms will be obtained by trained local staff using hand-held echocardiographic devices employing the ‘Single Parasternal Long Axis view with a Sweep of the Heart’ (SPLASH) technique and interpreted by experts remote from the site of acquisition. Approximately 1500 children and pregnant women will be screened across high-risk communities in Australia and Timor-Leste over an 18-month period. The study will use a type II effectiveness-implementation hybrid design. A tailored package of implementation strategies will be co-designed with communities and health services and mapped onto a Theory of Change framework. The clinical effectiveness will be assessed as the change in the proportion of the target population that are prescribed secondary prophylaxis for RHD by the end of the study compared with baseline. The implementation will be assessed as the adoption, penetration, sustainability, fidelity and cost of the programme with a mixed-methods theory-based and economic evaluation. Data will include numbers of normal, abnormal and uninterpretable SPLASH echocardiograms obtained, numbers of participants progressing through the cascade of care, interviews with staff and programme costs.Ethics and dissemination Ethical approval has been obtained from the Human Research Ethics Committee of the NT Department of Health and Menzies School of Health Research, Darwin (HREC-2022-4479), the Western Australian Aboriginal Health Ethics Committee (HREC-1237) and the Instituto Nasional Saude Publika Timor-Leste Ethics and Technical Committee (03-UEPD/INSP-TL/V/2023). Informed consent is required to be enrolled. Study findings will be disseminated in the communities involved and submitted for publication.Trial registration number NCT06002243.
