Abstract 4140309: Developing a Community-Informed Service Delivery Model to Increase Uptake of Rheumatic Heart Disease Primary Prevention

Introduction: Primary prevention of rheumatic heart disease (RHD) is aimed at timely diagnosis and treatment of superficial group A Streptococcal infections, most commonly Strep sore throat. However, uptake and delivery of primary prevention in RHD-endemic regions is suboptimal. Development of scalable and sustainable models is urgently needed. Community co-design is an important aspect of development, aimed at ensuring approaches are culturally and contextually appropriate and reach the highest number of community members. Aim: Utilize a community-based participatory research (CBPR) approach to co-develop a model for RHD primary prevention in Uganda. Methods: Group Level Assessment (GLA) was used to evaluate the community’s priorities and provide insights around sore throat in the community to identify potential interventions. Personas, or potential user archetypes, were then developed to capture the behaviors and characteristics of diverse future users of primary prevention in the district. Finally, these personas were used in community co-design workshops to identify barriers and facilitators to potential interventions, generate creative solutions to overcome identified barriers, and prioritize implementation models for testing. The final list of implementation strategies was taken by workshop participants to the broader community for additional validation and feedback. Results: The GLA sessions identified six key priorities: 1) Desire for formal treatment; 2) Lack of access to resources and long distances; 3) Competing traditional methods of treatment; 4) Strong influence of community leaders; 5) Importance of mothers as caregivers; and 6) Need for sore throat awareness and education. Five personas were created including: Hands-on Caregiver, Restricted Caregiver, Removed Family Decision Maker, Helpful Neighbor, and Influential Leader. Design workshops identified the highest rated interventions as train village health teams to diagnose, conduct outreach screening events, and designate a sore throat focal person at health facilities. Participants then proposed potential practical applications of these interventions. Conclusion: CBPR identified novel implementation strategies for an RHD primary prevention program in Uganda. Next steps include evaluation of the acceptability, feasibility, and uptake of these strategies via a planned implementation trial, and improved primary prevention in an RHD-endemic country.