Uganda Heart Institute (UHI), is a specialized, public, tertiary care medical facility owned by the Uganda Ministry of Health. It is a component of Mulago National Referral Hospital, the largest hospital in Uganda, which serves as the teaching hospital of Makerere University College of Health Sciences.
Rheumatic heart disease (RHD) represents a significant global health challenge, disproportionately affecting over 40 million people in low- and middle-income countries. Early detection through color Doppler echocardiography is crucial for treating RHD, but it requires specialized physicians who are often scarce in resource-limited settings. To address this disparity, artificial intelligence (AI)-driven tools for RHD screening can provide scalable, autonomous solutions to improve access to critical healthcare services in underserved regions. This paper introduces RADAR (Rapid AI-Assisted Echocardiography Detection and Analysis of RHD), a novel and generalizable AI approach for end-to-end spatiotemporal analysis of color Doppler echocardiograms, aimed at detecting early RHD in resource-limited settings. RADAR identifies key imaging views and employs convolutional neural networks to analyze diagnostically relevant phases of the cardiac cycle. It also localizes essential anatomical regions and examines blood flow patterns. It then integrates all findings into a cohesive analytical framework. RADAR was trained and validated on 1,022 echocardiogram videos from 511 Ugandan children, acquired using standard portable ultrasound devices. An independent set of 318 cases, acquired using a handheld ultrasound device with diverse imaging characteristics, was also tested. On the validation set, RADAR outperformed existing methods, achieving an average accuracy of 0.92, sensitivity of 0.94, and specificity of 0.90. In independent testing, it maintained high, clinically acceptable performance, with an average accuracy of 0.79, sensitivity of 0.87, and specificity of 0.70. These results highlight RADAR’s potential to improve RHD detection and promote health equity for vulnerable children by enhancing timely, accurate diagnoses in underserved regions.
Rheumatic heart disease is a major cause of premature cardiovascular morbidity and mortality globally. Over the past decade, echocardiographic screening has changed our understanding of the natural history of RHD, revealing a high burden of clinically silent, mild RHD among people who cannot recall a history of preceding acute rheumatic fever. This viewpoint outlines the evidence that this earliest form of rheumatic heart disease, only detectable through echocardiographic screening, is an intermediate stage that many, but not all, individuals may pass through on the pathway to advanced rheumatic heart disease. This shift in understanding has important clinical and research implications, including introducing a new and more pragmatic target for Streptococcus pyogenes vaccine trials for the indication of rheumatic heart disease prevention.
Background:Uganda's established HIV service platform could support integrated hypertension care, but organizational conditions required for implementation in resource-limited settings are poorly described. We characterized organizational readiness, implementation leadership, and implementation citizenship behaviour during implementation of integrated HIV-hypertension care in Kampala and Wakiso districts, Uganda. Methods:We conducted a prospective cohort study nested within a stepped-wedge cluster-randomized trial at 16 public and private-not-for-profit HIV clinics implementing "hypertension BASIC- (basic training, supply of blood pressure devices and medications)" or "hypertension PLUS (BASIC components plus enhanced training, performance feedback and differentiated service delivery for hypertension)". Healthcare providers completed the 12-item Organizational Readiness for Implementing Change scale at intervention rollout and trial completion, and the 12-item Implementation Leadership Scale and Implementation Citizenship Behavior Scale (six items) at six months and post intervention. Scores were standardized to 0-100. Changes were assessed using independent-samples tests, with facility-clustered linear regression as sensitivity analyses. Intraclass correlation coefficients (ICCs) assessed agreement between clinic-lead self-ratings and staff ratings. Results:Forty-three healthcare providers participated at baseline, 42 at six months, and 41 at completion. The median age was 34 years (IQR: 30-42), and 24 (56%) were female Organizational readiness remained high (mean scores, 88.8-94.6% across arms and assessment periods), without significant changes over time. Leadership scores generally exceeded 75%, while citizenship behaviour scores exceeded 80%. In facility-clustered analyses, HTN PLUS clinic leads reported increases in overall leadership (10.7 percentage points; 95% CI 1.1-20.3, p=0.009) and proactive leadership (12.8; 95% CI 0.8-24.9, p=0.026); HTN BASIC clinic leads reported increased supportive leadership (19.2; 95% CI 6.0-32.4, p=0.012). Staff leadership ratings and citizenship behaviour did not change significantly. Conclusion:Trial-supported HIV clinics demonstrated sustained readiness, strong leadership, and supportive citizenship behaviours for integrated care. However, declining leader-staff agreement highlights the value of multisource feedback. Future analyses should determine whether these organizational conditions translate into improved adoption, fidelity, and clinical outcomes. Trial Registration #:NCT05609513. Registration date, November 8, 2022.
