Peprah Emmanuel, Gyamfi Joyce, Patena John, Kayalioglu Hazal, Hameed Tania, Ogedegbe Gbenga, Do Hyungrok, Ojji Dike, Adenikinju Deborah, Ajaye Oba Tayo, Nwegbu Maxwell, Isa Hezekiah, Shedul Grace, Sopekan Alayo Y, Nnodu Obiageli E
Department of Global and Environmental Health, Implementing Sustainable Evidenced-based interventions through Engagement (ISEE Lab), NYU School of Global Public Health, New York, NY, United States of America.
Institute for Excellence in Health Equity, NYU Langone Medical Center, New York, NY, United States of America.
PLoS One. 2025 Jan 8;20(1):e0311900. doi: 10.1371/journal.pone.0311900. eCollection 2025.
Despite the proven efficacy of evidence-based healthcare interventions in reducing adverse outcomes and mortality associated with Sickle Cell Disease (SCD), a vast majority of affected individuals in Africa remain deprived of such care. Hydroxyurea (HU) utilization among SCD patients in Sub-Saharan Africa (SSA) stands at less than 1%, while in Nigeria, approximately 13% of patients benefit from HU therapy. To enhance HU utilization, targeted implementation strategies addressing provider-level barriers are imperative. Existing evidence underscores the significance of addressing barriers such as inadequate healthcare worker training to improve HU adoption. The ACCELERATE study aims to evaluate the adoption of HU among providers through the Screen, Initiate, and Maintain (SIM) intervention, facilitated by healthcare worker training, clinical reminders, and task-sharing strategies, thereby enhancing patient-level SCD management in Nigeria.
This study will implement the SIM intervention, encompassing patient screening, initiation of HU treatment, and maintenance of dosage, which will be implemented via the TAsk-Strengthening Strategy for Hemoglobinopathies (TASSH TCP), derived from our team's TAsk-Strengthening Strategy for Hypertension control (TASSH) trials. Employing a sequential exploratory mixed-methods approach within the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, this study will assess SIM adoption by providers in Nigeria. The primary outcome is the rate of SIM adoption at clinical sites at 12 months, with secondary outcomes including sustainability/maintenance of SIM intervention and implementation fidelity.
This study's findings will offer crucial insights into effective SCD management strategies, leveraging existing SCD clinical networks and resources in Nigeria to enhance HU adoption among providers in a scalable and sustainable manner. Additionally, the study will inform best practices for implementing HU therapy in resource-constrained settings, benefiting healthcare providers, policymakers, and stakeholders invested in improving SCD care delivery.
NCT06318143.
尽管循证医疗干预措施在降低与镰状细胞病（SCD）相关的不良结局和死亡率方面已被证明有效，但非洲绝大多数受影响个体仍无法获得此类护理。撒哈拉以南非洲（SSA）的SCD患者中羟基脲（HU）的使用率不到1%，而在尼日利亚，约13%的患者受益于HU治疗。为提高HU的使用率，必须制定针对性的实施策略，解决提供者层面的障碍。现有证据强调了解决诸如医护人员培训不足等障碍对提高HU采用率的重要性。加速研究旨在通过筛查、启动和维持（SIM）干预措施评估提供者对HU的采用情况，该干预措施由医护人员培训、临床提醒和任务分担策略推动，从而加强尼日利亚患者层面的SCD管理。
本研究将实施SIM干预措施，包括患者筛查、HU治疗启动和剂量维持，将通过血红蛋白病任务强化策略（TASSH TCP）来实施，该策略源自我们团队的高血压控制任务强化策略（TASSH）试验。本研究将在探索、准备、实施和维持（EPIS）框架内采用序贯探索性混合方法，评估尼日利亚提供者对SIM的采用情况。主要结局是临床场所12个月时SIM的采用率，次要结局包括SIM干预措施的可持续性/维持情况和实施保真度。
本研究的结果将为有效的SCD管理策略提供关键见解，利用尼日利亚现有的SCD临床网络和资源，以可扩展和可持续的方式提高提供者对HU的采用率。此外，该研究将为在资源有限的环境中实施HU治疗提供最佳实践信息，使致力于改善SCD护理服务的医疗保健提供者、政策制定者和利益相关者受益。
NCT06318143。
