Table 1.

Comparison of current and proposed SAP delivery approaches

	Current approach—National RHD Registry	Proposed approach—Decentralised RHD Registry at district-level health facilities
Location	Limited to central and regional referral centres	Expansion to Health centres III/IV (Lira and Gulu districts)
Staff	Dedicated research staff regionally	This approach will incorporate existing MOH staff at HCIII/IV at district and regional hospitals, as well as administrators and different stakeholders from Ministerial representatives
Patient records and data	REDCap/paper-based clinical records Web-based electronic database largely supporting research activities A mix of direct entry and transfer of paper records have been used. Not scalable; not enabled to support clinical management.	ACT application Keeps track of BPG injections Automatic adherence calculation Intended for direct entry by HCWs Managing patient features categorised for ‘due’ and ‘missed’ injections Iterative—patient reminder integration and tracking; clinician/specialist/MOH representative communication features Quality metrics—allows easily generated quality reports for examining overall adherence, referrals for procedures and the ability to compare across facilities and regions. Potentially scalable nationwide for RHD and other chronic illnesses.

ACT, active community case management tool; BPG, benzathine penicillin G; HC III/IV, health centre III/IV; HCW, healthcare worker; MOH, Ministry of Health; RHD, rheumatic heart disease; SAP, secondary antibiotic prophylaxis.