Universal Newborn Screening For Sickle Cell Disease In Mozambique
Tutkimuksen yleiskatsaus
Tila
Tila
Ehdot
Ehdot
Interventio / Hoito
Interventio / Hoito
Yksityiskohtainen kuvaus
This prospective mixed-methods hybrid effectiveness-implementation feasibility study will evaluate the feasibility and effectiveness of an implementation strategy package designed to improve early diagnosis and care entry for children born with sickle cell disease (SCD) in rural, low-resource settings. The implementation strategy package includes three components: 1) integration of essential products into national supply chain systems, 2) integration of systematic newborn screening using point-of-care-testing into clinical site workflows and 3) linkage of children who screen positive to a PEN-Plus Non-Communicable Disease (NCD) clinic for longitudinal care. Participants will be tracked longitudinally to evaluate protocol adoption over time and clinical outcomes among participating children at 2 years of age.
Primary Objective
- To test if combining three multi-level implementation strategies can facilitate systematic birth diagnosis and timely linkage to evidence-based care interventions for infants with SCD in under-resourced settings.
Secondary Objectives (Micro level):
- To test the clinical effectiveness of implementing the BB-SCD through the three combined implementation strategies to prevent excess mortality of children with SCD under the age of 2 years.
- To evaluate the effectiveness of combining the three implementation strategies to promote care retention among infants with SCD by 2 years of age.
Secondary Objectives (Meso level)
- To evaluate the institutional coverage and health facility staff adoption of the treatment for infants through the combined implementation strategies.
- To evaluate the need for a confirmatory test among positive and negative screening results using POCT.
- To conduct a cost-effectiveness analysis of the combined implementation strategies.
Secondary Objective (Macro level)
- To evaluate the operational effectiveness of integrating the procurement of SCD consumables into national supply chain systems to achieve sustainable availability, effective last mile delivery to relevant clinics and stockout avoidance.
Opintotyyppi
Opintotyyppi
Ilmoittautuminen (Arvioitu)
Ilmoittautuminen
Vaihe
Vaihe
- Ei sovellettavissa
Yhteystiedot ja paikat
Opiskeluyhteys
Opiskeluyhteys
- Nimi: Jane Hankins, MD
- Puhelinnumero: 888-226-4343
- Sähköposti: referralinfo@stjude.org
Osallistumiskriteerit
Kelpoisuusvaatimukset
Kelpoisuusvaatimukset
Opintokelpoiset iät
- Lapsi
- Aikuinen
- Vanhempi Aikuinen
Hyväksyy terveitä vapaaehtoisia
Kuvaus
Inclusion Criteria:
- Children participants: All infants between birth and 6.0 months of age who are born or receive care at secondary-level facilities involved in the UNIQUE study.
Children participants will fall into one of two categories:
- Patient participants: All infants between birth and 6.0 months of age who were screened through the UNIQUE study and tested positive for SCD (HbSS, HbSC, or other form of SCD) or had indeterminate results.
- Healthy control participants: Infants between birth and 6.0 months of age who screen negative for SCD (HbAA) through the UNIQUE study or tested positive for sickle cell trait (HbAS).
- Health facility staff participants: Healthcare staff ages ≥18 years working at secondary-level facilities involved in the UNIQUE study.
- Supply chain expert participants: Administrative professionals with experience working in or around the national supply chain systems in Mozambique to support procurement, importation, customs clearance, storage, and in-country distribution of medical products.
- National public health system expert participants: Administrative professionals with experience working in the national public health system (e.g., Ministry of Health, MISAU) who oversee the delivery of health services to infants in-country, such as neonatal testing and vaccination programs.
Exclusion Criteria:
Children participants:
- Stillbirths.
- Children who received an erythrocyte (blood) transfusion within 3 months of testing. Exogenous (transfused) HbA could artificially lower the sickle hemoglobin concentration, thus causing false-negative results.
- Patient participants: none
Healthy control participants:
- Stillbirths.
- Children who received an erythrocyte (blood) transfusion within 3 months of testing. Exogenous (transfused) HbA could artificially lower the sickle hemoglobin concentration, thus causing false-negative results.
- Health facility staff participants: none.
- Supply chain expert participants: none.
- National public health system expert participants: none.
Opintosuunnitelma
Miten tutkimus on suunniteltu?
Suunnittelun yksityiskohdat
- Ensisijainen käyttötarkoitus: Muut
- Jako: Ei satunnaistettu
- Inventiomalli: Rinnakkaistehtävä
- Naamiointi: Ei mitään (avoin tarra)
Aseiden lukumäärä
Aseet ja interventiot
Osallistujaryhmä / ArmOsallistujaryhmä / Arm |
Interventio / HoitoInterventio / Hoito |
|---|---|
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Muut: Patient participants
All infants between birth and 6.0 months of age who were screened through the UNIQUE study and tested positive for SCD (HbSS, HbSC, or other form of SCD) or had indeterminate results.
|
Infants will be screened for Sickle Cell Disease using with point-of-care testing (POCT).
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Muut: Healthy control participants
Infants between birth and 6.0 months of age who screen negative for SCD (HbAA) through the UNIQUE study or tested positive for sickle cell trait (HbAS).
|
Infants will be screened for Sickle Cell Disease using with point-of-care testing (POCT) and prospectively monitored for survival.
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Muut: Health facility staff participants
Healthcare staff ages ≥18 years working at secondary-level facilities involved in the UNIQUE study.
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The COACH survey will collect quantitative data on eight contextual factors that impact a site's ability to implement evidence-based interventions.
Interview questions will revolve primarily around the current process for SCD screening and care referrals, factors impacting newborn care delivery and screening, and challenges to integrating SCD newborn screening and care referral into standard care delivery.
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Muut: Supply chain expert participants
Administrative professionals with experience working in or around the national supply chain systems in Mozambique to support procurement, importation, customs clearance, storage, and in-country distribution of medical products.
|
Interview questions will revolve primarily around the current process for SCD screening and care referrals, factors impacting newborn care delivery and screening, and challenges to integrating SCD newborn screening and care referral into standard care delivery.
|
|
Muut: National public health system expert participants
Administrative professionals with experience working in the national public health system (e.g., Ministry of Health, MISAU) who oversee the delivery of health services to infants in-country, such as neonatal testing and vaccination programs.
|
Interview questions will revolve primarily around the current process for SCD screening and care referrals, factors impacting newborn care delivery and screening, and challenges to integrating SCD newborn screening and care referral into standard care delivery.
|
Mitä tutkimuksessa mitataan?
Ensisijaiset tulostoimenpiteet
Ensisijaiset tulostoimenpiteet
Tulosmittaus |
Aikaikkuna |
|---|---|
|
Percentage of eligible population screened for Sickle Cell Disease
Aikaikkuna: 3 years
|
3 years
|
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Percentage of new SCD cases linked to care
Aikaikkuna: 3 years
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3 years
|
Toissijaiset tulostoimenpiteet
Toissijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
|
Comparison of under-2 mortality between participants with SCD whom received longitudinal care and participants who screened negative for SCD
Aikaikkuna: 2 years post-screening and therapy
|
The primary outcome measure will be 'Alive and in care: Yes or No'.
|
2 years post-screening and therapy
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Percentage of SCD cases retained in care by 2 years of age
Aikaikkuna: 2 years post-screening and therapy
|
2 years post-screening and therapy
|
|
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Percentage of eligible secondary-level clinical wards implementing systematic screening and linkage to longitudinal care for new SCD cases
Aikaikkuna: 3 years
|
3 years
|
|
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Percentage of eligible health facility staff participants in secondary-level clinical wards implementing systematic screening and linkage to longitudinal care for new SCD cases
Aikaikkuna: 3 years
|
3 years
|
|
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Comparison of SCD Screening Performance Results from Initial point-of-care (POCT), Gazelle, and Hemoglobin Fractionation
Aikaikkuna: 3 years
|
Investigators will estimate the sensitivity (proportion of diseased subjects that yield a positive test result) and specificity (the proportion of non-diseased subjects that yield a negative test result) of the POCT for detecting SCD compared to the gold standard with basic proportions.
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3 years
|
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Cost-Effectiveness of Integrating SCD Consumables into National Supply Chains
Aikaikkuna: 2 to 5 years
|
The standard formula known as incremental cost-effectiveness ratios (ICERs) will be used.
ICER is a summary statistic used in economic evaluations to compare the relative value of different healthcare interventions.
It is scored by comparing the resulting cost-per-QALY against a predefined threshold, where lower ICERs indicate better value.
|
2 to 5 years
|
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Cost-Effectiveness of POCT for Early SCD Diagnosis
Aikaikkuna: 2 to 5 years
|
The standard formula known as incremental cost-effectiveness ratios (ICERs) will be used.
ICER is a summary statistic used in economic evaluations to compare the relative value of different healthcare interventions.
It is scored by comparing the resulting cost-per-QALY against a predefined threshold, where lower ICERs indicate better value.
|
2 to 5 years
|
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Cost-Effectiveness of Decentralized PEN-Plus SCD Management
Aikaikkuna: 2 to 5 years
|
The standard formula known as incremental cost-effectiveness ratios (ICERs) will be used.
ICER is a summary statistic used in economic evaluations to compare the relative value of different healthcare interventions.
It is scored by comparing the resulting cost-per-QALY against a predefined threshold, where lower ICERs indicate better value.
|
2 to 5 years
|
|
Frequency of SCD Supply Stockouts at Study Sites
Aikaikkuna: 5 years
|
5 years
|
Yhteistyökumppanit ja tutkijat
Sponsori
Sponsori
Tutkijat
Tutkijat
- Päätutkija: Jane Hankins, MD, St. Jude Children's Research Hospital
- Päätutkija: Ana O. Mocumbi, MD PhD FESC, Eduardo Mondlane University, National Institute of Health, Chronic Disease Determinants Program
Julkaisuja ja hyödyllisiä linkkejä
Hyödyllisiä linkkejä
Opintojen ennätyspäivät
Opi tärkeimmät päivämäärät
Opiskelun aloitus (Arvioitu)
Opiskelun aloitus
Ensisijainen valmistuminen (Arvioitu)
Ensisijainen valmistuminen
Opintojen valmistuminen (Arvioitu)
Opintojen valmistuminen
Opintoihin ilmoittautumispäivät
Ensimmäinen lähetetty
Ensimmäinen lähetetty
Ensimmäinen toimitettu, joka täytti QC-kriteerit
Ensimmäinen toimitettu, joka täytti QC-kriteerit
Ensimmäinen Lähetetty (Todellinen)
Ensimmäinen Lähetetty
Tutkimustietojen päivitykset
Viimeisin päivitys julkaistu (Todellinen)
Viimeisin päivitys julkaistu
Viimeisin lähetetty päivitys, joka täytti QC-kriteerit
Viimeisin lähetetty päivitys, joka täytti QC-kriteerit
Viimeksi vahvistettu
Viimeksi vahvistettu
Lisää tietoa
Tähän tutkimukseen liittyvät termit
Avainsanat
Muita asiaankuuluvia MeSH-ehtoja
- Geneettiset sairaudet, synnynnäiset
- Hematologiset sairaudet
- Anemia, hemolyyttinen, synnynnäinen
- Anemia, hemolyyttinen
- Anemia
- Hemoglobinopatiat
- Synnynnäiset, perinnölliset ja vastasyntyneiden sairaudet ja poikkeavuudet
- Hemic- ja imusuutteet
- Anemia, sirppisolu
- Terveyspalveluiden hallinto
- Terveydenhuollon laatu, saatavuus ja arviointi
- Tutkintatekniikat
- Epidemiologiset menetelmät
- Tiedonkeruu
- Terveydenhuollon arviointimekanismit
- Terveydenhuollon laatu
- Ympäristö ja kansanterveys
- Väestöominaisuudet
- Potilaan hoidon hallinta
- Terveys
- Päivystysjärjestelmät
- Tutkimukset ja kyselylomakkeet
- Point-of-Care Testing
- Public Health
Muut tutkimustunnusnumerot
Muut tutkimustunnusnumerot
- UNIQUE
- U1111-1335-3817 (Muu tunniste: World Health Organization (Universal Trial Number))
Yksittäisten osallistujien tietojen suunnitelma (IPD)
Aiotko jakaa yksittäisten osallistujien tietoja (IPD)?
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