Universal Newborn Screening For Sickle Cell Disease In Mozambique
Studie Overzicht
Toestand
Toestand
Conditie
Conditie
Interventie / Behandeling
Interventie / Behandeling
Gedetailleerde beschrijving
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.
Studietype
Studietype
Inschrijving (Geschat)
Inschrijving
Fase
Fase
- Niet toepasbaar
Contacten en locaties
Studiecontact
Studiecontact
- Naam: Jane Hankins, MD
- Telefoonnummer: 888-226-4343
- E-mail: referralinfo@stjude.org
Deelname Criteria
Geschiktheidscriteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
- Kind
- Volwassen
- Oudere volwassene
Accepteert gezonde vrijwilligers
Beschrijving
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.
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Ander
- Toewijzing: Niet-gerandomiseerd
- Interventioneel model: Parallelle opdracht
- Masker: Geen (open label)
Aantal wapens
Wapens en interventies
Deelnemersgroep / ArmDeelnemersgroep / Arm |
Interventie / BehandelingInterventie / Behandeling |
|---|---|
|
Ander: 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).
|
|
Ander: 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.
|
|
Ander: Health facility staff participants
Healthcare staff ages ≥18 years working at secondary-level facilities involved in the UNIQUE study.
|
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.
|
|
Ander: 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.
|
|
Ander: 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.
|
Wat meet het onderzoek?
Primaire uitkomstmaten
Primaire uitkomstmaten
Uitkomstmaat |
Tijdsspanne |
|---|---|
|
Percentage of eligible population screened for Sickle Cell Disease
Tijdsspanne: 3 years
|
3 years
|
|
Percentage of new SCD cases linked to care
Tijdsspanne: 3 years
|
3 years
|
Secundaire uitkomstmaten
Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
|
Comparison of under-2 mortality between participants with SCD whom received longitudinal care and participants who screened negative for SCD
Tijdsspanne: 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
Tijdsspanne: 2 years post-screening and therapy
|
2 years post-screening and therapy
|
|
|
Percentage of eligible secondary-level clinical wards implementing systematic screening and linkage to longitudinal care for new SCD cases
Tijdsspanne: 3 years
|
3 years
|
|
|
Percentage of eligible health facility staff participants in secondary-level clinical wards implementing systematic screening and linkage to longitudinal care for new SCD cases
Tijdsspanne: 3 years
|
3 years
|
|
|
Comparison of SCD Screening Performance Results from Initial point-of-care (POCT), Gazelle, and Hemoglobin Fractionation
Tijdsspanne: 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.
|
3 years
|
|
Cost-Effectiveness of Integrating SCD Consumables into National Supply Chains
Tijdsspanne: 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
|
|
Cost-Effectiveness of POCT for Early SCD Diagnosis
Tijdsspanne: 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
|
|
Cost-Effectiveness of Decentralized PEN-Plus SCD Management
Tijdsspanne: 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
Tijdsspanne: 5 years
|
5 years
|
Medewerkers en onderzoekers
Sponsor
Sponsor
Onderzoekers
Onderzoekers
- Hoofdonderzoeker: Jane Hankins, MD, St. Jude Children's Research Hospital
- Hoofdonderzoeker: Ana O. Mocumbi, MD PhD FESC, Eduardo Mondlane University, National Institute of Health, Chronic Disease Determinants Program
Publicaties en nuttige links
Studie record data
Bestudeer belangrijke data
Studie start (Geschat)
Studie start
Primaire voltooiing (Geschat)
Primaire voltooiing
Studie voltooiing (Geschat)
Studie voltooiing
Studieregistratiedata
Eerst ingediend
Eerst ingediend
Eerst ingediend dat voldeed aan de QC-criteria
Eerst ingediend dat voldeed aan de QC-criteria
Eerst geplaatst (Werkelijk)
Eerst geplaatst
Updates van studierecords
Laatste update geplaatst (Werkelijk)
Laatste update geplaatst
Laatste update ingediend die voldeed aan QC-criteria
Laatste update ingediend die voldeed aan QC-criteria
Laatst geverifieerd
Laatst geverifieerd
Meer informatie
Termen gerelateerd aan deze studie
Trefwoorden
Aanvullende relevante MeSH-voorwaarden
- Genetische ziekten, aangeboren
- Hematologische ziekten
- Bloedarmoede, hemolytisch, aangeboren
- Bloedarmoede, hemolytisch
- Bloedarmoede
- Hemoglobinopathieën
- Aangeboren, erfelijke en neonatale ziekten en afwijkingen
- Hemische en lymfatische ziekten
- Bloedarmoede, sikkelcel
- Health Services Administration
- Kwaliteit, toegang en evaluatie van de gezondheidszorg
- Onderzoekstechnieken
- Epidemiologische methoden
- Gegevensverzameling
- Evaluatiemechanismen voor gezondheidszorg
- Kwaliteit van de gezondheidszorg
- Milieu en volksgezondheid
- Bevolkingskenmerken
- Management voor patiëntenzorg
- Gezondheid
- Point-of-Care Systemen
- Enquêtes en vragenlijsten
- Point-of-Care Testing
- Public Health
Andere studie-ID-nummers
Andere studie-ID-nummers
- UNIQUE
- U1111-1335-3817 (Andere identificatie: World Health Organization (Universal Trial Number))
Plan Individuele Deelnemersgegevens (IPD)
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Informatie over medicijnen en apparaten, studiedocumenten
Bestudeert een door de Amerikaanse FDA gereguleerd geneesmiddel
Bestudeert een door de Amerikaanse FDA gereguleerd apparaatproduct
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