Table 1 Activities supporting integration of RHD into horizontal and vertical programs
From: Rheumatic heart disease: infectious disease origin, chronic care approach
| Â | Adding RHD elements to existing programs | Adding other disease elements to RHD programs (target PLW*-RHD) |
|---|---|---|
Vertical programs | • Sexual and reproductive health services: provision of secondary prophylaxis, echo screening of targeted high-risk pregnant women • HIV: RHD secondary prophylaxis for people with HIV and RHD co-morbidity & echocardiographic screening of targeted high-risk PLW** HIV • TB: Delivery of secondary prophylaxis through DOTS for people with TB and RHD co-morbidity | • Dental care: enchancing dental services for PLW-RHD to reduce endocarditis • Specialist Telemedicine • NCD* programs: Risk assessment and primary prevention of ischaemic heart disease to tackle co-morbidity for PLW RHD • Infectious diseases: Screening for infectious diseases in PLW-RHD, particularly prior to surgical intervention. |
Horizontal programs | • School programs: streptococcal pharyngitis and impetigo screening/treatment, secondary prophylaxis support • Environmental health: education and programs to target streptococcal pharyngitis and impetigo • Case Management: to support adherence & navigate the healthcare system • Medication supply: prioritisation of procurement of benzathine penicillin G. • Primary health care information technology solutions: RHD modules added to electronic/paper health records • Skills/training of primary health care staff | PRIMARY HEALTH CARE SETTING • Delivery of tertiary care in the primary setting: supporting advanced care for complications of RHD, including management of heart failure, arrhythmia and anticoagulation (including dental care and Telemedicine where available). • Lifestyle interventions: smoking, exercise, diet • Risk assessment: for coronary heart disease • Screen for diabetes, chronic kidney disease • Sexual & reproductive services for PLW-RHD • Case management |