The work of Case Western Reserve University and colleagues in Uganda continues to progress RHD control in the country, in part by leveraging existing HIV/AIDS infrastructure. In particular, the expansion of register-based control programs in Mbarara and Gulu has increased access to care and been supplemented by community awareness programs. In these communities, training of health care workers at all levels has been a priority.

Echocardiography screening of children in Kampala and Mbarara has further quantified the burden of disease and provided an important transition to clinical service delivery. Important qualitative work to understand factors influencing adherence to secondary prophylaxis with benzathine penicillin G was recently published in Global Heart, highlighting the importance of supportive families and health care providers. Barriers to adherence included limited resources to seek care, fear of injection pain, challenging communication with health staff and limited facilities able to deliver injections. To identify structural barriers to diagnosis, retention in care, and adherence to treatment, the partnership has adopted the cascade of care model from the HIV/AIDS community. The partnership will continue working to understand and tackle these barriers as more people are identified with RHD and enrolled in register based programs.