Challenges for the Implementation of the First Large-Scale Rheumatic Heart Disease Screening Program in Brazil: The PROVAR Study Experience

Comparison Between Different Strategies of Rheumatic Heart Disease Echocardiographic Screening in Brazil: Data From the PROVAR (Rheumatic Valve Disease Screening Program) Study

“…Besides the previously recognized factors (mainly related to suboptimal involvement of school representatives and staff and to involvement of parents14), the low coverage in public schools is also attributed to some particularities of Brazilian health regulations. First, nonphysicians are not allowed to acquire echocardiographic images outside research protocols or to make official diagnoses.…”

“…The method and the implementation of the PROVAR study have been described elsewhere14, 15: the study uses nonexperts for image acquisition, on portable (Vivid Q; GE Healthcare, Milwaukee, WI) and/or handheld (Vscan; GE Healthcare) devices for RHD echocardiographic screening, and telemedicine interpretation by experts in Brazil and the United States, according to the 2012 World Heart Federation9 criteria. The screening team consisted of 2 nurse research coordinators (KO and CG), 1 biomedical technician, and 1 imaging technician (CO); during the preparatory phase, these individuals underwent a combination of completing online RHD educational modules and at least 6 weeks of hands‐on training 20…”

“…Private schools of high‐income neighborhoods were randomly invited to participate. An RHD educational curriculum was delivered before screening in the following: (1) In public and private schools, a school‐wide educational process was provided to all students, teachers, and school staff, involving slide lectures on RHD basic concepts (replaced by a tablet‐based interactive module for 1400 random children), informative brochures for family awareness, and explanatory letters 14. Informed consents were sent home with the students.…”

“…However, serological and bacteriological data about group A streptococcal epidemiological features10, 11, 12 propose the existence of geographical determinants, suggesting that socioeconomic status may not be the unique factor. In Brazil, an upper‐middle income country still classified among the most socially unequal in the world,13 the PROVAR (Rheumatic Valve Disease Screening Program) study (the first large‐scale screening program of the country) was implemented in 201414 and revealed an echocardiographic prevalence of 42/1000 in preliminary analyses. However, public schools of underserved neighborhoods highlighted a marginal participation (<40%) 15.…”

Integration of echocardiographic screening by non-physicians with remote reading in primary care

“…The PC screening took advantage of the infrastructure and expertise developed for the PROVAR study14: collaboration for the development of cloud storage and reading systems dedicated to cardiovascular imaging and a collaborative reading schedule between Brazil and the USA, which can be leveraged for future projects. The SigTel system was developed by the Telehealth Network of Minas Gerais data centre, established in 2005 to initially connect public university hospitals in the state.…”