Abstract 11272: Barriers and Enablers of Rheumatic Heart Disease Care in a Resource Limited Setting

Abstract

Introduction: Rheumatic heart disease (RHD) has nearly been eradicated in wealthy nations but remains a significant public health concern in low-resource countries like Uganda. Many people living with RHD is these settings have not been diagnosed and many who are diagnosed have late-stage disease requiring surgery, an expensive intervention. Objectives: To explore the barriers and enablers to RHD care in a resource limited setting. Methods: This was a qualitative study. We held in-depth interviews among 36 RHD patients randomly selected from a computer-generated list of patients enrolled in the RHD registries in the Northern, Central, and South-western regions. The selected participants were interviewed by trained qualitative research staff. All interviews were tape recorded and transcribed verbatim. Data were analyzed by thematic content analysis and useful codes were generated by both inductive and deductive approaches. Generated codes were collapsed into themes. Coding was done by 3 independent researchers who compared their results and agreed on one codebook which was updated iteratively. Results: Barriers to care included financial constraints, high cost of medicines, poor access to RHD diagnostics, misdiagnosis, poor access to drugs, high cost of cardiac medicines and high costs of travel to health facilities. Enablers of RHD care included the desire to live, availability of drugs, diagnostics and healthcare workers at RHD clinics, good attitude, counseling and education by health workers, subsidised costs of services at RHD clinics, reminder systems and access to RHD services at nearer facilities. Conclusion: Enhancing enablers and mitigating barriers may improve access to RHD care in resource limited settings and significantly reduce the burden of disease.