ADUNU Expands to Oyam District: Launch Reflections and Next Steps

ADUNU (Accelerating Delivery of rheUmatic heart disease preventive iNterventions in Uganda) is a first-of-its-kind program designed to be fully integrated into the health system at the district level, delivering an evidence-based package of interventions built from decades of research on the prevention and treatment of Rheumatic Heart Disease (RHD). Implemented through Uganda’s public healthcare system with oversight from District Health Offices and technical support from the Uganda Heart Institute (UHI), ADUNU focuses on the two proven strategies: screening to detect RHD at earlier stages, and registry-based care to ensure patients remain connected to treatment and prophylaxis to prevent disease progression.

Learning from Kitgum: Building the Foundation

Over the past two years, ADUNU has operated in Kitgum District as its pilot and intensive site – our testing ground for what works, what doesn’t, and how the program can adapt to real-world challenges.

Through this work, more than 30,000 adults and children have been screened for RHD, with over 400 new cases of RHD identified and connected to ongoing care. These experiences have shaped a model that is now being refined for replication and scale – bringing us closer to ADUNU’s overarching goal of expanding high-quality RHD care across Uganda.

Expanding to Oyam: A Milestone for Scale-Up

This year, ADUNU expanded to Oyam District, marking the program’s first replication site. This expansion is significant – not only because it allows us to test the model in a new district with a distinct health system, but also because it brings us closer to our long-term vision of refining a scalable model for nationwide and regional adoption.

The official launch in Oyam followed months of engagement: participation in district health meetings, an inception meeting with district leadership and health center nurses and staff, and joint community outreach screenings with the Kitgum ADUNU team.

Led by Jafes Pulle and Doreen Nakagaayi, the launch event brought together leaders from the Ministry of Health, UHI, Oyam and Kitgum districts, and the ADUNU teams. It was an opportunity to share the mission of ADUNU and celebrate the beginning of this great partnership.

“The launch of the ADUNU cardiac screening initiative marks a transformative moment for Oyam District. For the first time, our communities, especially those in remote areas, will have access to early detection and life-saving care for heart disease. This is more than a medical program; it’s a commitment to equity, dignity, and the health of every citizen. We are proud to stand with our partners in bringing this vision to life.”

– Dr. Thomas Malinga, District Health Officer, Oyam

 Following the launch, an investigator team traveled to Uganda in August to meet with the District Health Office and local stakeholders. During this meeting lessons from the Kitgum district program were shared to support the Oyam team as it began taking ownership of the program. The ADUNU Coordinator in Kitgum and the ADUNU Focal Person (RHD nurse) presented on lessons learned, while Jafes Pulle and Doreen Nakagaayi reinforced the program’s goals and plans for training in Oyam. This sense of ownership was evident throughout the meetings and generated significant excitement about the work ahead.

Building Local Capacity: Training & Empowering Providers in Oyam

With the launch complete, training of health workers in Oyam is now underway. Based on lessons from Kitgum, the ADUNU team strengthened the training and certification pathway by adding enhanced virtual pre-learning resources, more structured hands-on mentorship, and a six-week conditional certification period. During this conditional period, providers practice screening independently at their health center or during outreach events to complete a required number of screening echos, receive targeted mentorship, and meet defined criteria before final certification.

Over the coming months, providers from one Health Center IV and six Health Center IIIs in Oyam are participating in the ADUNU training.

To date, 36 providers in Oyam have been trained in echocardiographic screening and RHD care. These providers are now in a monitoring conditional phase toward full certification, actively screening patients in their communities and identifying new cases. This hands-on mentorship approach is rapidly building district-level capacity, ensuring that RHD care becomes part of everyday clinical practice while boosting confidence in screening settings.

“Our training curriculum has undergone a thoughtful transformation, becoming simpler to deliver, stronger in content, and easier to implement across training, certification, and re-training. This evolution reflects our commitment to designing a replicable, scalable model that can be deployed across Uganda with consistency and impact.”
— Doreen Nakagaayi, ADUNU Program Lead, UHI Pediatric Cardiologist

“After seven years of clinical practice in Oyam, I’ve witnessed firsthand how difficult it’s been to manage cardiac patients, many dying without a definitive diagnosis due to lack of equipment, guidelines, and trained personnel. ADUNU has been long overdue. In just two months, it has transformed care: diagnosing RHD and other heart defects, linking patients to treatment, and sparking collaboration across health facilities. The response from clinicians and stakeholders has been overwhelmingly positive. Integrating ADUNU into routine services and sustaining it; is not just necessary, it’s urgent.”
— Dr. Michael Engola, ADUNU Medical Officer, Oyam

Looking Ahead

In the short term, Oyam’s focus is on building health worker capacity and expanding screening both within health centers and through community outreach. Kitgum’s success has shown that early detection and strong follow-up can dramatically improve care access and outcomes. We anticipate similar progress in Oyam, alongside new insights that will guide future scale-up.

The expansion to Oyam marks an important milestone for ADUNU. It highlights the program’s adaptability, the value of strong local partnerships, and the importance of ownership at every level. Together, Kitgum and Oyam are demonstrating what it takes to deliver high-quality, district-led RHD care, and shaping a model that can transform heart health across Uganda and beyond.