ABSTRACT
IntroductionIn 2020, the UK Health Security Agency (UKHSA) established a large-scale testing programme to rapidly identify individuals in England who were infected with SARS-CoV-2 and had COVID-19. This comprised part of the UK governments COVID-19 response strategy, to protect those at risk of severe COVID-19 disease and death and to reduce the burden on the health system. To assess the success of this approach, UKHSA commissioned an independent evaluation of the activities delivered by the NHS testing programme in England. The primary purpose of this evaluation is to capture key learnings from the rollout of testing to different target populations via various testing services between October 2020 and March 2022 and to use these insights to formulate recommendations for future pandemic preparedness strategy. Methods and analysisThe proposed study involves a stepwise mixed-methods approach, aligned with established methods for the evaluation of complex interventions in health, with retrospective and prospective components. A bottom-up approach will be taken, focusing on each of nine population-specific service settings. We will use a Theory of Change to understand the causal pathways and intended and unintended outcomes of each service, also exploring the effect of context on each individual service settings intended outcomes. Subsequently, the insights gained will be synthesised to identify process and outcome indicators to evaluate how the combined aims of the testing programme were achieved. A forward-looking, prospective component of this work will aim to inform testing strategy in preparation for future pandemics, through a participatory modelling simulation and policy analysis exercise. DisclaimerThis is a provisional draft protocol that represents research in progress. This research was commissioned and funded by UKHSA, to be performed between August 2022 and March 2023. The scope and depth of testing services and channels covered by this research were pre-agreed with UKHSA and are limited to the availability and provision of data available at the time this protocol was written. Ethics and disseminationFindings arising from this evaluation will be used to inform lessons learnt and recommendations for UKHSA on appropriate pandemic preparedness testing programme designs; findings will also be disseminated in peer-reviewed journals and at academic conferences. Strengths and limitations of the studyO_LIStrengths of this mixed-methods evaluation protocol include the use of theory-based, complex evaluation approaches and an iterative and participatory approach with the stakeholder (UKHSA) to the evaluation process and prospective modelling. C_LIO_LIGiven the scale and complexity of the COVID-19 testing response in England, there is a scarcity of previous relevant research into this, either in England or appropriate international comparators, warranting the mixed-methods evaluation approach we are adopting. C_LIO_LIThis is the first national-scale evaluation of the testing response to COVID-19 in England to incorporate most service settings, a programme which formed an integral part of the UK pandemic response strategy. The approach proposed could be applied to the evaluation of pandemic responses in other contexts or to other types of interventions. C_LIO_LIWhereas most complex interventions are accompanied by a prospective evaluation design initiated at the time of the intervention or earlier, this study predominantly comprises a retrospective evaluation and is therefore limited by the quality of existing research and the data available to the research team at the time of conducting the evaluation within the specified period allocated by UKHSA. C_LI
ABSTRACT
INTRODUCTION: Heart Failure (HF) is a growing public health concern in Morocco and there is a striking paucity on determinants of severe HF (SHF) in this population. The aim of this study was to identify patients admitted with HF at Ibn Rochd Hospital, Casablanca from 2011 onwards, when electronic record keeping began. METHODS: A total of 105 patients underwent a series of cardiological examinations between July 2011 and January 2014. The New York Heart Association (NYHA) criteria was used to evaluate the severity of HF. Patients with NYHA classification gradings of I and II were defined as having moderate HF (MHF) and those graded as III and IV were defined as having a SHF. Univariable and multivariable risk factors associated with SHF were explored using logistic regression. The results were reported following the RECORD (Reporting of studies Conducted using Observational Routinely-collected Data) statement. RESULTS: A total of 24 (33%) patients were identified as having a SHF. Four predictors of SHF were identified in univariate analysis: haemoglobin <12g/dL, neutrophil-to-lymphocyte ratio (NLR) >3, mean corpuscular haemoglobin concentration (MCHC) <32 picolitre, and high density lipoprotein (HDL) <0.35 (mmol/L). Only NLR>3 and HDL <0.35 mmol/L remained independent predictors in multivariable analysis. Patients with NLR >3 were at 6-fold increased odds of SHF [adjusted odds ratio (AOR): 6.78, 95% confidence interval (CI): 1.40-32.80, p=0.017], and those with HDL<0.35 (mmol/L) were at 10-fold increased odds of SHF [AOR: 10.11, 95% CI: 2.26-45.27, p=0.002]. CONCLUSION: The independent biomarkers of SHF identified in this study provide valuable information to ward clinicians in resource-constrained facilities to identify patients vulnerable to developing severe heart complications.