SCIENTIFIC PROGRAMS

Coordinator

Non-communicable diseases (NCDs) are a public health problem that threatens the sustainability of the national health service and compromises the achievement of sustainable development goals in our country. The World Health Organization's (WHO) global strategy for prevention and control focuses on controlling risk factors (tobacco use, alcohol abuse, physical inactivity, and unhealthy diet), the main diseases determined by these (cardiovascular, respiratory, cancer, and diabetes), trauma, and mental health disorders.

Recognizing its importance in Mozambique, the Ministry of Health has a National NCD Program. The National Institute of Health (INS) created the Program for Determinants of Chronic Diseases (PDDC) to respond to challenges related to research, epidemiological surveillance, and outreach in this area in Mozambique.

Program Objectives

Taking into account the INS's mission and vision, the PDDC has set the objective of contributing to the creation of scientific evidence in the area of prevention, diagnosis, and control of Non-Communicable Chronic Diseases (NCCD) through the promotion and implementation of epidemiological, clinical, basic, and operational research in this area. The program's main objectives are:

• Create institutional capacity for the training of National Health System health professionals in the diagnosis and surveillance of NCDs.;
• Develop research in DNT within the national health service.;
• Testing simplified models of epidemiological surveillance for NCDs;
• Testing sustainable models for equitable NCD healthcare delivery;
• Provide technical support for the implementation of digital health research in National Health System health facilities.

Research Areas

Considering the absence of statistical data to inform decisions in the area of NCDs, the INS has set a strategic objective for the triennium: “to generate knowledge in the area of non-communicable chronic diseases to subsidize health policies and action plans for adapting the national health service to the challenges of caring for endemic chronic diseases.” Thus, key activities have been defined as conducting surveys on the prevalence and profile of chronic diseases, both in hospitals and in the community, in territories representative of different social classes and groups.

Research priorities in determinants of chronic diseases include: models for integrating NCDs into the epidemiological surveillance system; evaluation of platforms for the integrated delivery of healthcare for NCDs; description of the profile and trends of NCDs, particularly community-based and hospital epidemiological research to determine the burden of chronic disease in Mozambique.

Specifically, the prioritized research areas include:

• Risk factors and target diseases of the WHO Global Strategy (Hypertension, Cardiovascular Diseases, Respiratory Diseases, Mental Health);
• Diseases prioritized in the WHO African Region strategy (Rheumatic disease, Neglected cardiomyopathies) and
• Prevalent conditions in the country caused by chronic complications of endemic infections such as Tuberculosis, Schistosomiasis, and HIV.

Clinical research projects are being carried out in the three regions of the country (Mavalane General Hospital, Beira Central Hospital, Nampula Central Hospital, Maputo Central Hospital). Community projects are currently underway in Maputo City, and in the Marracuene and Inharrime Districts.

Research Projects

Thus, PDDC implemented community and hospital-based projects in collaboration with the National Directorate of Medical Assistance and the National NTD Control Program of the Ministry of Health, in the three regions of the country. These involved health professionals from reference health units at Mavalane General Hospital, Maputo Central Hospital, Beira Central Hospital, and Nampula Central Hospital, as well as the Inharrime Health Center. Clinical research was conducted at Maputo Central Hospital and Mavalane General Hospital in the areas of trauma, cardiovascular diseases, and chronic complications of infectious diseases, specifically those resulting from HIV and streptococcal infections. Clinical trials focused on the use of drugs or treatment strategies for arrhythmias, heart failure, and rheumatic heart disease that are suitable for the Mozambican context.

Another important activity, dictated by the lack of specific financing lines for NCDs in Mozambique, was the development of funding proposals for submission to various funding entities. The approval of some of these proposals provided support for the team's research and academic training activities. The list of implemented projects, including funding sources, partner institutions, and implementation results, is presented in Table 1.

Extension The PDDC has outreach projects that support the Mavalane General Hospital in reorganizing outpatient services, implementing chronic disease risk factor consultations, and providing various furniture for the hospital, namely: acquisition and installation of the entrance door to the ward; acquisition of a desk for newborn registration; sphygmomanometers, stethoscopes, glucometers and their consumables; support for activities in the Internal Medicine ward, facilitation of training/courses in NCDs, and technical-scientific support for the installation of the research unit.

Additionally, PDDC has supported the implementation of conditions for health education in schools in the Mavalane area, with an emphasis on preventing risk factors for chronic diseases. This program began in 2019 as an activity targeting poverty-associated cardiovascular diseases, with a focus on rheumatic heart disease.

Clinical Trials:

1. Clinical trial of medication tolerability for heart failure STRONG
2. Influenza Vaccine Clinical Trial in Patients with Heart Failure IVVE
3. Non-inferiority clinical trial of rivaroxaban as an anticoagulant in patients with atrial fibrillation associated with rheumatic heart disease (INVICTUS)

Clinical Research:

1. Cardiovascular disease prevention in women (RESCUE)
2. Phase II of the longitudinal study of atherosclerosis detection in adolescents on antiretroviral treatment DETECTIVE II
3. Rheumatic fever pilot hospital surveillance (VIGIFER)
4. Clinical Characterization and Cost Analysis of In-Hospital Stroke Care (STRANGE)

Community-based research

1. Analysis of demand determinants for cardiovascular disease services by men infected with HIV MEN'S GAP;

Projects in Collaboration with the Health Systems Program:

1. Estimate of the Cost of Treatment for COVID-19 Patients According to National Symptomatic Treatment Protocols;
2. Perceptions of access and quality of medicines in the city of Maputo QUALMEDS)

Partners

Ongoing projects involve collaboration with national institutions (Eduardo Mondlane University, Mozambican Institute for Health Research and Training, National Institute of Statistics, Central Hospitals, among others) and various international entities, namely: from England (Imperial College London, Magdi Yacoub Institute, Liverpool University, Brunel University, Queen Margaret University), South Africa (University of Cape Town, University of Stellenbosch, Hatter Institute for Cardiovascular Research in Africa), Uganda (Makerere University), Portugal (University of Porto, Institute of Hygiene and Tropical Medicine of Lisbon), the United States of America (University of California San Diego, Harvard University, Columbia University, University of Washington), and Australia (Torrens University, University of Melbourne).