Abstract
Group A Streptococcal (GAS) infections of the upper respiratory tract (and skin) that are left untreated can trigger an autoimmune response known as Acute Rheumatic Fever (ARF). Repeated episodes of ARF or severe attacks that are left untreated, can lead to permanent cardiac damage known as Rheumatic Heart Disease (RHD). RHD is a major cause of morbidity and mortality worldwide. Indigenous communities in Aotearoa New Zealand, Australia and the Pacific Region have very high rates of ARF and RHD. With no GAS vaccine, ARF/RHD is prevented with painful monthly injections of Benzathine Penicillin G (BPG) (known as secondary prophylaxis (SP)), given for at least 10 years or more. This prevents GAS infections that can lead to ARF occurrence, and either lead to or worsen RHD. The overall aim was to support drug design efforts towards developing a more acceptable Penicillin for ARF/RHD prevention that promotes sustained compliance amongst those at risk of ARF/RHD. To contribute to this work, BPG SP for ARF/RHD prevention and contextualisation was explored in a remote village in Fiji Natewa by engaging with health professional(s), community leaders and sourcing local information. Results showed that health inequities associated with ARF and RHD exist, resource challenges relating to BPG are present, and accessibility issues connected with BPG SP were identified. Information concerning health challenges are relevant for drug design efforts and ARF/RHD prevention.