Position statement of the World Heart Federation on the prevention and control of rheumatic heart disease

Benzathine Penicillin G for the Management of RHD: Concerns About Quality and Access, and Opportunities for Intervention and Improvement

Benzathine penicillin G is an important antibiotic for the treatment and prevention of group A streptococcal infections associated with rheumatic fever and rheumatic heart disease. However, as rheumatic heart disease has receded as a public health priority in most high-income settings, attention to the supply, manufacture, and accessibility of benzathine penicillin G has declined. Concerns about the quality, efficacy, and innovation of the drug have emerged following plasma analysis and anecdotal reports from low-resource settings. This review collates core issues in supply and delivery of benzathine penicillin G as a foundation for concerted efforts to improve global quality and access. Opportunities for intervention and improvement are explored.

The second rheumatic heart disease forum report

The second rheumatic heart disease (RHD) forum was held on February 18, 2013, at the Sixth World Congress of Pediatric Cardiology and Cardiac Surgery in Cape Town, South Africa, to focus attention on key areas in global RHD control, management, and prevention. Building on the foundation of the first RHD forum, over 150 interested participants met to discuss critical issues on the RHD landscape. Unique to this meeting was a mixture of diverse backgrounds and disciplines, all crucially important to the conversation around RHD control and prevention. Some clear priorities have emerged for RHD activities in the next era: the necessity for political intervention and policy change; increasing the health workforce by incorporating teaching, training, and task-shifting; revitalizing the research agenda by merging basic, clinical, and translational research; and obtaining universal access to high-quality penicillin. There was also an urgent request for new resources; for existing resources to be further developed, improved, and shared across platforms; and for resources to be supported in the nonmedical arena. Finally, the necessity of involving the patient community in the ongoing discussion was highlighted. The participants of both the first and second RHD forum represent a new, thriving, and growing community of RHD activists who should usher in a new era of significant improvements in RHD control and prevention.

A conceptual framework for comprehensive rheumatic heart disease control programs

The World Health Organization, World Heart Federation, and other organizations recommend comprehensive control programs for rheumatic fever (RF) and rheumatic heart disease (RHD). However, advice on components of control programs are simple lists, with little guidance on program structure or priorities. In particular, there are limited recommendations on "stepwise" implementation and few guidelines on which program components should take temporal priority. An evidence-based framework for describing, prioritizing, and implementing comprehensive RF/RHD control programs is needed. A literature review of existing RF/RHD control program recommendations generated a list of program components. Descriptions and analysis of RF/RHD control programs informed temporal prioritizing of component parts. Relevant programmatic research from other vertical disease control programs was reviewed for generalizable implementation experiences. Twenty-five individual components of comprehensive RF/RHD control programs were identified. These fell into "baseline" program requirements (including burden of disease data, treatment guidelines, and human resources) and requirements for providing primary, secondary, and tertiary interventions. Primordial prevention and research priorities were overarching themes. These components were developed into a conceptual framework schema. Existing literature contains valuable lessons on the design and implementation of comprehensive RF/RHD control programs. Fashioning these guidelines and programmatic experiences into a conceptual framework schema benefits clinicians, policy makers, and RHD advocates.