Table 1

Rheumatic heart disease workshop summary

Topic areaOpportunities to consider/research questions?
Capacity building
  • Innovative strategies to improve equitable research partnerships.

  • Training and support for resource and research capacity in endemic settings (eg, basic sciences, behavioural studies, clinical research, interventional cardiology, cardiac surgery and implementation science).

  • Training and utilisation of health economics research to inform policy.

Translation stage basic sciencesHost-specific considerations:
  • Improve our understanding of the GAS, ARF, RHD pathogenesis within endemic regions.

  • Multiomics studies (eg, risk and non-risk human leukocyte antigen haplotypes).

    Development of appropriate animal models and surrogate assays.

  • Development of novel immunomodulatory treatments.

  • Natural infection models to identify risk and resilience factors.


GAS-specific considerations:
  • Development of novel immunomodulatory treatments.

  • Natural infection models to identify risk and resilience factors.

  • Understanding the role of carriage in disease presentation and progression.

  • Understanding GAS’s genomic profile including the documentation of antibiotic resistant isolates.


Vaccine/therapeutics considerations:
  • Vaccine safety-ensuring that candidates are both efficacious and would not adverse outcomes (eg, cross-reactivity/autoimmunity).

  • Development of accessible point of care diagnostics.

  • Development of long-acting penicillin.

  • Innovative approaches for newer formulations of known prophylaxis.

  • The development of durable heart valve materials that are acceptable, feasible and affordable within low-resource settings.

Translation stage clinical researchLongitudinal cohort study considerations:
  • Incidence, prevalence, disease progression, complication rates and mortality data to inform downstream interventions.

  • Human challenge and transmission studies.

  • Observational studies assessing the role of throat versus impetigo infections on disease progression.

  • Assessing individual factors (social determinants of health) impacting disease progression.

  • Deciphering the benefits of preventative strategies (individually or in conjunction with others).

  • Long-term outcomes among individuals with asymptomatic RHD.

  • Impact of long-term antibiotic prophylaxis and monitoring of antimicrobial consumption, antibiotic resistance and effect on bystander pathogens.


Randomised clinical trial considerations:
  • Evaluation of therapeutic management (utilisation of WHO-approved immunomodulatory therapeutics, newer preparations of penicillin).

  • Testing/evaluating simplified algorithms in low-resource settings to support provisional diagnosis of ARF patients.

  • Re-evaluation of current guidelines to ensure efficacy alongside updated technologies.

  • Evaluation of simulation-based training to low-resource settings to improve proficiency and reduce training time periods.

  • Development and testing of clinical decision rules with sufficient sensitivity and specificity for GAS.

Translation stage implementation scienceHealthcare innovation/optimisation considerations:
  • Integration of RHD care model within health services and community-based programmes that have been successful (eg, HIV continuum of care).

  • Novel approaches and strategies are needed to support case finding of at-risk groups, it was suggested to target including antenatal care screening, school-based programmes and oral health programmes. This could also be supported using RHD registries and surveillance sites.

  • Innovative decentralised approaches to support patient care in low-resource settings.

  • Initiatives focused on environmental health, housing and modifiable social determinants of health.

  • Methods to incorporate innovative technologies to improve health outcomes (eg, mobile health technologies, point of care diagnostics, patient retention, artificial intelegence/machine learning, health system optimisation, data collection, aggregation and analysis).

  • ARF, acute rheumatic fever; GAS, group A streptococcal; RHD, rheumatic heart disease.