Stakeholders Want a Menu of Choices: Findings from a Consultation Workshop on Improving Access to Secondary Prophylaxis of Rheumatic Fever and Rheumatic Heart Disease.

Intramuscular (IM) injection of benzathine benzylpenicillin G (BPG) forms the cornerstone of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) secondary prophylaxis. BPG is available as either a low-cost powdered formulation or a costlier pre-filled suspension. Most of the global RHD burden lies in low- and middle-income countries, which rely on the powdered formulation. Prospects of achieving RHD control targets continue to be hindered by global BPG supply issues. Guided by a preliminary consultation of global stakeholders published in 2016 which outlined the desired characteristics and changes to the existing BPG product, much progress has been made in improving tolerability of BPG for ARF/RHD secondary prophylaxis. A second stakeholder consultation of experts and consumer representatives was convened during the World Congress on Rheumatic Heart Disease in Abu Dhabi, UAE, in November 2023 with the objective of evaluating alternate delivery models and the need for new BPG formulations. Topics explored included current barriers and enablers to local secondary prophylaxis uptake, desired changes to the delivery model and ways to improve access to secondary prophylaxis in resource-limited settings. Our findings highlight inadequacies of the current one-size-fits-all approach and the need for education, access to health systems and personnel as well as flexibility and adaptability to meet individual and community needs for effective programme delivery while new and improved BPG formulations, which will overcome current barriers, are eagerly awaited.