RF and RHD Research.

Rheumatic heart disease (RHD) remains a major neglected disease of poverty. It affects an estimated 33 million persons—mostly in lowand middle-income countries (LMICs) and in low-resource settings of vulnerable populations in high-income countries [1-3]. Recent advances and improvements in the early detection, evaluation, and treatment of acute group A streptococcal pharyngitis has made the prevention and control of RHD feasible in many LMICs [4]. Point-of-care antigen diagnostic testing that provides confirmatory results without the need for bacterial culture and relatively uncomplicated clinical practice guidelines for definitive treatment are now available [4]. The combination of primary prevention and long-term secondary prophylaxis strategies also makes the prevention and eradication of RHD possible. However, sustained effective implementation, scale-up, and spread of these strategies have not occurred in many low-resource settings in LMICs, leading to a continuing high burden of RHD [1,2]. Although ideal epidemiological data are sparse, the systematic review from Uganda and Tanzania published in this issue of Global Heart shows that along with this high burden, there are frequent nonfatal complications of heart failure, pulmonary hypertension, and atrial fibrillation, with case fatality rates in medical and surgical wards of 17% (95% CI: 13% to 21%) and 27% (95% CI: 18% to 36%), respectively [5]. Their identification of critical barriers and facilitators within the domains of individual knowledge, family support, provider communication and knowledge, and systems design in the effective prevention, treatment, and control of group A streptococcal pharyngitis and RHD provide an appropriate starting point for identifying strategies for addressing the implementation gap [5].