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Technical support for RHD control programs

2.0 Technical support

2.1 Conceptual framework for comprehensive RF/RHD control programs

RhEACH has been instrumental in developing a conceptual framework for comprehensive, register based, RHD control programs.  This priority based resource provides a foundation for designing, implementing and evaluating RHD control programs.
 
The framework is being used to structure some of our implementation and evaluation packages but remains a work in progress. We appreciate feedback on the structure: whether it has been helpful for conceptualizing your program and suggestions for components to add or remove.

2.2 Technical support to researchers and control programs

Initiating, revising or integrating an RHD control program, or disease control efforts can be challenging. Few programs will be staffed by disease specific experts and rarely is there sufficient human resource or capacity to draw on evidence and experience from other settings. There is an unmet need for expert advice.  RhEACH offers a range of different technical support services to RHD programs:

  • Document review
    We are happy to provide independent comment on planning documents, advocacy documents, media releases or other materials wherever possible.
  • Research support
    Formal research collaborations with RhEACH require shared planning and advance consultation. However, we realise that sometimes it's helpful to have a fresh pair of eyes review abstracts or articles, particularly when being they're submitted in less familiar languages. We are happy to help out where possible.
  • Referencing support
  • Key sources about RHD control can sometimes be difficult to track down, especially when internet connectivity is limited. We can sometimes assist in connecting you with authors to provide copies of published articles or other resources for your research. 

Often the best support, ideas and suggestions comes from peers working in similar settings. We are committed to fostering regional networks, including:

  • Facilitating introductions between potential collaborators
  • Providing advice on formalising relationships, including assistance in developing memoranda of understanding and other agreements
  • Supporting networks to coalesce into Centres of Excellence and transitioning the technical support role to have a regional approach. 
  • Unfortunately we are unable to provide funding for research or control programs.

2.3 Evaluation framework

As RHD control programs continue to develop, need for a robust approach for describing and evaluating their impact increases. Using a standardised approach for program evaluation makes it possible to evaluate programs across time and place, improving comparability of results and helping elucidate best practice. However, the burden of administering high quality monitoring and evaluation can be considerable in small programs with limited funding and human resources. 

RhEACH will help develop a simple evaluation framework which can be delivered without the need for specific training in monitoring or evaluation. We will support local program implementers to translate their program evaluation into visually comprehensible infographic, illustrating areas priority areas for program strengthening.

2.4 Benzathine penicillin G supply

Access to a reliable supply of high quality benzathine penicillin G (BPG) is one of the most important components of RHD control efforts. However, clinicians in many parts of the world report that BPG is often out of stock, questionable quality or difficult to administer.  When supplies can not be found people living with RHD may miss out on prophylaxis, risking sub-therapeutic serum levels of BPG and dangerous recurrences of rheumatic fever. RhEACH has produced a single page summary of challenges in access BPG. 
We are committed to improving global access to BPG in a number of ways:

  • Developing a relationship with procurement specialists to help local programs understand barriers to supply within a country
  • Exploring supply side interventions to improve quality 
  • Supporting efforts to develop novel delivery mechanism for penicillin

We would also like to hear from:

  • Potential partners from the pharmaceutical industry
  • Clinicians with case reports of anaphylaxis
  • Researchers with an interest in anaphylactic drug reactions in low and middle income country settings

2.5 Vaccine development support

Although sustained RHD control programs can achieve substantial reductions in the burden of disease, a vaccine is likely to be integral to definitive elimination of RHD. A vaccine against group A streptococcus, preventing RF and RHD is closer than ever before, with human trials underway:

  • See summary of vaccine developments here
  • The Governments of Australia and New Zealand are funding a joint effort to accelerate vaccine progress. See press release 

These developments in basic science must be partnered with attention to implementation science attention in vaccine delivery. RhEACH intends to address a number of challenges

  • Reducing the delay between vaccine development and delivery
  • Supporting countries to extract the most useful information for including a prospective vaccine on national immunisation schedules.
  • Understanding vaccine update decisions related to an RF vaccine 

2.6 Opportunities to integrate and create diagonal approaches

Integrating RF/RHD control programs into existing health care delivery structures is critical for sustainability and comprehensive care. However, achieving meaningful integration remains a challenge in most settings.  Awaiting opportunities for integration to emerge and pervade RF/RHD programs has been historically insufficient. Allocating time, funding and resources to create space for integration activities is critical.

RhEACH will undertake a literature review of integration and diagonal approaches from other disease sectors and examine opportunities for integration relevant to RF/RHD control programs. We would love to profile examples of real-world integration in RHD care/control!