Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) have significant impact on the health of children and young adults. It remains common in low- and middle- income countries in the Global South and has lifelong health consequences. The underlying cause is an abnormal immune reaction to sore throat and/or skin infections caused by a specific bacteria (Group A streptococcus, GAS). RHD can be prevented with penicillin antibiotics, if diagnosed and treated early. Yet, in South Africa, a middle- income country, the burden of RHD is largely unchanged despite relatively good access to penicillin antibiotics in the community. This is research gap.

In this project, we will explore the potential underlying reasons for this by doing three things: (1) organise a local stakeholder group of experts and laypersons to discuss the underlying reasons, potential interventions and guide the project; (2) describe patients with suspected GAS sore throat and/or skin infections treated in the community; (3) hold workshops with our stakeholder group to outline a research proposal for future funding. Better identifying patients in the community with predisposing GAS infections (i.e. sore throat and skin infection) will help ensure that prevention measures and other interventions have a higher chance of success.