Background: Rheumatic heart disease (RHD) is the leading cause of cardiovascular inequality between Indigenous and non-Indigenous Australians. It occurs as an autoimmune complication of acute rheumatic fever (ARF) triggered by preventable Group A Streptococcus (Strep A) infections. Environmental determinants, such as inadequate housing and infrastructure, underpin the disproportionate burden of Strep A, ARF, and RHD among Indigenous Australians. The STARFISH (STopping Acute Rheumatic Fever Infections to Strengthen Health) program, funded by the NHMRC Synergy Grant, investigates the most effective environmental health initiatives (EHIs) to reduce Strep A infections and prevent ARF.
Methods: This multidisciplinary program employs a mixed-methods approach across three thematic areas: (1) identifying mechanisms of Strep A transmission and the EHIs most likely to disrupt it; (2) developing a robust evaluation framework for assessing current EHIs; and (3) conducting place-based trials and prospective observational studies to assess EHI effectiveness in high-risk communities.
Results: STARFISH is expected to produce high-quality, policy-relevant evidence to guide the prevention of ARF and accelerate Australia’s efforts to eliminate RHD within the next decade. The outcomes will inform local, jurisdictional, and national policies, particularly those related to housing and environmental health infrastructure in remote settings.
Conclusion: Underpinned by Indigenous leadership, STARFISH addresses a critical question: What are the most effective EHIs to reduce Strep A infections and prevent ARF? By targeting environmental determinants, the program aims to close the gap in cardiovascular health outcomes and strengthen public health policy pertaining to the elimination of RHD for Indigenous Australians.