Background:
Remote, northern Australia has among the world’s highest reported rates of acute rheumatic fever (ARF). Accurate and timely diagnosis of Strep A pharyngitis, a precursor to ARF, is challenging in this setting as children with sore throats rarely present to clinics and culture swabs take up to a week to reach laboratories, reducing viability. Whilst molecular point-of-care testing (PoCT) for Strep A is now available as a diagnostic tool, no studies to date have utilised this tool within primary prevention strategies for children at high risk of ARF.
Methods:
We aim to implement a molecular Strep A PoCT program across 30 remote communities in northern Australia and evaluate the impact on timely treatment of Strep A pharyngitis and prevention of ARF. Children aged 5–15 years presenting to clinics for any reason will be assessed using a sore throat checklist and offered Strep A PoCT if symptomatic. Those positive will be offered treatment as per Australian guidelines. The primary outcome is timely treatment of Strep A pharyngitis. Secondary outcomes include cost effectiveness, impact on ARF rates and acceptability to clinicians and communities.
Results:
We will present the rationale and protocol for this study which will be co-designed with Aboriginal community-controlled health services to ensure acceptability, feasibility and usefulness for remote Aboriginal communities.
Conclusion:
The availability of new diagnostic tools for early detection and treatment of Strep A pharyngitis in remote clinics is a potential game changer for ARF prevention. This study will demonstrate the potential utility for programs globally.