title: Adherence to secondary antibiotic prophylaxis for patients with rheumatic heart disease diagnosed through screening in Fiji.
abstract: Echocardiographic screening for rheumatic heart disease (RHD) can detect subclinical cases; however, adequate adherence to secondary antibiotic prophylaxis (SAP) is required to alter disease outcomes. We aimed to investigate the adherence to SAP among young people with RHD diagnosed through echocardiographic screening in Fiji and to investigate factors associated with adherence.
  
  
  
  Patients diagnosed with RHD through echocardiographic screening in Fiji from 2006 to 2014 were included. Dates of benzathine penicillin G injections were collected from 76 health clinics nationally from December 2011 to December 2014. Adherence was measured using the proportion of days covered (PDC). Multivariate logistic regression analysis was used to identify characteristics associated with any adherence (≥1 injection received) and adequate adherence (PDC ≥0.80).
  
  
  
  Of 494 patients, 268 (54%) were female and the median age was 14 years. Overall, 203 (41%) had no injections recorded and just 33 (7%) had adequate adherence. Multivariate logistic regression showed increasing age (OR 0.93 per year, 95% CI 0.87-0.99) and time since diagnosis ≥1.5 years (OR 0.53, 95% CI 0.37-0.79) to be inversely associated with any adherence. Non-iTaukei ethnicity (OR 2.58, 95%CI 1.04-6.33) and urban residence (OR 3.36, 95% CI 1.54-7.36) were associated with adequate adherence, whereas time since diagnosis ≥1.5 years (OR 0.38, 95%CI 0.17-0.83) was inversely associated with adequate adherence.
  
  
  
  Adherence to SAP after screening in Fiji is currently inadequate for individual patient protection or population disease control. Secondary prevention should be strengthened before further screening can be justified.
authors.affiliation: Department of Paediatrics, University of Melbourne, Parkville, Vic, Australia.|Murdoch Childrens Research Institute, Parkville, Vic, Australia.|Royal Children's Hospital, Parkville, Vic, Australia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Engelman
authors.affiliation: Department of Paediatrics, Colonial War Memorial Hospital, Suva, Fiji.
authors.forename: Reapi L
authors.initials: RL
authors.lastname: Mataika
authors.affiliation: Department of Paediatrics, Colonial War Memorial Hospital, Suva, Fiji.|College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji.|Fiji Rheumatic Heart Disease Control Program, Suva, Fiji.
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Kado
authors.affiliation: Fiji Rheumatic Heart Disease Control Program, Suva, Fiji.
authors.forename: Maureen
authors.initials: M
authors.lastname: Ah Kee
authors.affiliation: Department of Paediatrics, University of Melbourne, Parkville, Vic, Australia.|Murdoch Childrens Research Institute, Parkville, Vic, Australia.
authors.forename: Susan
authors.initials: S
authors.lastname: Donath
authors.affiliation: Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Parks
authors.affiliation: Department of Paediatrics, University of Melbourne, Parkville, Vic, Australia.|Murdoch Childrens Research Institute, Parkville, Vic, Australia.|Royal Children's Hospital, Parkville, Vic, Australia.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Steer
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005006:Ethnicity; D005260:Female; D005367:Fiji; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening; D016017:Odds Ratio; D010349:Patient Compliance; D010401:Penicillin G Benzathine / Q000627:therapeutic use*; D012214:Rheumatic Heart Disease / Q000175:diagnosis / Q000188:drug therapy*; D055502:Secondary Prevention; D014505:Urban Population; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D010401:Penicillin G Benzathine
keywords: Pacific Islands; Rheumatic heart disease; adherencia a la medicación; adhésion au traitement; adolescencia; adolescent; antibiotic prophylaxis; cardiopathie rhumatismale; cribado masivo; dépistage de masse; enfermedad cardiaca reumática; islas del Pacífico; mass screening; medication adherence; prevención secundaria; profilaxis antibiótica; prophylaxie antibiotique; prévention secondaire; secondary prevention; îles du Pacifique