title: Adherence to Secondary Prophylaxis for Acute Rheumatic Fever and Rheumatic Heart Disease: A Systematic Review.
abstract: BACKGROUND
  Optimal delivery of regular benzathine penicillin G (BPG) injections prescribed as secondary prophylaxis for acute rheumatic fever (ARF) and rheumatic heart disease (RHD) is vital to preventing disease morbidity and cardiac sequelae in affected pediatric and young adult populations. However, poor uptake of secondary prophylaxis remains a significant challenge to ARF/RHD control programs.
  
  
  OBJECTIVE
  In order to facilitate better understanding of this challenge and thereby identify means to improve service delivery, this systematic literature review explored rates of adherence and factors associated with adherence to secondary prophylaxis for ARF and RHD worldwide.
  
  
  METHODS
  MEDLINE was searched for relevant primary studies published in the English language from 1994-2014, and a search of reference lists of eligible articles was performed. The methodological quality of included studies was evaluated using a modified assessment tool.
  
  
  RESULTS
  Twenty studies were included in the review. There was a range of adherence to varying regimens of secondary prophylaxis reported globally, and a number of patient demographic, clinical, socio-cultural and health care service delivery factors associated with adherence to secondary prophylaxis were identified.
  
  
  CONCLUSIONS
  Insights into factors associated with lower and higher adherence to secondary prophylaxis may be utilized to facilitate improved delivery of secondary prophylaxis for ARF and RHD. Strategies may include ensuring an effective active recall system, providing holistic care, involving community health workers and delivering ARF/RHD health education.
authors.affiliation: Royal Children's Hospital, Melbourne, Victoria, Australia.|College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia.
authors.forename: Priya M
authors.initials: PM
authors.lastname: Kevat
authors.affiliation: College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia.|Department of Paediatrics, Cairns Base Hospital, Cairns, Queensland, Australia.
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Reeves
authors.affiliation: Apunipima Cape York Health Council and Torres and Cape Hospital and Health Service, Queensland, Australia.
authors.forename: Alan R
authors.initials: AR
authors.lastname: Ruben
authors.affiliation: College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia.|Research and development unit, Primary health care and dental care, Southern Älvsborg county, Region Västra Götaland, Sweden.|Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Sweden.
authors.forename: Ronny
authors.initials: R
authors.lastname: Gunnarsson
keywords: Acute rheumatic fever; adherence; benzathine benzylpenicillin; benzathine penicillin; compliance; penicillin G
  benzathine; rheumatic heart disease; secondary prophylaxis.