Stakeholders Want a Menu of Choices: Findings from a Consultation Workshop on Improving Access to Secondary Prophylaxis of Rheumatic Fever and Rheumatic Heart Disease

Thel K. Hla; Stephanie L. Enkel; Joseph Kado; Elizabeth Eadie-Mirams; Rosemary Wyber; Jonathan Carapetis; Laurens Manning

doi:10.5334/gh.1555

Stakeholders Want a Menu of Choices: Findings from a Consultation Workshop on Improving Access to Secondary Prophylaxis of Rheumatic Fever and Rheumatic Heart Disease

Volume 21 (2026): Issue 1

By: Thel K. Hla , Stephanie L. Enkel , Joseph Kado , Elizabeth Eadie-Mirams, Rosemary Wyber , Jonathan Carapetis and Laurens Manning

Open Access

|May 2026

Figures & Tables

Table 1

Summary of main findings from the stakeholder consultation with regards to secondary prophylaxis delivery and profile of BPG formulation.

Secondary prophylaxis	Current model: Pharmacological prophylaxis: Intramuscular injection of BPG every 3–4 weeks Delivery: By a healthcare worker in a healthcare facility By a healthcare worker in schools/homes
	Alternate/Preferred model as per stakeholders: Consumer-centred delivery with careful education to support informed decision making and personal autonomy Pharmacological prophylaxis: Choice of— Intramuscular injection of BPG every 3–4 weeks High dose BPG delivered subcutaneously 10-weekly Small dose BPG self-administered subcutaneously weekly Daily oral penicillin (only in highly selected/special populations) Delivery: Choice of— Self-administration at home Home administration by a trained parent or caregiver By a healthcare worker in a healthcare facility By a healthcare worker in schools/homes
Profile of BPG	Preferred product characteristics of new BPG formulation as previously reported (23) Dose interval longer than 6 weeks, ideally up to 6 months Less painful than existing formulation or ideally painless Suitable for subcutaneous injection Cold chain independent Comparable or lower than the annual cost of existing formulations and delivery
	Additional preferred product characteristics of the new BPG formulation reported from this consultation Quality product meeting rigorous standards (GMP certified) Able to be manufactured in adequate quantities to meet global demands from both high- and low-resource settings Accountable and transparent supply chain (prevent stockouts) Cost-effective within the context of broader health systemic costs (direct and indirect costs) beyond price equivalence per dose to current formulation A ‘cost-plus’ tiered pricing model, prioritising consumers in LMICs to ensure equitable access while not disincentivising manufacturers from quality assured production

[i] Abbreviations: BPG—benzathine benzylpenicillin G; GMP—Good Manufacturing Practice; LMICs—Low- and Middle-income Countries.

Articles in this issue

DOI: https://doi.org/10.5334/gh.1555 | Journal eISSN: 2211-8179

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Language: English

Page range: 39 - 39

Submitted on: Jun 17, 2025

Accepted on: Apr 29, 2026

Published on: May 18, 2026

Published by: Ubiquity Press

In partnership with: Paradigm Publishing Services

Publication frequency: 1 issue per year

Keywords:

benzathine benzylpenicillin (BPG),

penicillin,

rheumatic heart disease,

rheumatic fever,

secondary prophylaxis,

consumer perspective,

stakeholder perspective

© 2026 Thel K. Hla, Stephanie L. Enkel, Joseph Kado, Elizabeth Eadie-Mirams, Rosemary Wyber, Jonathan Carapetis, Laurens Manning, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 21 (2026): Issue 1