Delivery of secondary antibiotic prophylaxis (SAP) for rheumatic heart disease (RHD) is challenging in many settings. We aimed to investigate adherence to SAP among young people with screening-detected RHD in Fiji, and to understand current practice and evaluate opportunities to improve adherence.
We collected SAP injection data from 76 health clinics across Fiji. Adherence was measured using the proportion of days covered (PDC) from 2012 to 2014. Multivariate logistic regression analysis was used to identify characteristics associated with adherence. A structured interview used the WHO adherence framework to evaluate attitudes, practice, barriers and improvement strategies.
494 patients were included in the adherence study (median age 14 years). 203 (41%) had no injections recorded and just 33 (7%) had adequate adherence (PDC≥0.8). NoniTaukei ethnicity (OR 2.6) and urban residence (OR 3.4) were associated with adequate adherence, whereas time since diagnosis ≥1.5 years (OR 0.4) was inversely associated.
101 young people were interviewed. Reasons for missing injections included lack of awareness, feeling well, transport factors and medication unavailability. Inclusion of adolescents in decision making and improving educational materials were among the opportunities identified. Reminder strategies, particularly phone-based, were considered helpful by 94%.
This is the first study to assess adherence following screening, and the first to utilise the PDC measure for RHD adherence. Adherence in Fiji is currently inadequate for individual patient protection or population disease control. We characterised several factors influencing adherence, from which interventions can be developed. These interventions should be prioritized over further screening.