A conceptual framework for comprehensive rheumatic heart disease control programs

The World Health Organization, World Heart Federation, and other organizations recommend comprehensive control programs for rheumatic fever (RF) and rheumatic heart disease (RHD). However, advice on components of control programs are simple lists, with little guidance on program structure or priorities. In particular, there are limited recommendations on "stepwise" implementation and few guidelines on which program components should take temporal priority. An evidence-based framework for describing, prioritizing, and implementing comprehensive RF/RHD control programs is needed. A literature review of existing RF/RHD control program recommendations generated a list of program components. Descriptions and analysis of RF/RHD control programs informed temporal prioritizing of component parts. Relevant programmatic research from other vertical disease control programs was reviewed for generalizable implementation experiences. Twenty-five individual components of comprehensive RF/RHD control programs were identified. These fell into "baseline" program requirements (including burden of disease data, treatment guidelines, and human resources) and requirements for providing primary, secondary, and tertiary interventions. Primordial prevention and research priorities were overarching themes. These components were developed into a conceptual framework schema. Existing literature contains valuable lessons on the design and implementation of comprehensive RF/RHD control programs. Fashioning these guidelines and programmatic experiences into a conceptual framework schema benefits clinicians, policy makers, and RHD advocates.