Currently a large proportion of those suffering rheumatic heart disease are not diagnosed, or are diagnosed at a late stage when damage to the heart is very severe. Rheumatic heart disease remains the leading cause of maternal cardiac complications in pregnancy. In many rheumatic heart disease-endemic countries there is little or no access to life-saving heart valve surgery. Measures to halt the progression to severe rheumatic heart disease require long-term treatments and a well-functioning health system to deliver this service.
Additionally, because treatment is long-term, it can be costly and challenging for patients to regularly visit a healthcare facility, and some patients may avoid the injections due to discomfort or fear of adverse events. A steady supply of benzathine penicillin G is an essential prerequisite for treatment of sore throat and to prevent recurrent infection. However, the antibiotic is prone to global shortages. High manufacturing costs and low purchase prices have pushed some manufacturers out of the market while demand for the drug is rising. When the medication is not available on the shelf, necessary long-term treatment regimens are disrupted.
