Subcutaneous injections of penicillin (SCIP): Convenient and effective treatment for Maori, Pacific Peoples and their whanau in preventing rheumatic heart disease

BackgroundAcute rheumatic fever (ARF) and rheumatic heart disease (RHD) remain significant health issues for M[a]ori and Pacific communities in Aotearoa New Zealand (NZ). Subcutaneous injection of penicillin (SCIP) enables injections to be given 10-weekly as an alternative to the standard secondary prophylaxis of four-weekly intramuscular (IM) injections. As part of a clinical trial involving participants who have been on SCIP for at least one year, we aim to explore treatment adherence, pain management, and quality of life for M[a]ori and Pacific participants and their wh[a]nau. MethodologyA community centred approach aligned with Kaupapa M[a]ori, and Pacific-centred research values was used. Semi-structured interviews were conducted with 10 wh[a]nau (family), including nine participants on SCIP. Data collection occurred between March and September 2024. Thematic analysis was used to identify key themes from participants experiences. Principal findingsSix themes emerged: Reduced burden of treatment; emotional impact from reduced injection frequency; wh[a]nau-centered care by healthcare providers, relationship building (whakawhanaungatanga), health literacy, and pain management. Participants reported significant improvements in quality of life and valued SCIPs flexibility, allowing injections at home, work, or school, with the added convenience of visits every 10-weeks. Strong relationships with healthcare providers, especially research nurses, were essential for adherence. Emotional barriers, such as stress associated with frequent injections, were reduced with SCIP. ConclusionsThis study highlights the benefits of SCIP in reducing physical and emotional barriers, which in turn enhances the quality of life for M[a]ori and Pacific participants with ARF. The findings emphasise the importance of culturally responsive, wh[a]nau-centered models of care. SCIP has the potential to improve adherence to secondary prophylaxis, with the potential to be offered as a standard treatment, improving health outcomes across NZ and internationally.