STARFISH

Rheumatic heart disease (RHD) stems from the abnormal immune response of acute rheumatic fever (ARF) triggered by preventable group A streptococcal (Strep A) infections.

The environment and context in which people live is the major determinant of the inequitable burden of Strep A, ARF and RHD for Australian Indigenous people. STARFISH comprehensively integrates a complementary and diverse team with skills in research with Indigenous communities, infectious diseases, molecular microbiology, public and environmental health, housing, architecture, anthropology, primary health care, modelling, clinical trials, spatial demography and data linkage.

Our key question is: What are the most effective environmental health initiatives to reduce Strep A infections and prevent ARF among communities at greatest risk? 

1. Indigenous governance, cultural security and data sovereignty in all research initiatives to ensure both-ways learning
2. Service-Research to ensure ‘no research occurs without service’
3. Sustainability, both financial and programmatic, of all environmental health initiatives
4. Holistic health following an Indigenous understanding of health and wellbeing
5. Voice of participants and community leaders will be listened to, empowered and supported to drive change

We will seek to align with the four Priority Reforms of the National Agreement on Closing the Gap in all aspects of STARFISH.

The questions asked by communities and collaborators underpinning the STARFISH grant are practical enquiries about Strep A infections and what can be done. The pragmatic, stepwise, approach to tackling Strep A can be distilled into five key questions from stakeholders: 

1. How is Strep A transmitted?
2. How can Strep A transmission be disrupted by environmental health initiatives?
3. What environmental health initiatives to disrupt Strep A transmission are most acceptable to communities?
4. How can the effect of environmental health initiatives be meaningfully and objectively evaluated?
5. How can environmental health initiatives be funded and embedded into action?

Funding: National Health Medical Research Council of Australia