{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T19:10:42Z","timestamp":1781550642208,"version":"3.54.5"},"reference-count":17,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:00:00Z","timestamp":1760054400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Cure Kids New Zealand","award":["7012"],"award-info":[{"award-number":["7012"]}]},{"name":"Te Niwha Infectious Disease Platform"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) remain significant health issues for M\u0101ori 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 four-weekly intramuscular (IM) injections. As part of a clinical trial involving participants with ARF who have been on SCIP for at least one year, we aim to explore treatment adherence, pain management, and quality of life for M\u0101ori and Pacific participants and their families (wh\u0101nau). A community centred approach aligned with Kaupapa M\u0101ori, and Pacific-centred research values was used. Semi-structured interviews were conducted with 10 families, including nine participants on SCIP. Data collection occurred between March and August 2024. Thematic analysis was used to identify key themes from participants\u2019 experiences. Six themes emerged: Reduced burden of treatment; emotional impact from reduced injection frequency; family-centered care by healthcare providers; relationship building (whakawhanaungatanga); health literacy; and pain management. Participants valued SCIP\u2019s 10-week dosing interval, which contributed to improvements in quality of life. The extended dosing interval also alleviated emotional barriers, including the stress associated with more frequent injections. Participants valued that nurses offered them the choice of which location to receive their injections, at home, in a clinic, at work, or at school. Strong relationships with healthcare providers, especially research nurses, were essential for adherence. This study highlights that the extended dosing interval provided by SCIP reduced the physical and emotional burdens participants experienced with their monthly IM BPG injections, thereby enhancing quality of life. The findings emphasise the importance of culturally responsive, family-centered models of care. SCIP offers an opportunity to improve adherence to secondary prophylaxis and if implemented as a standard treatment option, improve health outcomes both in NZ and internationally.<\/jats:p>","DOI":"10.1371\/journal.pgph.0004895","type":"journal-article","created":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T17:34:16Z","timestamp":1760117656000},"page":"e0004895","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Subcutaneous injections of penicillin (SCIP): Convenient and effective treatment for M\u0101ori, Pacific Peoples and their families in preventing rheumatic heart disease"],"prefix":"10.1371","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-4634-1145","authenticated-orcid":true,"given":"Julie","family":"Cooper","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monleigh","family":"Muliaumasealii","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dhevindri","family":"Moodley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqui","family":"Ulugia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anneka","family":"Anderson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3461-7223","authenticated-orcid":true,"given":"Julie","family":"Bennett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,10,10]]},"reference":[{"issue":"25","key":"pgph.0004895.ref001","first-page":"2982","article-title":"Global burden of cardiovascular diseases and risk factors, 1990-2019: update from the GBD 2019 study","volume":"76","author":"GA Roth","year":"2020","journal-title":"J Am Coll Cardiol"},{"issue":"25","key":"pgph.0004895.ref002","doi-asserted-by":"crossref","first-page":"2361","DOI":"10.1016\/j.jacc.2022.11.005","article-title":"The global burden of cardiovascular diseases and risk: a compass for future health","volume":"80","author":"M Vaduganathan","year":"2022","journal-title":"J Am Coll Cardiol"},{"issue":"1","key":"pgph.0004895.ref003","doi-asserted-by":"crossref","first-page":"36","DOI":"10.3201\/eid2701.191791","article-title":"Rising ethnic inequalities in acute rheumatic fever and rheumatic heart disease, New Zealand, 2000-2018","volume":"27","author":"J Bennett","year":"2021","journal-title":"Emerg Infect Dis"},{"key":"pgph.0004895.ref004","volume-title":"New Zealand Guidelines for Rheumatic Fever: Diagnosis, Management and Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease","author":"Heart Foundation of New Zealand","year":"2014"},{"issue":"1","key":"pgph.0004895.ref005","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.gheart.2014.10.001","article-title":"A qualitative examination of secondary prophylaxis in rheumatic heart disease: factors influencing adherence to secondary prophylaxis in Uganda","volume":"10","author":"DM Huck","year":"2015","journal-title":"Glob Heart"},{"issue":"10","key":"pgph.0004895.ref006","doi-asserted-by":"crossref","first-page":"2951","DOI":"10.1093\/jac\/dkaa282","article-title":"Subcutaneous administration of benzathine benzylpenicillin G has favourable pharmacokinetic characteristics for the prevention of rheumatic heart disease compared with intramuscular injection: a randomized, crossover, population pharmacokinetic study in healthy adult volunteers","volume":"75","author":"JH Kado","year":"2020","journal-title":"J Antimicrob Chemother"},{"issue":"1","key":"pgph.0004895.ref007","doi-asserted-by":"crossref","first-page":"106506","DOI":"10.1016\/j.jinf.2025.106506","article-title":"High dose, subcutaneous injections of benzathine penicillin G (SCIP) to prevent rheumatic fever: a single arm, phase IIa trial of safety and pharmacokinetics","volume":"91","author":"J Bennett","year":"2025","journal-title":"J Infect"},{"key":"pgph.0004895.ref008","doi-asserted-by":"crossref","DOI":"10.1016\/j.hlc.2022.06.515","article-title":"Subcutaneous Infusions of High-Dose Benzathine Penicillin G (SCIP) is safe, tolerable and potentially suitable for less frequent dosing for rheumatic heart disease secondary prophylaxis","volume":"31","author":"J Kado","year":"2022","journal-title":"Heart Lung Circ"},{"issue":"5","key":"pgph.0004895.ref009","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0302493","article-title":"\u201cHurts less, lasts longer\u201d; 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