Acute rheumatic fever (ARF) is an inflammatory disease that primarily affects the heart, joints, and blood vessels due to recurrent infection with Group A Streptococcus bacterium (GAS) (1). Untreated ARF can lead to irreversible damage to the heart valves resulting in rheumatic heart disease (RHD)(2, 3). Despite being entirely preventable, within Australia the burden of ARF is almost exclusively witnessed in the Indigenous population, particularly 5-14 year olds (4). In Australia, ARF/RHD are predominantly found in remote settings, particularly far north Queensland, where several barriers to care exist. Geographic remoteness prohibits the ability of health care providers to obtain timely results for testing for GAS impetigo infection using microbial culture (3, 5). Consequently, current clinical guidelines recommend that in high prevalence settings, patients presenting with symptoms of GAS (pharyngitis & impetigo) infection be treated with painful intramuscular benzathine benzylpenicillin injections (BPG) without requirement for microbial testing confirmation (2). The Roche Diagnostics Liat system is a PCR PoC diagnostic test for the detection of GAS (pharyngitis) for throat swab specimens that delivers a result in ~15 minutes. This device was included on the Australian Register of Therapeutic Goods (ARTG) in Australia in 2017. The burden of GAS impetigo for Indigenous children living in remote northern Australia is higher than anywhere else in the world (6, 7). However, there is currently no TGA approved point of care test (PoCT) to address the need for reliable and efficient molecular testing for GAS impetigo/pyoderma. The SToPPING ARF skin trial has been codesigned with several Aboriginal and Torres Strait Islander Community Controlled Health Organisation’s (ATSICCHOs) to address a community identified need for increased diagnostic capacity for GAS impetigo in ARF/RHD endemic communities. This trial aims to determine the sensitivity and specificity of the cobas Liat Strep A PoCT for diagnosis of GAS infections in skin swab specimens, compared to a reference laboratory standard. It is anticipated that results will facilitate revision of current clinical guidelines, avoiding unnecessary and painful intramuscular BPG injections.  Reducing unnecessary prescription of BPG treatment will improve antimicrobial stewardship and reduce burden on the worldwide shortage of BPG. Improving testing capacity in remote regions will improve patient access to care, reduce time to treatment, reduce potential infectious days in community and prevent progression to ARF/RHD in vulnerable communities. Study findings will be shared directly with participating communities through consumer directed summary reports and scientific reports shared with ATSICCHOs.
Last updated14 June 2026