Identifying the research, advocacy, policy and implementation needs for the prevention and management of respiratory syncytial virus lower respiratory tract infection in low- and middle-income countries

Introduction The high burden of respiratory syncytial virus (RSV) infection in young children disproportionately occurs in low- and middle-income countries (LMICs). The PROUD (Preventing RespiratOry syncytial virUs in unDerdeveloped countries) Taskforce of 24 RSV worldwide experts assessed key needs for RSV prevention in LMICs, including vaccine and newer preventive measures. Methods A global, survey-based study was undertaken in 2021. An online questionnaire was developed following three meetings of the Taskforce panellists wherein factors related to RSV infection, its prevention and management were identified using iterative questioning. Each factor was scored, by non-panellists interested in RSV, on a scale of zero (very-low-relevance) to 100 (very-high-relevance) within two scenarios: (1) Current and (2) Future expectations for RSV management. Results Ninety questionnaires were completed: 70 by respondents (71.4% physicians; 27.1% researchers/scientists) from 16 LMICs and 20 from nine high-income (HI) countries (90.0% physicians; 5.0% researchers/scientists), as a reference group. Within LMICs, RSV awareness was perceived to be low, and management was not prioritised. Of the 100 factors scored, those related to improved diagnosis particularly access to affordable point-of-care diagnostics, disease burden data generation, clinical and general education, prompt access to new interventions, and engagement with policymakers/payers were identified of paramount importance. There was a strong need for clinical education and local data generation in the lowest economies, whereas upper-middle income countries were more closely aligned with HI countries in terms of current RSV service provision. Conclusion Seven key actions for improving RSV prevention and management in LMICs are proposed.


Introduction
We have an ambitious aim that we are very passionate about which is to create a global effort and program to abolish the terrible burden of respiratory syncytial virus (RSV) disease in babies and infants in low-and lower-middle income countries (LMICs). We take inspiration from what has been done with ending polio through the Rotary campaign and want to achieve a similar world-wide goal with RSV. We feel that this is the perfect time to start such a campaign with several vaccines, antibodies, and treatments for RSV on the near horizon.
To accomplish this, we have formed the PROUD (Preventing RespiratOry syncytial virUs in unDerdeveloped countries) Task Forcea powerful opinion group of RSV experts from around the world.
We are taking a stepwise approach towards the achievement of our objectives. The purpose of this questionnaire is to better understand and quantify the impact of RSV and future expectations in RSV management in LMICs. The results of this research will be published in a peer-reviewed journal and we would welcome you to be an author on the paper.  Decision Research is a research tool with a proven methodology that can provide powerful insight into decision making and understanding the impact of a disease and its treatment. This questionnaire was developed following three 'Cataloguing' sessions with the PROUD Taskforce wherein a list o f all possible items related to the current and future prevention and treatment of RSV infection in children was created (the 'Catalogue'). At each Cataloguing session, members of the Task Force were asked a series of overlapping questions about RSV in children, the responses to which were then discussed and expanded upon. The outputs from the three sessions were then amalgamated and condensed to form the final Catalogue. The questionnaire is designed to measure, in an objective manner, the relevance in your country of each of the items in the Catalogue. This will provide us with a rich dataset for analysis, enabling an in-depth understanding of the burden and management of RSV in LMICs.

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For more information on the Decision Research process, please see: Carbonell-Estrany X et al. Acta Paediatr 2018;107:854-860.

Instructions
There are two sections or parts to the remainder of the questionnaire: • Section 1the current situation regarding RSV management in your country • Section 2realistic future expectations for RSV management in your country For each section, please answer each question by making a vertical mark on the line (visual analogue scale) next to the question to indicate how relevant you think that particular issue is in your country (or country you are representing if relocated).
For example: Relevance Recognising the long-term economic sequelae of RSV very low___________________________________I________________________very high  Not relevant The need for longer term follow-up for RSV patients very low___________________________ I_______________________________very high  Not relevant Please note that: • In each section, the Catalogue items are repeatedthis will enable multivariate analysis on the relative importance of and interrelationships between the items within each context (current situation, realistic expectations, and ideal hopes) • The Catalogue items are randomisedthis reduces any (unintentional) rationalisation of answers and reduces visual analogue scale fatigue • The visual analogue scale is deliberately not numberedthis avoids the tendency for number preference • There is the option of marking an item as 'Not relevant' if not applicable to the situation in your country • This questionnaire should take 30-45 minutes to complete The availability of a maternal vaccine for RSV

1.23
The worry that new strategies for RSV prophylaxis and treatment will be unaffordable 1.07

24
The need for regular educational events, such as webinars, to update the important topic of paediatric and maternal vaccines for RSV

1.11
The need for training on RSV diagnosis and enabling distinction from bacterial infection

1.02
Understanding that RSV can be a problem in children with particular comorbidities 1.17 The need for RSV prevention in all children not just those at high risk 1.05 The importance of international vaccine programmes such as GAVI