• Edwards Lifesciences Foundation
  • Rotary International
  • Medtronic Australia and New Zealand
  • Timor-Leste Ministerio da Saude
  • Hospital Nacional Guido Valadares (HNGV) 
  • Maluk Timor  
  • East Timor Hearts Fund  

The NEARER SCAN / LENO BESIK study aims to evaluate the implementation of a diagnostic approach to screening for RHD in children and pregnant women, that incorporates novel technology (handheld echocardiography performed by local healthcare staff with offsite image review) into routine health service provision.

  • To evaluate the implementation strategy and document enablers and barriers to its success in facilitating access to diagnostic testing for RHD for the target population.
  • To determine the outcomes of the echo screening intervention on access to guideline-based management of RHD and patient movement through their cascade of care from screening to diagnosis, retention in care, treatment prescription and treatment adherence. 

The study is a co-designed, implementation research project that will improve equitable access to culturally safe, best quality care for RHD in high-burden Aboriginal and Torres Strait Islander communities in Australia, and in Timor-Leste. The research addresses an area of unmet need, using novel technologies and embedding them in health practice, to enhance and accelerate diagnosis of RHD outside acute health settings and improve outcomes. The study will be conducted in partnership with community leaders and local partners. 

Chief Investigators:
Project Manager:
  • Meghan Bailey
Contact information:
Project dates:
  • 2022 – May 2025
Information for study participants:

Participants will be identified through local community health centres and hospitals in the study locations.

These publications relate to the study:

  1. Davis K, Remenyi B, Draper AD, Dos Santos J, Bayley N, Paratz E, et al. Rheumatic heart disease in Timor-Leste school students: an echocardiography-based prevalence study. Med J Aust. 2018 Apr 16;208(7):303–7.
  2. Davis K, de Oliveira LN, da Silva Almeida I, Noronha M, Martins J, Dos Santos M, et al. Morbidity and mortality of rheumatic heart disease and acute rheumatic fever in the inpatient setting in Timor-Leste. J Paediatr Child Health. 2021 Sep;57(9):1391–6.
  3. Francis JR, Fairhurst H, Yan J, Monteiro AF, Lee AM, Maurays J, et al. Abbreviated Echocardiographic Screening for Rheumatic Heart Disease by Nonexperts with and without Offsite Expert Review: A Diagnostic Accuracy Study. Journal of the American Society of Echocardiography [Internet]. 2023 Feb 17 [cited 2023 Apr 23];0(0). Available from:
  4. Francis JR, Fairhurst H, Whalley G, Kaethner A, Ralph A, Yan J, et al. The RECARDINA Study protocol: diagnostic utility of ultra-abbreviated echocardiographic protocol for handheld machines used by non-experts to detect rheumatic heart disease. BMJ Open. 2020 May 27;10(5):e037609.
  5. Francis JR, Whalley GA, Kaethner A, Fairhurst H, Hardefeldt H, Reeves B, et al. Single-View Echocardiography by Nonexpert Practitioners to Detect Rheumatic Heart Disease: A Prospective Study of Diagnostic Accuracy. Circ Cardiovasc Imaging. 2021 Aug;14(8):e011790.
  6. Remenyi B, Davis K, Draper A, Bayley N, Paratz E, Reeves B, et al. Single Parasternal-Long-Axis-View-Sweep Screening Echocardiographic Protocol to Detect Rheumatic Heart Disease: A Prospective Study of Diagnostic Accuracy. Heart Lung Circ. 2020 Jun;29(6):859–66.
  7. Francis JR, Fairhurst H, Hardefeldt H, Brown S, Ryan C, Brown K, et al. Hyperendemic rheumatic heart disease in a remote Australian town identified by echocardiographic screening. Med J Aust. 2020 Aug;213(3):118–23.
  8. Mitchell AG, Diddo J, James AD, Guraylayla L, Jinmarabynana C, Carter A, et al. Using community-led development to build health communication about rheumatic heart disease in Aboriginal children: a developmental evaluation. Aust N Z J Public Health. 2021 Jun;45(3):212–9.
  9. Hardefeldt HA, Monteiro Fernandes A, Yan J, Francis JR. Acute Rheumatic Fever: Recent Advances. Pediatr Infect Dis J. 2023 Feb 1;42(2):e42–4.