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
Authors: Carbonell-Estrany Xavier , Simões Eric A. F , Bont Louis J , Gentile Angela , Homaira Nusrat , Scotta Marcelo Comerlato , Stein Renato T , Torres Juan P , Sheikh Jarju , Broor Shobha , Khuri-Bulos Najwa , Nokes D James , Munywoki Patrick K , Bassat Quique , Sharma Arun K , Basnet Sudha , Garba Maria , De Jesus-Cornejo Joanne , Lupisan Socorro P , Nunes Marta C , Divarathna Maduja , Fullarton John R , Rodgers-Gray Barry S , Keary Ian , Reñosa Mark Donald C , Verwey Charl , Moore David P , Noordeen Faseeha , Kabra Sushil , do Vale Marynéa Silva , Paternina-De La Ossa Rolando , Mariño Cristina , Figueras-Aloy Josep , Krilov Leonard , Berezin Eitan , Zar Heather J , Paudel Krishna , Safadi Marco Aurelio Palazzi , Dbaibo Ghassan , Jroundi Imane , Jha Runa , Rafeek Rukshan A. M , Pinheiro Rossiclei de Souza , Bracht Marianne , Muthugala Rohitha , Lanari Marcello , Martinón-Torres Federico , Mitchell Ian , Irimu Grace , Pandey Apsara , Krishnan Anand , Mejias Asuncion , da Costa Marcela Santos Corrêa , Shrestha Shrijana , Pernica Jeffrey M , de Carvalho Felipe Cotrim , Jalango Rose E , Ibrahim Hafsat , Ewa Atana , Ensinck Gabriela , Ulloa-Gutierrez Rolando , Miralha Alexandre Lopes , Lucion Maria Florencia , Hassan Md Zakiul , Akhtar Zubair , Aleem Mohammad Abdul , Chowdhury Fahmida , Rojo Pablo , Sande Charles , Musau Abednego , Zaman Khalequ , Helena Luiza , Arlant Falleiros , Ghimire Prakash , Price April , Subedi Kalpana Upadhyay , Brenes-Chacon Helena , Goswami Doli Rani , Rahman Mohammed Ziaur , Hossain Mohammad Enayet , Chisti Mohammod Jobayer , Vain Nestor E , Lim Audrey , Chiu Aaron , Papenburg Jesse , Juarez Maria del Valle , Senaratne Thamarasi , Arunasalam Shiyamalee , Strand Tor A , Ayuk Adaeze , Ogunrinde Olufemi , Tavares Lohanna Valeska de Sousa , Garba Comfort , Garba Bilkisu I , Dawa Jeanette , Gordon Michelle , Osoro Eric , Agoti Charles N , Nyawanda Bryan , Ngama Mwanajuma , Tabu Collins , Mathew Joseph L , Cornacchia Andrew , Rai Ganesh Kumar , Jain Amita , Giongo Mateus Sfoggia , Paes Bosco A 
Published: November 2022

IntroductionThe 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.MethodsA 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.ResultsNinety 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.ConclusionSeven key actions for improving RSV prevention and management in LMICs are proposed.