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Keywords: child; rheumatic heart disease; risk EN child rheumatic heart disease risk 1848 1850 3 06/09/23 20230613 NES 230613 The GOAL trial (Determining the Impact of Penicillin in Latent RHD; URL: https://www.clinicaltrials.gov; Unique identifier: NCT03346525) was a randomized controlled trial of secondary antibiotic prophylaxis (SAP) compared with no prophylaxis among Ugandan children with latent, or screen-detected, rheumatic heart disease (RHD).[1],[2] SAP resulted in a significant reduction in RHD progression (worsening of diagnostic category) versus no prophylaxis (0.8% versus 8.3%; I P i <0.001), whereas nearly half of the children, regardless of SAP administration, regressed (improvement in diagnostic category) over 2 years.[2] Understanding risk factors for progression and regression of latent RHD at the time of screening echocardiogram could refine approaches to SAP in RHD, which would have both individual and health system benefit. In contrast, participants were more likely to regress if they were older at diagnosis and if they had borderline RHD, as compared with definite RHD. These data begin to unravel level of risk of RHD progression, with both sociodemographic and echocardiographic risk factors incorporated into the analyses. [Extracted from the article]