Remote-living Indigenous Australians have the highest reported rates of Acute Rheumatic Fever (ARF) globally. ARF is an autoimmune complication triggered by preventable Strep A infections. Eliminating Rheumatic Heart Disease in Australia requires addressing the critical evidence gap about how to prevent Strep A transmission. With Indigenous leadership, STARFISH aims to answer: What are the most effective environmental health initiatives to reduce Strep A infections and prevent ARF among communities at greatest risk? Evidence produced by STARFISH is likely to extend into major policy initiatives around remote housing and inform policy decisions by local communities, jurisdictions and nationally.