Strengthening therapeutic adherence and pharmacovigilance to antimalarial treatment in Manaus, Brazil: a multicomponent strategy using mHealth

Malaria Journal

María de la Paz Ade¹  Diego Macías Saint-Gerons²  Alinne Paula Rodrigues Antolini³  João Altecir Nepomuceno³  Marcus Lacerda⁴  Wuelton Marcelo Monteiro⁴  Jady Shayenne Mota Cordeiro⁴  Rayanne Silva de Matos Fonseca⁴  Marcelo Yoshito Wada⁵  Márcia Helena Maximiano Faria de Almeida⁵  Andrea Beratarrechea⁶  Fernanda Simioni Gasparotto⁷  Karen Fleck⁷  Sheila Rodovalho⁸  Ádila Liliane Barros Dias⁸  Myrna Barata Machado⁹  Cristiano Fernandes da Costa⁹  Robin Rojas-Cortés^1,10  Analía I. Porrás^1,10  José Luis Castro^1,10  André Lacerda Ulysses de Carvalho^1,11  Shanthi Narayan Pal^1,12 

[1] Department of Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization (PAHO/WHO);Department of Medicine, University of Valencia, INCLIVA Health Research Institute and CIBERSAM;Environmental Surveillance Management - Department of Health;Fundação de Medicina Tropical Dr. Heitor Vieira Dourado;General-Coordination for Surveillance of Zoonoses and Vector-Borne Diseases, Secretariat of Health Surveillance, Ministry of Health;Institute of Clinical Effectiveness and Health Policy (IECS);Pharmacovigilance Office (GFARM), Brazilian Health Regulatory Agency (Anvisa);Programa de Pós-Gradação Em Medicina Tropical, Universidade Do Estado Do Amazonas;State of Amazonas Health Surveillance Foundation, Amazonas State Health Secretariat;Unit of Medicines and Health Technologies (MT), Dep. of Health Systems and Services (HSS), Pan American Health Organization (PAHO/WHO);Unit of Medicines and Health Technologies (MT), Dep. of Health Systems and Services (HSS), Pan American Health Organization (PAHO/WHO;World Health Organization Headquarters;

关键词: Primaquine;    Adherence;    Pharmacovigilance;    mHealth;    SMS;   

DOI  :  10.1186/s12936-022-04047-3

来源: DOAJ

【 摘 要 】

Abstract Background Public health initiatives for improving adherence to primaquine based regimens and enhancing effective pharmacovigilance are needed to support the efforts for malaria elimination in real world conditions. Methods A multicomponent patient-oriented strategy using a Smart Safety Surveillance (3S) approach including: (1) educational materials for treatment counselling and identification of warning symptoms of haemolytic anaemia; (2) an mHealth component using Short Message Service (SMS) treatment reminders and (3) development and implementation of follow-up phone surveys three days after treatment completion, using a web-based platform linked to the local information system of malaria. Adherence was measured using the Morisky Medication Adherence Scale. Self-reported events were registered using a structured questionnaire and communicated to the Brazilian Health Regulatory Agency. Results Educational materials were disseminated to 5594 patients, of whom 1512 voluntarily entered the mHealth component through the local information system; 7323 SMS were sent, and 1062 participants completed a follow-up survey after treatment. The mean age of patients was 37.36 years (SD 13.65), 61.24% were male, 98.54% were infected with. Plasmodium vivax and 95.90% received a short regimen of chloroquine plus primaquine (CQ + PQ 7 days), as per malaria case management guidelines in Brazil. From the 1062 surveyed participants 93.31% were considered adherent to the treatment. Most of the patients (95.20%) reported at least one adverse event. Headache, lack of appetite and nausea/vomiting were the most frequently reported adverse events by 77.31%, 70.90% and 56.78% of the patients respectively. A quarter of the patients reported anxiety or depression symptoms; 57 (5.37%) patients reported 5 to 6 warning symptoms of haemolytic anaemia including jaundice and dark urine in 44 (4.14%). Overall, three patients presenting symptoms of haemolytic anaemia attended a hospital and were diagnosed with G6PD deficiency, and one had haemolysis. All of them recovered. Conclusions Under real world conditions, a multicomponent patient-oriented strategy using information and communication technologies allowed health care providers to reinforce treatment adherence and enhance safety surveillance of adverse events associated with regimens using primaquine. Active monitoring through phone surveys also reduced under-reporting of ADRs. This approach is low-cost, scalable and able to support prioritized activities of the national malaria programme.

【 授权许可】

Unknown