Community engagement among forest goers in a malaria prophylaxis trial: implementation challenges and implications

Malaria Journal

Research

Christopher Pell¹  Siv Sovannaroth²  Olaf Müller³  Franca Conradis-Jansen⁴  Mom Ean⁵  Riccardo Murgia⁵  Monnaphat Jongdeepaisal⁵  Panarasri Khonputsa⁵  Phaik Yeong Cheah⁶  James J. Callery⁶  Thomas J. Peto⁶  Rupam Tripura⁶  Arjen M. Dondorp⁶  Bipin Adhikari⁶  Lorenz von Seidlein⁶  Richard J. Maude⁷ 

[1] Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands;Amsterdam UMC, Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands;Amsterdam Public Health Research Institute, Global Health Program, Amsterdam, The Netherlands;Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia;Heidelberg Institute of Global Health, Medical School, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany;Heidelberg Institute of Global Health, Medical School, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany;Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK;Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK;The Open University, Milton Keynes, UK;

关键词: Chemoprophylaxis;    Clinical trial;    Community engagement;    Malaria;    Southeast Asia;   

DOI  :  10.1186/s12936-023-04610-6

 received in 2023-01-28, accepted in 2023-05-26,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundMalaria transmission in Southeast Asia is increasingly confined to forests, where marginalized groups are exposed primarily through their work. Anti-malarial chemoprophylaxis may help to protect these people. This article examines the effectiveness and practical challenges of engaging forest-goers to participate in a randomized controlled clinical trial of anti-malarial chemoprophylaxis with artemether-lumefantrine (AL) versus a control (multivitamin, MV) for malaria in northeast Cambodia.MethodsThe impact of engagement in terms of uptake was assessed as the proportion of people who participated during each stage of the trial: enrolment, compliance with trial procedures, and drug intake. During the trial, staff recorded the details of engagement meetings, including the views and opinions of participants and community representatives, the decision-making processes, and the challenges addressed during implementation.ResultsIn total, 1613 participants were assessed for eligibility and 1480 (92%) joined the trial, 1242 (84%) completed the trial and received prophylaxis (AL: 82% vs MV: 86%, p = 0.08); 157 (11%) were lost to follow-up (AL: 11% vs MV: 11%, p = 0.79); and 73 (5%) discontinued the drug (AL-7% vs MV-3%, p = 0.005). The AL arm was associated with discontinuation of the study drug (AL: 48/738, 7% vs 25/742, 3%; p = 0.01). Females (31/345, 9%) were more likely (42/1135, 4%) to discontinue taking drugs at some point in the trial (p = 0.005). Those (45/644, 7%) who had no previous history of malaria infection were more likely to discontinue the study drug than those (28/836, 3%) who had a history of malaria (p = 0.02). Engagement with the trial population was demanding because many types of forest work are illegal; and the involvement of an engagement team consisting of representatives from the local administration, health authorities, community leaders and community health workers played a significant role in building trust. Responsiveness to the needs and concerns of the community promoted acceptability and increased confidence in taking prophylaxis among participants. Recruitment of forest-goer volunteers to peer-supervise drug administration resulted in high compliance with drug intake. The development of locally-appropriate tools and messaging for the different linguistic and low-literacy groups was useful to ensure participants understood and adhered to the trial procedures. It was important to consider forest-goers` habits and social characteristics when planning the various trial activities.ConclusionsThe comprehensive, participatory engagement strategy mobilized a wide range of stakeholders including study participants, helped build trust, and overcame potential ethical and practical challenges. This locally-adapted approach was highly effective as evidenced by high levels of trial enrolment, compliance with trial procedures and drug intake.

【 授权许可】

CC BY   
© The Author(s) 2023

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