Assessing the acceptability and feasibility of reactive drug administration for malaria elimination in a Plasmodium vivax predominant setting: a qualitative study in two provinces in Thailand

BMC Public Health

Research

Kanokwan Suwannarong¹  Cheewanan Lertpiriyasuwat²  Suravadee Kitchakarn²  Prayuth Sudathip²  Andreas Mårtensson³  Nisachon Bubpa⁴  Kimberly A. Baltzell⁵  Jintana Chaiwan⁶  Timothy P. Finn⁶  Michelle S. Hsiang⁷  Adam Bennett⁸  Chris Cotter⁹  Thanomsin Ponlap^1,10  Kannika Thammasutti^1,10 

[1] Center of Excellence for Emerging and Re-Emerging Infectious Diseases in Animals, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand;SUPA71 Co., Ltd, Bangkok, Thailand;Department of Disease Control, Division of Vector Borne Diseases, Ministry of Public Health, Nonthaburi, Thailand;Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden;Faculty of Nursing, Khon Kaen University, Khon Kaen Province, Thailand;Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA;School of Nursing, University of California San Francisco, San Francisco, CA, USA;Malaria Elimination Initiative, Institute for Global Health Sciences, University of California San Francisco, 550 16th Street, 3rd floor, 94158, San Francisco, CA, USA;Malaria Elimination Initiative, Institute for Global Health Sciences, University of California San Francisco, 550 16th Street, 3rd floor, 94158, San Francisco, CA, USA;Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA;Department of Pediatrics, University of California San Francisco, Benioff Children’s Hospital, San Francisco, CA, USA;Malaria Elimination Initiative, Institute for Global Health Sciences, University of California San Francisco, 550 16th Street, 3rd floor, 94158, San Francisco, CA, USA;Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA;PATH, Seattle, WA, USA;Malaria Elimination Initiative, Institute for Global Health Sciences, University of California San Francisco, 550 16th Street, 3rd floor, 94158, San Francisco, CA, USA;Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden;SUPA71 Co., Ltd, Bangkok, Thailand;

关键词: Reactive drug administration;    Feasibility;    Acceptability;    Malaria elimination;    Thailand;   

DOI  :  10.1186/s12889-023-15852-z

 received in 2023-01-11, accepted in 2023-05-09,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundReactive case detection (RACD) or testing and treatment of close contacts of recent malaria cases, is commonly practiced in settings approaching malaria elimination, but standard diagnostics have limited sensitivity to detect low level infections. Reactive drug administration (RDA), or presumptive treatment without testing, is an alternative approach, but better understanding regarding community acceptability and operational feasibility are needed.MethodsA qualitative study was conducted as part of a two-arm cluster randomized-controlled trial evaluating the effectiveness of RDA targeting high-risk villages and forest workers for reducing Plasmodium vivax and P. falciparum malaria in Thailand. Key informant interviews (KIIs) and focus group discussions (FGDs) were conducted virtually among key public health staff, village health volunteers (VHVs), and household members that implemented or received RDA activities. Transcriptions were reviewed, coded, and managed manually using Dedoose qualitative data analysis software, then underwent qualitative content analysis to identify key themes.ResultsRDA was well accepted by household members and public health staff that implemented it. RDA participation was driven by fear of contracting malaria, eagerness to receive protection provided by malaria medicines, and the increased access to health care. Concerns were raised about the safety of taking malaria medicines without having an illness, particularly if underlying health conditions existed. Health promotion hospital (HPH) staff implementing RDA noted its operational feasibility, but highlighted difficulty in traveling to remote areas, and requested additional travel resources and hiring more VHVs. Other challenges were highlighted including the need for additional training for VHVs on malaria activities and the inability of HPH staff to conduct RDA due to other health priorities (e.g., Covid-19). More training and practice for VHVs were noted as ways to improve implementation of RDA.ConclusionsTo maximize uptake of RDA, regular education and sensitization campaigns in collaboration with village leaders on the purpose and rationale of RDA will be critical. To alleviate safety concerns and increase participant safety, a rigorous pharmacovigilance program will be important. To accelerate uptake of RDA, trust between HPH staff and VHVs and the communities they serve must continue to be strengthened to ensure acceptance of the intervention.Trial registrationThis study was approved by the Committee on Human Research at the University of California San Francisco (19–28,060) and the local Ethics Committee for Research in Human Subjects at Tak Provincial Health office (009/63) and Kanchanaburi Provincial health office (Kor Chor 0032.002/2185). Local authorities and health officers in the provinces, districts, and villages agreed upon and coordinated the implementation of the study. All methods in this study were carried out in accordance with relevant guidelines and regulations.

【 授权许可】

CC BY   
© The Author(s) 2023

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