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.

Publication date: Jul 13, 2023

Reactive 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. A 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. RDA 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. To 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. This 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.

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Concepts Keywords
Eagerness Acceptability
Epidemiology Feasibility
Software Malaria elimination
Thailand Reactive drug administration


Type Source Name
disease MESH malaria
pathway KEGG Malaria
disease MESH infections
drug DRUGBANK Tropicamide
disease VO effectiveness
drug DRUGBANK Etoperidone
disease MESH Covid-19
disease IDO intervention
pathway REACTOME Reproduction
disease IDO parasite
disease MESH parasitemia
drug DRUGBANK Methylergometrine
disease VO effective
disease VO population
drug DRUGBANK Primaquine
drug DRUGBANK Dextrose unspecified form
drug DRUGBANK Phosphate ion
disease MESH G6PD deficiency
disease IDO blood
drug DRUGBANK Coenzyme M
disease MESH vivax malaria
drug DRUGBANK Alpha-1-proteinase inhibitor
drug DRUGBANK Pentaerythritol tetranitrate
disease MESH hypertension
drug DRUGBANK Artesunate
drug DRUGBANK Mefloquine
disease VO device
disease VO dose
disease VO protocol
disease VO adverse event
disease IDO facility
disease IDO country
disease IDO infection
drug DRUGBANK Trestolone
disease VO Imovax ID
disease MESH allergy
disease MESH fainting
disease VO organization
drug DRUGBANK Chloroquine
disease MESH communicable diseases
disease VO time
disease MESH contraindications
disease IDO history
disease MESH asymptomatic infections
drug DRUGBANK Spinosad
disease MESH hemolysis
disease VO frequency
disease VO vaccination
disease MESH AIDS
disease MESH Tuberculosis
pathway KEGG Tuberculosis
drug DRUGBANK Artemisinin
disease MESH Emerging Infectious Diseases
disease VO USA
disease MESH Vector Borne Diseases
disease VO vaccine
drug DRUGBANK Artenimol
drug DRUGBANK Piperaquine
disease VO Plasmodium falciparum
disease IDO site
drug DRUGBANK Stavudine
drug DRUGBANK Fenamole
drug DRUGBANK Zalcitabine
disease VO report
drug DRUGBANK Gold
drug DRUGBANK Artemether
drug DRUGBANK Lumefantrine
drug DRUGBANK Caffeine
disease MESH Drug Toxicity

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