Rolling out the radical cure for vivax malaria in Asia: a qualitative study among policy makers and stakeholders.
Rolling out the radical cure for vivax malaria in Asia: a qualitative study among policy makers and stakeholders.
复制标题
DOI：
10.1186/s12936-021-03702-5
复制
发表时间：
2021-03-23
期刊：
影响因子：
3
通讯作者：
von Seidlein L
中科院分区：
文献类型：
--
作者：
Adhikari B;Awab GR;von Seidlein L
一系列因素阻碍了根治间日疟的治疗方案的广泛实施。这导致间日疟的相对比例增加，是实现到2030年消除全球疟疾目标的一个重要障碍。本研究的主要目的是探讨目前指导间日疟治疗计划的政策，以及影响南亚/东南亚和亚太国家实施根治性治疗的因素。这是在代表国家疟疾控制方案或在国家疟疾政策中发挥作用和影响的受访者中进行的定性研究。来自南亚/东南亚和亚太地区17个国家的33名受访者参加了2020年10月15日至12月15日的采访。除了两次面对面访谈和录音外，几乎进行了半结构化访谈。使用QSR NVivo对转录的音频记录进行专题分析。与重点关注恶性疟疾，特别是抗药性恶性疟原虫菌株相比，防治间日疟的政策没有得到充分重视。尽管熟悉伯氨喹（PQ）作为实现根治的基本治疗，但受访者对G6 PD检测的必要性提出质疑。据报告，可选的G6 PD检测依从性较差。对不良事件的恐惧导致卫生工作者在开PQ处方时犹豫不决。在G6 PD是强制性的国家，受访者在周边卫生设施中经常遇到G6 PD快速诊断试剂盒缺货的情况，而这些检测的保质期较短更是雪上加霜。这些挑战在各参与国都得到不同程度的回应。大多数受访者同意，较短的治疗方案，如单剂量他非诺喹可以解决这些问题，但强制性G6 PD检测将是必要的。包括他非诺喹或高剂量PQ在内的较短方案的建议需要操作证据证明床旁G6 PD检测（生物传感器）的稳健性能。在南亚/东南亚和亚太国家，根治措施的实施和坚持率很低。较短的治疗方案与适当的护理点定量G6 PD测试可以解决目前的挑战。关于护理点定量G6 PD测试的操作证据，包括将此类测试整合到根治方案中的可行性，对于确保其实施至关重要。在线版本包含补充材料，可通过10.1186/s12936-021-03702-5获得。
Wide-spread implementation of treatment regimens for the radical cure of vivax malaria is hindered by a range of factors. This has resulted in an increase in the relative proportion of vivax malaria and is an important obstacle in the achievement of global malaria elimination by 2030. The main objective of this study was to explore the current policies guiding the treatment plans on vivax malaria, and the factors affecting the implementation of radical cure in South/South East Asian and Asian Pacific countries. This was a qualitative study among respondents who represented national malaria control programmes (NMCPs) or had a role and influence in the national malaria policies. 33 respondents from 17 countries in South/South East Asia and Asia Pacific participated in interviews between October 15 and December 15, 2020. Semi-structured interviews were conducted virtually except for two face to face interviews and audio-recorded. Transcribed audio-records underwent thematic analysis using QSR NVivo. Policies against vivax malaria were underprioritized, compared with the focus on falciparum malaria and, in particular, drug resistant Plasmodium falciparum strains. Despite the familiarity with primaquine (PQ) as the essential treatment to achieve the radical cure, the respondents contested the need for G6PD testing. Optional G6PD testing was reported to have poor adherence. The fear of adverse events led health workers to hesitate prescribing PQ. In countries where G6PD was mandatory, respondents experienced frequent stockouts of G6PD rapid diagnostic kits in peripheral health facilities, which was compounded by a short shelf life of these tests. These challenges were echoed across participating countries to various degrees. Most respondents agreed that a shorter treatment regimen, such as single dose tafenoquine could resolve these problems but mandatory G6PD testing will be needed. The recommendation of shorter regimens including tafenoquine or high dose PQ requires operational evidence demonstrating the robust performance of point of care G6PD tests (biosensors). There was sparse implementation and low adherence to the radical cure in South/South East Asian and Asian pacific countries. Shorter treatment regimens with appropriate point of care quantitative G6PD tests may resolve the current challenges. Operational evidence on point of care quantitative G6PD tests that includes the feasibility of integrating such tests into the radical cure regimen are critical to ensure its implementation. The online version contains supplementary material available at 10.1186/s12936-021-03702-5.
登录
查看更多内容
影响因子：
5.7
作者：
Chu CS;White NJ
通讯作者：
White NJ
影响因子：
3
作者：
Adhikari B;James N;Newby G;von Seidlein L;White NJ;Day NP;Dondorp AM;Pell C;Cheah PY
通讯作者：
Cheah PY
影响因子：
3.7
作者：
Abeyasinghe RR;Galappaththy GN;Smith Gueye C;Kahn JG;Feachem RG
通讯作者：
Feachem RG
影响因子：
3.8
作者：
Carlton JM;Sina BJ;Adams JH
通讯作者：
Adams JH
影响因子：
3
作者：
John GK;Douglas NM;von Seidlein L;Nosten F;Baird JK;White NJ;Price RN
通讯作者：
Price RN