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Effectiveness, Safety, and Acceptability of Primaquine Mass Drug Administration in Low-Endemicity Areas in Southern Thailand: Proof-of-Concept Study.
Kaewkungwal, Jaranit; Roobsoong, Wanlapa; Lawpoolsri, Saranath; Nguitragool, Wang; Thammapalo, Suwich; Prikchoo, Pathomporn; Khamsiriwatchara, Amnat; Pawarana, Rungrawee; Jarujareet, Pawinee; Parker, Daniel M; Sripoorote, Piyarat; Kengganpanich, Mondha; Ngamjarus, Chetta; Sattabongkot, Jetsumon; Cui, Liwang.
Afiliación
  • Kaewkungwal J; Department of Tropical Hygiene, Mahidol University, Bangkok, Thailand.
  • Roobsoong W; Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
  • Lawpoolsri S; Department of Tropical Hygiene, Mahidol University, Bangkok, Thailand.
  • Nguitragool W; Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
  • Thammapalo S; Ministry of Public Health, Nonthaburi, Thailand.
  • Prikchoo P; Ministry of Public Health, Nonthaburi, Thailand.
  • Khamsiriwatchara A; Center of Excellence for Biomedical and Public Health Informatics (BIOPHICS), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
  • Pawarana R; Center of Excellence for Biomedical and Public Health Informatics (BIOPHICS), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
  • Jarujareet P; Center of Excellence for Biomedical and Public Health Informatics (BIOPHICS), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
  • Parker DM; Department of Population Health and Disease Prevention, University of California, Irvine, Irvine, CA, United States.
  • Sripoorote P; Department of Epidemiology and Biostatistics, University of California, Irvine, Irvine, CA, United States.
  • Kengganpanich M; Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
  • Ngamjarus C; Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand.
  • Sattabongkot J; Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand.
  • Cui L; Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
JMIR Public Health Surveill ; 10: e51993, 2024 Jun 26.
Article en En | MEDLINE | ID: mdl-38922648
ABSTRACT

BACKGROUND:

A challenge in achieving the malaria-elimination target in the Greater Mekong Subregion, including Thailand, is the predominance of Plasmodium vivax malaria, which has shown extreme resilience to control measures.

OBJECTIVE:

This proof-of-concept study aimed to provide evidence for implementing primaquine mass drug administration (pMDA) as a strategy for P. vivax elimination in low-endemicity settings.

METHODS:

The study employed a mixed-methods trial to thoroughly evaluate the effectiveness, safety, acceptability, and community engagement of pMDA. The quantitative part was designed as a 2-period cluster-crossover randomized controlled trial. The intervention was pMDA augmented to the national prevention and control standards with directly observed treatment (DOT) by village health volunteers. The qualitative part employed in-depth interviews and brainstorming discussions. The study involved 7 clusters in 2 districts of 2 southern provinces in Thailand with persistently low P. vivax transmission. In the quantitative part, 5 cross-sectional blood surveys were conducted in both the pMDA and control groups before and 3 months after pMDA. The effectiveness of pMDA was determined by comparing the proportions of P. vivax infections per 1000 population between the 2 groups, with a multilevel zero-inflated negative binomial model adjusted for cluster and time as covariates and the interaction. The safety data comprised adverse events after drug administration. Thematic content analysis was used to assess the acceptability and engagement of stakeholders.

RESULTS:

In the pre-pMDA period, the proportions of P. vivax infections in the pMDA (n=1536) and control (n=1577) groups were 13.0 (95% CI 8.2-20.4) and 12.0 (95% CI 7.5-19.1), respectively. At month 3 post-pMDA, these proportions in the pMDA (n=1430) and control (n=1420) groups were 8.4 (95% CI 4.6-15.1) and 5.6 (95% CI 2.6-11.5), respectively. No statistically significant differences were found between the groups. The number of malaria cases reduced in all clusters in both groups, and thus, the impact of pMDA was inconclusive. There were no major safety concerns. Acceptance among the study participants and public health care providers at local and national levels was high, and they believed that pMDA had boosted awareness in the community.

CONCLUSIONS:

pMDA was associated with high adherence, safety, and tolerability, but it may not significantly impact P. vivax transmission. As this was a proof-of-concept study, we decided not to scale up the intervention with larger clusters and samples. An alternative approach involving a targeted primaquine treatment strategy with primaquine and DOT is currently being implemented. We experienced success regarding effective health care workforces at point-of-care centers, effective collaborations in the community, and commitment from authorities at local and national levels. Our efforts boosted the acceptability of the malaria-elimination initiative. Community engagement is recommended to achieve elimination targets. TRIAL REGISTRATION Thai Clinical Trials Registry TCTR20190806004; https//www.thaiclinicaltrials.org/show/TCTR20190806004.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Primaquina / Malaria Vivax / Administración Masiva de Medicamentos / Antimaláricos Límite: Adolescent / Adult / Child / Female / Humans / Male / Middle aged País/Región como asunto: Asia Idioma: En Revista: JMIR Public Health Surveill Año: 2024 Tipo del documento: Article País de afiliación: Tailandia Pais de publicación: Canadá

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Primaquina / Malaria Vivax / Administración Masiva de Medicamentos / Antimaláricos Límite: Adolescent / Adult / Child / Female / Humans / Male / Middle aged País/Región como asunto: Asia Idioma: En Revista: JMIR Public Health Surveill Año: 2024 Tipo del documento: Article País de afiliación: Tailandia Pais de publicación: Canadá