Chakim Irfanul, Pumpaibool Tepanata, Fauzi Ekha Rifki
College of Public Health Sciences, Chulalongkorn University, Institute Building 2-3, Soi Chulalongkorn 62, Phyathai Rd, Pathumwan, Bangkok 10330, Thailand.
Faculty of Public Health, Universitas Muhammadiyah Semarang, Semarang, Indonesia.
J Trop Med. 2022 Mar 11;2022:4317522. doi: 10.1155/2022/4317522. eCollection 2022.
After decades of successful artemisinin regimen in combating malaria, its effectiveness has decreased since parasite resistance to the treatment regimen has begun to appear. Adherence to artemisinin combination therapy (ACT) in a population is considered to be the key factor contributing to such resistance phenomenon. Although several studies have tried to demonstrate adherence to several ACT types in a population, only a limited number of studies demonstrated adherence to dihyrdroartemisinin + piperaquine (DHP) regimen. The present study was conducted in two localities representing low and high endemic areas in Indonesia. Active case detection (ACD) and passive case detection (PCD) have been applied to screen for malaria case in the localities. At day 3, patients were visited in the house to be interviewed using structured questionnaire. Capillary sample of each patient was also collected on Whatman® filter paper at day 60 to observe the piperaquine metabolite of the patients. 47 and 91 (out of 62 and 138) patients from Jambi and Sumba, respectively, were successfully enrolled in this study. In Jambi, the level of adherence was 66%, while that in Sumba was 79.1%. The associated factors of adherence in our study settings are patient age group (OR = 1.65 [CI: 0.73-3.73]) and patients' knowledge of malaria prevention measure (OR = 0.29 [CI: 0.09-0.9]). Our study suggested that the adherence to ACT medication among population in our study setting is considered to be less than 80%, which needs to be elevated to avoid the growing trend of treatment failure as seen globally. Additionally, our study found that metabolite at day 60 after prescription of piperaquine could be a potential marker for monitoring adherence to piperaquine drug in a population.
在青蒿素疗法成功对抗疟疾数十年后，由于疟原虫对该治疗方案产生耐药性，其有效性已有所下降。人群中对青蒿素联合疗法（ACT）的依从性被认为是导致这种耐药现象的关键因素。尽管有多项研究试图证明人群对几种ACT类型的依从性，但仅有少数研究证明了对双氢青蒿素+哌喹（DHP）疗法的依从性。本研究在印度尼西亚代表低流行区和高流行区的两个地区开展。已采用主动病例检测（ACD）和被动病例检测（PCD）对这些地区的疟疾病例进行筛查。在第3天，前往患者家中使用结构化问卷进行访谈。在第60天，还在沃特曼®滤纸上采集了每位患者的毛细血管样本，以观察患者体内的哌喹代谢物。来自占碑和松巴的患者分别有47例和91例（分别占62例和138例中的比例）成功纳入本研究。在占碑，依从性水平为66%，而在松巴为79.1%。我们研究环境中依从性的相关因素是患者年龄组（OR = 1.65 [CI：0.73 - 3.73]）和患者对疟疾预防措施的了解（OR = 0.29 [CI：0.09 - 0.9]）。我们的研究表明，在我们的研究环境中，人群对ACT药物的依从性被认为低于80%，需要提高以避免全球范围内出现的治疗失败增长趋势。此外，我们的研究发现，哌喹处方后第60天的代谢物可能是监测人群中哌喹药物依从性的潜在标志物。
