Copernicus Institute of Sustainable Development, Utrecht University, Princetonlaan 8a, 3484 CB, Utrecht, the Netherlands.
Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Ratchathewi DistrictBangkok, 10400, Thailand.
BMC Public Health. 2022 Apr 30;22(1):864. doi: 10.1186/s12889-022-13212-x.
Triple Artemisinin-based Combination Therapies (TACTs) are being developed as a response to artemisinin and partner drug resistance in Southeast Asia. However, the desirability, timing and practical feasibility of introducing TACTs in Southeast Asia is subject to debate. This study systematically assesses perspectives of malaria experts towards the introduction of TACTs as first-line treatment for uncomplicated falciparum malaria in Southeast Asia.
A two-round Delphi study was conducted. In the first round, 53 malaria experts answered open-ended questions on what they consider the most important advantages, disadvantages, and implementation barriers for introducing TACTs in Southeast Asia. In the second round, the expert panel rated the relevance of each statement on a 5-point Likert scale.
Malaria experts identified 15 advantages, 15 disadvantages and 13 implementation barriers for introducing TACTs in Southeast Asia in the first round of data collection. In the second round, consensus was reached on 13 advantages (8 perceived as relevant, 5 as not-relevant), 12 disadvantages (10 relevant, 2 not-relevant), and 13 implementation barriers (all relevant). Advantages attributed highest relevance related to the clinical and epidemiological rationale of introducing TACTs. Disadvantages attributed highest relevance related to increased side-effects, unavailability of fixed-dose TACTs, and potential cost increases. Implementation barriers attributed highest relevance related to obtaining timely regulatory approval, timely availability of fixed-dose TACTs, and generating global policy support for introducing TACTs.
The study provides a structured oversight of malaria experts' perceptions on the major advantages, disadvantages and implementation challenges for introducing TACTs in Southeast Asia, over current practices of rotating ACTs when treatment failure is observed. The findings can benefit strategic decision making in the battle against drug-resistant malaria.
为应对东南亚地区青蒿素及其联合用药的耐药性，正在开发三联青蒿素类复方疗法（TACTs）。然而，在东南亚引入 TACTs 作为治疗无并发症恶性疟原虫疟疾的一线药物是否可取、时机是否合适以及实际是否可行仍存在争议。本研究系统评估了疟疾专家对在东南亚引入 TACTs 作为治疗无并发症恶性疟原虫疟疾一线药物的看法。
进行了两轮德尔菲研究。在第一轮中，53 名疟疾专家回答了关于他们认为在东南亚引入 TACTs 的最重要的优势、劣势和实施障碍的开放性问题。在第二轮中，专家组对每个陈述的相关性进行了 5 点李克特量表评估。
疟疾专家在第一轮数据收集时确定了在东南亚引入 TACTs 的 15 个优势、15 个劣势和 13 个实施障碍。在第二轮中，就 13 个优势（8 个认为相关，5 个不相关）、12 个劣势（10 个相关，2 个不相关）和 13 个实施障碍（全部相关）达成了共识。被认为具有最高相关性的优势与引入 TACTs 的临床和流行病学原理有关。被认为具有最高相关性的劣势与增加的副作用、固定剂量 TACTs 的不可用性以及潜在的成本增加有关。被认为具有最高相关性的实施障碍与及时获得监管批准、及时获得固定剂量 TACTs 以及为引入 TACTs 争取全球政策支持有关。
本研究对疟疾专家对在东南亚引入 TACTs 作为目前在观察到治疗失败时轮换使用青蒿素类复方疗法（ACTs）的当前做法的主要优势、劣势和实施挑战的看法进行了系统的监督。研究结果可以为抗击耐药性疟疾的战略决策提供参考。
