Santos Alicia P C, Brito Marcelo A M, Oliveira Ana P S, Dávila Rafaela N, Gama Hiran S S, Silva Evellyn A R T, Amazonas Hélio A, Balieiro Patrícia C S, Rufatto Rosilene, Grewal Daumerie Penny, Peterka Cássio R L, Batista Pereira Dhélio, Lacerda Marcus V G, Murta Felipe L G
Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil.
Universidade do Estado do Amazonas, Manaus, Brazil.
Malar J. 2024 Dec 23;23(1):399. doi: 10.1186/s12936-024-05209-1.
To eliminate malaria by 2035, Brazil must address Plasmodium vivax. Previously, first-line treatment was chloroquine plus 7-day primaquine (PQ) without glucose-6-phosphate dehydrogenase (G6PD) deficiency testing. In 2021, point-of-care quantitative G6PD testing and single-dose tafenoquine (TQ) were piloted in two municipalities. This study evaluated healthcare professional (HCP) and patient perceptions of TQ implementation.
This qualitative observational study in Manaus and Porto Velho municipalities evaluated the pilot implementation of the new P. vivax malaria treatment algorithm in high/medium-complexity healthcare units (phase one), then low-complexity units (phase two). Qualitative data collection began 30 days after the first TQ treatment in each phase, i.e., October 2021 and March 2022. Perceptions of TQ were assessed using semi-structured in-depth interviews and field notes until saturation. Data were analysed through debriefing sessions, and systematic organization in Excel and MAXQDA, with themes derived by inductive and deductive analysis.
The study included 55 patients who received TQ and 94 HCPs. HCPs viewed the TQ single-dose regimen as a significant advancement over 7-day PQ, enhancing adherence. Patients appreciated the shorter duration of treatment and perceived a rapid clinical recovery and fewer side effects. HCPs also noted that TQ resulted in fewer recurrences of P. vivax. The single-dose administration of TQ facilitated complete supervision of the treatment, reduced HCP workload and ensured that patients received the necessary care and did not share the medication with family members. TQ packaging instilled patient trust, though HCPs working in the community found the packaging too bulky. Prescription insecurities among HCPs after initial training prompted requests for additional training. While some patients initially doubted single-dose efficacy, confidence grew with experience. TQ implementation increased awareness of pharmacovigilance and enhanced patient communication, with HCPs adhering to protocols for monitoring haemolysis symptoms.
Single-dose TQ for P. vivax malaria in Brazil's Amazon region was positively received by HCPs and patients. Positive perceptions of the medication may aid in improving patient adherence to malaria treatment, thereby reducing malaria recurrences. The findings underscore the importance of adaptive training to optimize P. vivax radical cure implementation.
为在2035年前消除疟疾，巴西必须应对间日疟原虫。此前，一线治疗方案是氯喹加7天的伯氨喹（PQ），且不进行葡萄糖-6-磷酸脱氢酶（G6PD）缺乏症检测。2021年，在两个城市试点了即时护理定量G6PD检测和单剂量他非诺喹（TQ）。本研究评估了医疗保健专业人员（HCP）和患者对TQ实施的看法。
这项在马瑙斯和波多韦柳市进行的定性观察性研究，在高/中等复杂性医疗单位（第一阶段）评估了新的间日疟原虫疟疾治疗方案的试点实施情况，然后在低复杂性单位（第二阶段）进行评估。定性数据收集在每个阶段首次使用TQ治疗30天后开始，即2021年10月和2022年3月。使用半结构化深度访谈和现场记录评估对TQ的看法，直至达到饱和状态。通过汇报会以及在Excel和MAXQDA中进行系统整理来分析数据，通过归纳和演绎分析得出主题。
该研究纳入了55名接受TQ治疗的患者和94名HCP。HCP认为TQ单剂量方案相较于7天的PQ有显著进步，提高了依从性。患者赞赏治疗疗程更短，感觉临床恢复迅速且副作用更少。HCP还指出，TQ导致间日疟原虫复发更少。TQ的单剂量给药便于对治疗进行全程监督，减轻了HCP的工作量，并确保患者得到必要的护理且不与家人共用药物。TQ的包装增强了患者的信任，不过在社区工作的HCP认为包装过于笨重。初次培训后HCP存在处方方面的顾虑，因此要求进行额外培训。虽然一些患者最初怀疑单剂量的疗效，但随着经验的积累信心增强。TQ的实施提高了对药物警戒的认识并加强了与患者的沟通，HCP遵守监测溶血症状的方案。
巴西亚马逊地区用于间日疟原虫疟疾的单剂量TQ受到HCP和患者的积极认可。对该药物的积极看法可能有助于提高患者对疟疾治疗的依从性，从而减少疟疾复发。研究结果强调了适应性培训对于优化间日疟原虫根治实施的重要性。
