Assessing the acceptibility and feasibility of reactive drug administration for malaria elimination in a Plasmodium vivax predominant setting: a qualitative study in two provinces in Thailand

• Reactive case detection (RACD) or testing and treatment of close contacts of recent malaria cases, is commonly practiced in settings approaching malaria elimination, but standard diagnostics have limited sensitivity to detect low level infection. Reactive drug administration (RDA), or presumptive treatment without testing, is an alternative approach, but better understanding regarding community acceptability and operational feasibility are needed. This qualitative study is part of a larger randomized-controlled trial evaluating the effectiveness of RDA targeting high-risk villages and forest workers for reducing Plasmodium vivax and P. falciparum malaria in Thailand. Here, we aim to explore the acceptability and feasibility RDA, and to better understand the challenges to its potential future implementation. Qualitative data collection using key informant interviews (KIIs) and focus group discussions (FGDs) were conducted virtually among key public health staff, village health volunteers (VHVs), and community members that implemented or received RDA activities. KIIs and FGDs were audio-recorded and transcribed. Transcriptions were reviewed, coded, and managed manually using Dedoose qualitative data analysis software, then underwent qualitative content analysis to identify key themes. RDA was well accepted by community members and public health staff that implemented it. Community participation was driven by fear of contracting malaria, eagerness to receive protection provided by malaria medicines, and the increased access to health care. Concerns were raised about the safety of taking malaria medicines without having an illness, particularly if underlying health conditions existed. Staff implementing RDA noted its operational feasibility, but highlighted difficulty in traveling to remote areas, and requested additional travel resources and hiring more staff. Other challenges were highlighted including the need for additional training for VHVs on malaria activities and the inability ofHPH staff to conduct RDA due to other health priorities (e.g., Covid-19). More training and practice forVHVs were noted as ways to improve implementation of RDA. To maximize uptake of RDA, local health provider and community education regarding its rational and purpose of RDA are critical. To alleviate safety concerns and ensure participant safety, a rigorous pharmacovigilance program is important. To optimize implementation, an adequate number of trained and resourced staff are needed, particularly for accessing remote and hard-to-reach areas.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskap -- Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Health Sciences -- Public Health, Global Health, Social Medicine and Epidemiology (hsv//eng)

Nyckelord

reactive drug administration

feasibility

acceptability

malaria elimination

Plasmodium vivax

Thailand

Infektionssjukdomar

Infectious Diseases

Publikations- och innehållstyp

vet (ämneskategori)

ovr (ämneskategori)