Ethical considerations in deploying triple artemisinin-based combination therapies for malaria: An analysis of stakeholders’ perspectives in Burkina Faso and Nigeria

Abstract

Background Artemisinin-based combination therapies (ACTs) are the recommended treatment for uncomplicated Plasmodium falciparum malaria in all malaria endemic countries. Artemisinin resistance, partner drug resistance, and subsequent ACT failure are widespread in Southeast Asia. The more recent independent emergence of artemisinin resistance in Africa is alarming. In response, triple artemisinin-based combination therapies (TACTs) are being developed to mitigate the risks associated with increasing drug resistance. Since ACTs are still effective in Africa, where malaria is mainly a paediatric disease, the potential deployment of TACTs raises important ethical questions. This paper presents an analysis of stakeholders’ perspectives regarding key ethical considerations to be considered in the deployment of TACTs in Africa provided they are found to be safe, well-tolerated and effective for the treatment of uncomplicated malaria. Methods We conducted a qualitative study in Burkina Faso and Nigeria assessing stakeholders’ (policy makers, suppliers and end-users) perspectives on ethical issues regarding the potential future deployment of TACTs through 68 in-depth interviews and 11 focus group discussions. Findings Some respondents suggested that there should be evidence of local artemisinin resistance before they consider deploying TACTs, while others suggested that TACTs should be deployed to protect the efficacy of current ACTs. Respondents suggested that additional side effects of TACTs compared to ACTs should be minimal and the cost of TACTs to end-users should not be higher than the cost of current ACTs. There was some disagreement among respondents regarding whether patients should have a choice of treatment options between ACTs and TACTs or only have TACTs available, while ACTs are still effective. The study also suggests that community, public and stakeholder engagement activities are essential to support the introduction and effective uptake of TACTs. Conclusion Addressing ethical issues regarding TACTs and engaging early with stakeholders will be important for their potential deployment in Africa.

A framework for stakeholder engagement in the adoption of new anti-malarial treatments in Africa: a case study of Nigeria

“…The qualitative phase of the study conducted with purposively selected respondents in both the federal capital city of Nigeria, Abuja and in a North-central State, Kwara, has been described previously [ 26 , 27 , 31 ]. For this case study, information from the 33 IDIs and 6 FGDs with key stakeholders (Table 1 ) was extracted.…”

Interventions to address antimicrobial resistance: an ethical analysis of key tensions and how they apply in low- income and middle-income countries

“…To do so, we draw on some of our own experiences living in LMICs, interacting with communities (eg, via community advisory boards, community clinics, clinical trials and primary healthcare services in remote communities) 14 and conducting research on the issues related to AMR in LMICs, particularly South and Southeast Asia and Sub-Saharan Africa. [14][15][16][17][18][19][20] The ethical tensions laid out in this article are thereby juxtaposed with day-to-day lived experiences of stakeholders in AMR interventions in LMICs, particularly the practicalities of health services and patients' interactions with both formal and informal healthcare providers. Aligning with our experiences, we focus more on human health and less on animal and environmental health.…”

“…Our initial normative analysis is primarily guided by the existing literature, with our original contribution being the analysis of whether these often-generalised or universalised issues identified in existing normative literature are, indeed, generalisable to LMIC settings. To do so, we draw on some of our own experiences living in LMICs, interacting with communities (eg, via community advisory boards, community clinics, clinical trials and primary healthcare services in remote communities)14 and conducting research on the issues related to AMR in LMICs, particularly South and Southeast Asia and Sub-Saharan Africa 14–20. The ethical tensions laid out in this article are thereby juxtaposed with day-to-day lived experiences of stakeholders in AMR interventions in LMICs, particularly the practicalities of health services and patients’ interactions with both formal and informal healthcare providers.…”

Evaluation of Pathogenicity of Entomopathogenic Oomycetes Lagenidium giganteum and L. ajelloi against Anopheles Mosquito Larvae

“…An increase in malaria cases was recorded compared with 227 million cases reported in 2019, which is attributed to the disruption of services due to the COVID-19 pandemic [1]. In addition, there is increasing evidence of the emergence of partial resistance towards artemisinin-based combination therapies (ACTs), the main chemotherapeutic intervention for malaria in the African Region [2]. Consequently, WHO encourages an integrated approach towards vector-borne disease control, calling on countries to prioritize research on the exploration and development of novel mosquito control strategies [3].…”