Evaluation of the effect of supervised anti-malarial treatment on recurrences of Plasmodium vivax malaria

Abstract

Background Relapses in vivax malaria have posed great challenges for malaria control, and they also account for a great proportion of reported cases. Knowing the real effectiveness of a 7-day primaquine (PQ) scheme is crucial in order to evaluate not only the cost-effectiveness of implementing new anti-hypnozoite drugs, but also how health education strategies can guarantee better compliance and be reinforced. This study aimed to evaluate the effect of daily treatment with chloroquine and PQ supervised by health workers versus prescription without supervision. Methods The outcome was the passive detection of new positive thick blood smears up to 180 days, based on the official data records from the National Malaria Control Programme. The recurrences seen in the real life were, therefore, used as a surrogate for true relapses. Results Patients under supervised treatment had a lower risk of recurrence up to day 180 when compared to the unsupervised treatment (17.9% vs. 36.1%; p = 0.027). Conclusions The lack of supervision in the non-supervised group (which followed standard of care in the real life) enabled proper comparison, as consent itself would have lead to greater compliance in this group. Future studies should scale such an analysis to different settings in the Brazilian Amazon.

Effect of weekly versus daily primaquine on Plasmodium vivax malaria recurrences: A real-life cohort study

“…Non-adherence to standard treatment in the Brazilian Amazon can contribute to the recurrence of malaria 13,14 . Patients with G6PDd can be prone to recurrence when the test is not performed, possibly due to treatment discontinuation owing to the patients' fear of undergoing hemolysis when using daily PQ treatment [Nascimento et al, personal communication].…”

Evaluating recurrent episodes of malaria incidence in Timika, Indonesia, through a Markovian multiple-state model

“…These results are in accordance with those of study ( Daher et al., 2019 ) finding no difference in the time and frequency of recurrences between adherent and non-adherent patients. However, the rate of transition is faster in the treatment-adherent group, indicating that the recurrence of Plasmodium infection is correlated to treatment supervision–malaria recurrence increases in the absence of treatment supervision and decreases with treatment supervision conducted by health workers ( Dinelly et al., 2021 ). Consistently taking medication according to the guidelines leads to the elimination of Plasmodium from the bloodstream.…”

Accelerating towards P. vivax elimination with a novel serological test-and-treat strategy: a modelling case study in Brazil

“…This is particularly true if directly observed treatment is required for optimal PQ radical cure efficacy. 30 G6PD testing has been shown to be cost-effective in preventing primaquine-associated hospitalisations and is likely to be required for such campaigns. 10 A formal cost-impact analysis will be required to confirm the cost-benefit of Pv SeroTAT.…”