Expert perspectives on the introduction of Triple Artemisinin-based Combination Therapies (TACTs) in Southeast Asia: a Delphi study

Abstract

Background 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. Methods 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. Results 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. Conclusions 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.

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

“…additional side effects are generally considered minimal, they could deter parents from giving TACTs to their children [37]. This is consistent with previous studies documenting the experience of several malaria-endemic countries indicating that a perceived increase of side effects affected the uptake of ACTs following the change in malaria drug policies from chloroquine and sulfadoxine-pyramethamine to ACTs [38,39].…”

Strategies for deploying triple artemisinin-based combination therapy in the Greater Mekong Subregion

“…Moreover, respondents stressed that training programs should include education messages to address potential misconceptions about the new therapy. For the introduction of TACTs, communication strategies were also deemed necessary which should highlight advantages in terms of clinical benefits, TACTs’ potential to protect antimalarial drugs, and indirect benefits such as reduced frequency of policy changes [ 14 ].…”

“…Data was collected through in-depth interviews with key actors in the healthcare systems in Cambodia, Vietnam and Lao PDR. The implementation challenges for introducing TACT in Southeast Asia identified in the previously conducted Delphi study [ 14 ] was considered as a starting point for the in-depth interviews (Table 1 ). Furthermore, one participatory workshop was conducted in Cambodia.…”

“…Some scholars and representatives of policy institutes perceive TACT as a useful intervention towards malaria elimination in the GMS, while others prefer relying on current strategies of rotating ACT until malaria elimination is established. A recently conducted Delphi study systematically assessed expert perspectives towards the introduction of TACT in Southeast Asia [ 14 ]. Prominent malaria experts identified major advantages, disadvantages and implementation barriers for introducing TACT and they rated the relevance of each item on a 5-point Likert scale.…”

How to Decide the Proportion of Online to Face-to-Face Components of a Blended Course? A Delphi Study

“…To determine which criteria are the most important, a cut-off point was applied. Using a cut-off point is a common technique for determining Delphi consensus and carrying over statements from one Delphi round to the next (de Haan et al, 2022; von der Gracht, 2012). There are no recognized formulae or defined standards to guide the selection of cut-off points.…”