Stakeholder perceptions on the deployment of multiple first-line therapies for uncomplicated malaria: a qualitative study in the health district of Kaya, Burkina Faso

Abstract

Background In Burkina Faso, malaria remains the first cause of medical consultation and hospitalization in health centres. First-line case management of malaria in the country’s health facilities is based on the use of artemisinin-based combination therapy (ACT). To optimize the use of these anti-malarial drugs in the perspective of mitigating the emergence of artemisinin resistance, which is a serious threat to malaria control and elimination, a pilot programme using multiple first-line therapies (MFTs) [three artemisinin-based combinations—pyronaridine–artesunate, dihydroartemisinin–piperaquine and artemether-lumefantrine] has been designed for implementation. As the success of this MFT pilot programme depends on the perceptions of key stakeholders in the health system and community members, the study aimed to assess their perceptions on the implementation of this strategy. Methods Semi-structured interviews, including 27 individual in-depth interviews and 41 focus groups discussions, were conducted with key stakeholders including malaria control policymakers and implementers, health system managers, health workers and community members. Volunteers from targets stakeholder groups were randomly selected. All interviews were recorded, transcribed and translated. Content analysis was performed using the qualitative software programme QDA Miner. Results The interviews revealed a positive perception of stakeholders on the implementation of the planned MFT programme. They saw the strategy as an opportunity to strengthen the supply of anti-malarial drugs and improve the management of fever and malaria. However, due to lack of experience with the products, health workers and care givers expressed some reservations about the effectiveness and side-effect profiles of the two anti-malarial drugs included as first-line therapy in the MFT programme (pyronaridine–artesunate, dihydroartemisinin–piperaquine). Questions were raised about the appropriateness of segmenting the population into three groups and assigning a specific drug to each group. Conclusion The adherence of both populations and key stakeholders to the MFT implementation strategy will likely depend on the efficacy of the proposed drugs, the absence of, or low frequency of, side-effects, the cost of drugs and availability of the different combinations.

Evaluation of Segmentation, Rotation, and Geographic Delivery Approaches for Deployment of Multiple First-Line Treatment (MFT) to Respond to Antimalarial Drug Resistance in Africa: A Qualitative Study in Seven Sub-Sahara Countries

“…ACT registrations for first-line treatment reflect the status at the time of the study for each country. Countries conducting MFT pilots at the time of the study (Kenya and Burkina Faso) were excluded because stakeholders' perceptions and attitudes towards MFT had already been investigated and published [18,20]. The perceptions of MFT in countries that did not have practical experience with the intervention were prioritized, to identify potential barriers and drivers of implementation in advance.…”

“…Feasibility and acceptability studies can help identify potential barriers and facilitators of implementation. A recent pilot conducted in Burkina Faso investigated stakeholders' perceptions of an MFT intervention that relied on a segmentation approach [18]. Authors found that the adherence by both the population and key stakeholders would depend on treatment efficacy, low severity level of side effects, cost, and drug availability.…”

Breaking the cycle of malaria treatment failure

“…Interruptions in the supply chain, inconsistent stocking, and inadequate funding persist in Angola's drug procurement but it is not clear that these result from the choice to deploy multiple therapies at once ( 65 ). Burkina Faso adopted AL and ASAQ simultaneously in 2005 ( 66 ), and recent field trials and interviews have indicated a general level of acceptance of MFT as a worthwhile national drug policy ( 67 – 69 ). The major challenge in Burkina Faso was patient and provider preference for AL, which led to AL being used as treatment of choice for about 70% of uncomplicated falciparum cases by 2018 ( 70 ).…”

“…Recent studies suggest that perceptions of MFT are changing and moving towards acceptance ( 67 , 69 ). The simplest starting point for communication around MFT is one that establishes the equivalence of certain antimalarial therapies ( 67 , 71 )—for example that AL, ASAQ, and AS-pyronaridine have equal efficacies and equal resistance risks—as this will help steer the health system to a uniform drug distribution in which each of these ACTs is prescribed or sold in approximately equal amounts. If the therapies are substantially different in efficacy or resistance risk, they should not be deployed together in a simple equal-distribution MFT policy.…”

Genome-Wide Identification and Expression Analysis of TPS Gene Family in Liriodendron chinense

“…Volatile terpenes can also serve as interspecific or interplant “alarm” signals to trigger the defense responses of neighboring plants [ 20 ]. Terpenes, such as artemisinin, are used to treat malaria [ 21 ].…”