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. 2023 Aug 21;109(4):752-760.
doi: 10.4269/ajtmh.23-0245. Print 2023 Oct 4.

Preferences of Patients and Providers in High-Burden Malaria Settings for Long-Acting Malaria Chemoprevention

Kimberly K Scarsi  1   2 , Harlan Sayles  3 , Kelvin Kapungu  4 , Peter Sifuna  5 , Matthew M Ippolito  6   7 , Renae Furl  2 , Matthew J Anderson  3 , Joelle Dountio Ofimboudem  8 , Gershom Chongwe  9 , Jack Hutter  5 , Steven P Rannard  10 , Andrew Owen  11 , Susan Swindells  2
Affiliations

Preferences of Patients and Providers in High-Burden Malaria Settings for Long-Acting Malaria Chemoprevention

Kimberly K Scarsi et al. Am J Trop Med Hyg. .

Abstract

Antimalarial medications are recommended for chemoprevention as part of malaria control programs to decrease the morbidity and mortality related to more than 200 million infections each year. We sought to evaluate patient and provider acceptability of malaria chemoprevention in a long-acting formulation. We administered questionnaires to patients and providers in malaria endemic districts in Kenya and Zambia. Questions explored preferences and concerns around long-acting antimalarial formulations compared with oral formulations. We recruited 202 patient respondents (Kenya, n = 102; Zambia, n = 100) and 215 provider respondents (Kenya, n = 105; Zambia, n = 110). Long-acting injection was preferred to oral pills, whereas oral pills were preferred to implant or transdermal administration by patient respondents. Of 202 patient respondents, 80% indicated that they 'definitely would try' malaria chemoprevention offered by injection instead of oral pills. Of parents or guardians, 84% of 113 responded that they 'definitely would' have their child age < 12 years and 90% of 88 'definitely would' have their child ≥12 years receive an injection for malaria prevention. Provider respondents indicated that they would be more likely to prescribe a long-acting injectable product compared with an oral product for malaria chemoprevention in adults (70%), adolescents ages 12 years and older (67%), and children <12 years (81%). Potential for prolonged adverse effects with long-acting products was the highest concern for patient respondents, while higher medication-related cost was cited as the most concerning barrier to implementation by providers. Overall, these findings indicate enthusiasm for the development of long-acting injectable antimalarials to provide individual delivery method options across age groups.

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Conflict of interest statement

Disclosures: A. O. and S. R. are directors of Tandem Nano Ltd and co-inventors of drug delivery patents including an atovaquone long-acting injectable formulation (PCT/GB2017/051746). S. R. has been co-investigator on funding received by the University of Liverpool from AstraZeneca, ViiV Healthcare, and Gilead Sciences. SR has received personal fees from Gilead Sciences. A. O. has been co-investigator on funding received by the University of Liverpool from ViiV Healthcare and Gilead Sciences. A. O. has received personal fees from Gilead and Assembly Biosciences. S. S. reports research funding to her institution from ViiV Healthcare. All other authors report no potential conflicts.

Figures

Figure 1.
Figure 1.
Regions of survey implementation.
Figure 2.
Figure 2.
Patient responses to whether they would take a long-acting injectable product instead of an oral product for malaria chemoprevention. Results are reported overall as well as by demographic or clinical characteristics. P values are from Fisher’s exact tests.
Figure 3.
Figure 3.
Preferences of patients for most and least preferred method of malaria chemoprevention administration.
Figure 4.
Figure 4.
Patient reported concerns with injectable long-acting malaria chemoprevention.
Figure 5.
Figure 5.
Provider responses to whether they would prescribe a long-acting injectable product instead of an oral product for malaria chemoprevention.
Figure 6.
Figure 6.
Provider perceived barriers with injectable long-acting malaria chemoprevention.
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