Co-design of a routine clinical review to improve the safety of high dose radical cure treatment for Plasmodium vivax malaria: findings from Cambodia and Ethiopia
Abstract Background Low dose primaquine regimens are widely used to treat Plasmodium vivax malaria, but they have limited efficacy and effectiveness. Short courses with higher daily doses as well as single dose tafenoquine have the potential to improve effectiveness but can increase the risk of adve...
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2025-05-01
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| Online Access: | https://doi.org/10.1186/s12936-025-05425-3 |
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| author | Sarah A. Cassidy-Seyoum Muthoni Mwaura Keoratha Chheng Muhaba Kejela Kansite Gellebo Korra Tsegaberhan Wodaj Tamiru Shibiru Degaga Michelle S. Hsiang Lorenz von Seidlein Rupam Tripura Bipin Adhikari Benedikt Ley Dysoley Lek Ric N. Price Nora Engel Kamala Thriemer |
| author_facet | Sarah A. Cassidy-Seyoum Muthoni Mwaura Keoratha Chheng Muhaba Kejela Kansite Gellebo Korra Tsegaberhan Wodaj Tamiru Shibiru Degaga Michelle S. Hsiang Lorenz von Seidlein Rupam Tripura Bipin Adhikari Benedikt Ley Dysoley Lek Ric N. Price Nora Engel Kamala Thriemer |
| author_sort | Sarah A. Cassidy-Seyoum |
| collection | DOAJ |
| description | Abstract Background Low dose primaquine regimens are widely used to treat Plasmodium vivax malaria, but they have limited efficacy and effectiveness. Short courses with higher daily doses as well as single dose tafenoquine have the potential to improve effectiveness but can increase the risk of adverse events. A clinical review visit on day 3 post-treatment initiation could facilitate adherence and improve safety, but it is unclear how it could be integrated into routine malaria care. Methods Between March and September 2023, focus group discussions (FGDs) with P. vivax malaria patients and healthcare providers were conducted in Cambodia and Ethiopia. In the FGDs participants co-designed a day 3 review suitable for their setting based on material infrastructure ‘building blocks’ (location, implementer, procedures, and support mechanisms). Nine FGDs were completed in three health facility catchment areas in Cambodia and six FGDs in four facilities in Ethiopia. Data were analysed using an inductive-deductive analytical process allowing the development of themes. Results Participants in Cambodia and Ethiopia had different preferences for the material infrastructure of the day 3 review, from which a model for each country was developed. In Cambodia, proximity to patients was prioritized, maintaining the existing referral mechanism in which the initial day 3 review is conducted in the community, focusing on an enhanced symptom assessment. In Ethiopia, continuity of care was prioritized, resulting in the day 3 review occurring at the location of initial diagnosis, with a tiered approach to procedures conducted during the visit. In addition, the dynamics and relationships between people (relational infrastructure), specifically collaboration, were identified as key facilitators for the review’s implementation in both study countries. Collaboration across levels of the health system and among healthcare providers was found to be a process influenced and necessitated by the environment (e.g., the infrastructural and epidemiological contexts), contributing to quality of care, continuity of care, safety, and effective treatment. Conclusion Identifying how clinical review visits could be adapted to local settings is important and can be achieved through co-creation. Collaboration has the potential to enable quality of care and patient safety. Suitable ways of reinforcing this relational infrastructure are required to optimize case management of patients. |
| format | Article |
| id | doaj-art-3b9b0adc08354d47b1bf452daae08db7 |
| institution | OA Journals |
| issn | 1475-2875 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
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| spelling | doaj-art-3b9b0adc08354d47b1bf452daae08db72025-08-20T02:39:04ZengBMCMalaria Journal1475-28752025-05-0124112010.1186/s12936-025-05425-3Co-design of a routine clinical review to improve the safety of high dose radical cure treatment for Plasmodium vivax malaria: findings from Cambodia and EthiopiaSarah A. Cassidy-Seyoum0Muthoni Mwaura1Keoratha Chheng2Muhaba Kejela3Kansite Gellebo Korra4Tsegaberhan Wodaj5Tamiru Shibiru Degaga6Michelle S. Hsiang7Lorenz von Seidlein8Rupam Tripura9Bipin Adhikari10Benedikt Ley11Dysoley Lek12Ric N. Price13Nora Engel14Kamala Thriemer15Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin UniversityGlobal and Tropical Health Division, Menzies School of Health Research, Charles Darwin UniversityMahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityDepartment of Sociology and Social Anthropology, Arba Minch UniversityDepartment of Sociology and Social Anthropology, Arba Minch UniversityDepartment of English Language and Literature, Arba Minch UniversityGlobal and Tropical Health Division, Menzies School of Health Research, Charles Darwin UniversityMalaria Elimination Initiative, Institute for Global Health Sciences, University of California San Francisco (UCSF)Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityMahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityMahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityGlobal and Tropical Health Division, Menzies School of Health Research, Charles Darwin UniversityNational Centre for Parasitology, Entomology, and Malaria ControlGlobal and Tropical Health Division, Menzies School of Health Research, Charles Darwin UniversityGlobal and Tropical Health Division, Menzies School of Health Research, Charles Darwin UniversityGlobal and Tropical Health Division, Menzies School of Health Research, Charles Darwin UniversityAbstract Background Low dose primaquine regimens are widely used to treat Plasmodium vivax malaria, but they have limited efficacy and effectiveness. Short courses with higher daily doses as well as single dose tafenoquine have the potential to improve effectiveness but can increase the risk of adverse events. A clinical review visit on day 3 post-treatment initiation could facilitate adherence and improve safety, but it is unclear how it could be integrated into routine malaria care. Methods Between March and September 2023, focus group discussions (FGDs) with P. vivax malaria patients and healthcare providers were conducted in Cambodia and Ethiopia. In the FGDs participants co-designed a day 3 review suitable for their setting based on material infrastructure ‘building blocks’ (location, implementer, procedures, and support mechanisms). Nine FGDs were completed in three health facility catchment areas in Cambodia and six FGDs in four facilities in Ethiopia. Data were analysed using an inductive-deductive analytical process allowing the development of themes. Results Participants in Cambodia and Ethiopia had different preferences for the material infrastructure of the day 3 review, from which a model for each country was developed. In Cambodia, proximity to patients was prioritized, maintaining the existing referral mechanism in which the initial day 3 review is conducted in the community, focusing on an enhanced symptom assessment. In Ethiopia, continuity of care was prioritized, resulting in the day 3 review occurring at the location of initial diagnosis, with a tiered approach to procedures conducted during the visit. In addition, the dynamics and relationships between people (relational infrastructure), specifically collaboration, were identified as key facilitators for the review’s implementation in both study countries. Collaboration across levels of the health system and among healthcare providers was found to be a process influenced and necessitated by the environment (e.g., the infrastructural and epidemiological contexts), contributing to quality of care, continuity of care, safety, and effective treatment. Conclusion Identifying how clinical review visits could be adapted to local settings is important and can be achieved through co-creation. Collaboration has the potential to enable quality of care and patient safety. Suitable ways of reinforcing this relational infrastructure are required to optimize case management of patients.https://doi.org/10.1186/s12936-025-05425-3MalariaVivax malariaRadical cureNovel treatmentPharmacovigilanceTreatment monitoring |
| spellingShingle | Sarah A. Cassidy-Seyoum Muthoni Mwaura Keoratha Chheng Muhaba Kejela Kansite Gellebo Korra Tsegaberhan Wodaj Tamiru Shibiru Degaga Michelle S. Hsiang Lorenz von Seidlein Rupam Tripura Bipin Adhikari Benedikt Ley Dysoley Lek Ric N. Price Nora Engel Kamala Thriemer Co-design of a routine clinical review to improve the safety of high dose radical cure treatment for Plasmodium vivax malaria: findings from Cambodia and Ethiopia Malaria Journal Malaria Vivax malaria Radical cure Novel treatment Pharmacovigilance Treatment monitoring |
| title | Co-design of a routine clinical review to improve the safety of high dose radical cure treatment for Plasmodium vivax malaria: findings from Cambodia and Ethiopia |
| title_full | Co-design of a routine clinical review to improve the safety of high dose radical cure treatment for Plasmodium vivax malaria: findings from Cambodia and Ethiopia |
| title_fullStr | Co-design of a routine clinical review to improve the safety of high dose radical cure treatment for Plasmodium vivax malaria: findings from Cambodia and Ethiopia |
| title_full_unstemmed | Co-design of a routine clinical review to improve the safety of high dose radical cure treatment for Plasmodium vivax malaria: findings from Cambodia and Ethiopia |
| title_short | Co-design of a routine clinical review to improve the safety of high dose radical cure treatment for Plasmodium vivax malaria: findings from Cambodia and Ethiopia |
| title_sort | co design of a routine clinical review to improve the safety of high dose radical cure treatment for plasmodium vivax malaria findings from cambodia and ethiopia |
| topic | Malaria Vivax malaria Radical cure Novel treatment Pharmacovigilance Treatment monitoring |
| url | https://doi.org/10.1186/s12936-025-05425-3 |
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