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Enhancing Primaquine Adherence for Plasmodium vivax Malaria: A Cluster-Randomized Controlled Trial in Myanmar
Kyawt Mon Win
Kyawt Mon Win
Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;
Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;
Department of Public Health, Ministry of Health, Naypyidaw, Myanmar;
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Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;
Department of Public Health, Ministry of Health, Naypyidaw, Myanmar;
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Pyae Linn Aung
Pyae Linn Aung
Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;
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Nay Yi Yi Linn
Nay Yi Yi Linn
Department of Public Health, Ministry of Health, Naypyidaw, Myanmar;
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Zau Ring
Zau Ring
State Public Health Department, Kachin, Myanmar;
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Myat Phone Kyaw
Myat Phone Kyaw
Myanmar Health Network Organization, Yangon, Myanmar;
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Wang Nguitragool
Wang Nguitragool
Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;
Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; and
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Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; and
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Liwang Cui
Liwang Cui
Division of Infectious Diseases and International Medicine, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida
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Jetsumon Sattabongkot
Jetsumon Sattabongkot
Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;
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Saranath Lawpoolsri
saranath.law@mahidol.ac.th
Saranath Lawpoolsri
Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;
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The rising prevalence of Plasmodium vivax (P. vivax) malaria challenges elimination efforts, particularly in the Greater Mekong Subregion, although adherence to the required 14-day primaquine (PQ) regimen remains a major obstacle. This study evaluated the effectiveness of a family-administered, directly observed treatment intervention in improving adherence to PQ among patients with confirmed P. vivax from October 2022 to March 2023. A cluster-randomized controlled trial was conducted in five intervention villages and five control villages in Kachin State, Myanmar. A total of 427 patients in the intervention group (supervised dosing) and 425 patients in the control group (unsupervised dosing), all diagnosed with P. vivax, underwent a 14-day PQ regimen, with the intervention group being supervised by trained family members. Pill counts on day 14 were assessed and compared between the two groups using Poisson generalized linear mixed models. Parasite reappearance identified by polymerase chain reaction was compared between the two groups using survival analysis. Cumulative malaria incidence at baseline, as well as at months 6 and 12, was compared between the two groups. Treatment adherence was significantly higher in the intervention group (98.8%) compared with the control group (77.6%). Parasite reappearance rates were similar between the groups (P = 0.20) on days 14, 28, and 42. However, the cumulative incidence of malaria over 1 year was significantly lower in the intervention group (P <0.001) compared with the control group. In malaria-endemic areas with limited resources, a family-administered, directly observed treatment intervention offers an efficient approach to enhance PQ adherence and achieve the radical cure of P. vivax malaria.
Author Notes
Financial support: This research was funded by the
Disclosure: The study protocol was approved by the Institutional Review Board of the University of Public Health, Yangon, Myanmar (UPH-IRB: 2022/Research/6), and the Ethics Committee for Human Research Study, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand (MUTM 2022–064-01). Participants were informed about the study and signed consent forms before participating. Informed consent was obtained from the parents or legal guardians if participants were under 18 years old.
Current contact information: Kyawt Mon Win, Pyae Linn Aung, Wang Nguitragool, and Jetsumon Sattabongkot, Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand, E-mails: kyawtmonwin@gmail.com, pyaelinn.aun@mahidol.ac.th, wang.ngu@mahidol.edu, and jetsumon.pra@mahidol.edu. Nay Yi Yi Linn, Department of Public Health, Ministry of Health, Naypyidaw, Myanmar, E-mail: centralnmcp@gmail.com. Zau Ring, State Public Health Department, Kachin, Myanmar, E-mail: zauring.kachinsphd@gmail.com. Myat Phone Kyaw, Myanmar Health Network Organization, Yangon, Myanmar, E-mail: kyaw606@gmail.com. Liwang Cui, Division of Infectious Diseases and International Medicine, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, E-mail: liwangcui@usf.edu. Saranath Lawpoolsri, Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand, E-mail: saranath.law@mahidol.ac.th.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 0 | 0 | 0 |
| Full Text Views | 167 | 167 | 167 |
| PDF Downloads | 132 | 132 | 132 |