Feasibility and Acceptability of a Strategy Deploying Multiple First-Line Artemisinin-Based Combination Therapies for Uncomplicated Malaria in the Health District of Kaya, Burkina Faso

Abstract

(1) Background: Effective malaria case management relies on World Health Organization (WHO) recommended artemisinin-based combination therapies (ACTs), but partial resistance to artemisinin has emerged and is spreading, threatening malaria control and elimination efforts. The strategy of deploying multiple first-line therapies (MFT) may help mitigate this threat and extend the therapeutic life of current ACTs. (2) Methods: A district-wide pilot quasi-experimental study was conducted, deploying three different ACTs at the public health facility (PHF) level for uncomplicated malaria treatment from December 2019 to December 2020 in the health district (HD) of Kaya, Burkina Faso. Mixed methods, including household and health facility-based quantitative and qualitative surveys, were used to evaluate the pilot programme. (3) Results: A total of 2008 suspected malaria patients were surveyed at PHFs, of which 79.1% were tested by rapid diagnostic test (RDT) with 65.5% positivity rate. In total, 86.1% of the confirmed cases received the appropriate ACT according to the MFT strategy. The adherence level did not differ by study segment (p = 0.19). Overall, the compliance level of health workers (HWs) with MFT strategy was 72.7% (95% CI: 69.7–75.5). The odds of using PHF as the first source of care increased after the intervention (aOR = 1.6; 95% CI, 1.3–1.9), and the reported adherence to the 3-day treatment regimen was 82.1%; (95% CI: 79.6–84.3). Qualitative results showed a high acceptance of the MFT strategy with positive opinions from all stakeholders. (4) Conclusions: Implementing an MFT strategy is operationally feasible and acceptable by stakeholders in the health systems in Burkina Faso. This study provides evidence to support the simultaneous use of multiple first-line artemisinin combination therapies in malaria-endemic countries such as Burkina Faso.

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

“…These elements generated a sense of familiarity with the segmentation approach, which led to a slight preference for this deployment strategy over the other options. Similar findings were reported by Kabore et al (2023) [17] who showed that implementing MFT with a segmentation approach was operationally feasible and acceptable in Burkina Faso. In our survey, the main concern associated with the segmentation approach was a shortage of drugs.…”

“…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. In addition, they also showed that such an intervention was operationally feasible and acceptable by stakeholders in the health system in Burkina Faso [17].…”

“…Similarly, various MFT deployment strategies have been envisaged, but none of them have been tested at scale yet. These strategies include (a) rotation during which an ACT is scheduled to be used for a certain duration of time before being replaced by another one, or until a certain resistance threshold is observed; (b) segmentation, where different ACTs are given to different segments of the population (pediatric, pregnant women, adults), or through different distribution channels (clinics, pharmacies, health centers); (c) geographic, where different ACTs are distributed to different administrative regions [13,17].…”

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

“…Authors found that the adherence by both the population and key stakeholders would depend on treatment efficacy, low level of side effects, cost, and drug availability. In addition, they also showed that such an intervention was operationally feasible and acceptable by stakeholders in the health system in Burkina Faso [17].…”

“…Similarly, various MFT deployment strategies have been envisaged, but none of them has been tested at scale yet. These strategies include a) rotation during which an ACT is scheduled to be used for a certain duration of time before being replaced by another one, or until a certain resistance threshold is observed; b) segmentation, where different ACTs are given to different segments of the population (pediatric, pregnant women, adults), or through different distribution channels (clinics, pharmacies, health centers); c) geographic, where different ACTs are distributed to different administrative regions [13,17].…”