Strengthening therapeutic adherence and pharmacovigilance to antimalarial treatment in Manaus, Brazil: a multicomponent strategy using mHealth

• Published in: Malaria Journal
• Main Authors: Diego Macías Saint-Gerons, Sheila Rodovalho, Ádila Liliane Barros Dias, André Lacerda Ulysses de Carvalho, Andrea Beratarrechea, Wuelton Marcelo Monteiro, Myrna Barata Machado, Cristiano Fernandes da Costa, Marcelo Yoshito Wada, Márcia Helena Maximiano Faria de Almeida, Rayanne Silva de Matos Fonseca, Jady Shayenne Mota Cordeiro, Alinne Paula Rodrigues Antolini, João Altecir Nepomuceno, Karen Fleck, Fernanda Simioni Gasparotto, Marcus Lacerda, Robin Rojas-Cortés, Shanthi Narayan Pal, Analía I. Porrás, María de la Paz Ade, José Luis Castro
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMC 2022
• Subjects: Primaquine; Adherence; Pharmacovigilance; mHealth; SMS; Arctic medicine. Tropical medicine; RC955-962; Infectious and parasitic diseases; RC109-216; Arctic
• Online Access: https://doi.org/10.1186/s12936-022-04047-3; https://doaj.org/article/ccdde1111fde410ab64ea42e794dc2ed

Abstract Background Public health initiatives for improving adherence to primaquine based regimens and enhancing effective pharmacovigilance are needed to support the efforts for malaria elimination in real world conditions. Methods A multicomponent patient-oriented strategy using a Smart Safety Surveillance (3S) approach including: (1) educational materials for treatment counselling and identification of warning symptoms of haemolytic anaemia; (2) an mHealth component using Short Message Service (SMS) treatment reminders and (3) development and implementation of follow-up phone surveys three days after treatment completion, using a web-based platform linked to the local information system of malaria. Adherence was measured using the Morisky Medication Adherence Scale. Self-reported events were registered using a structured questionnaire and communicated to the Brazilian Health Regulatory Agency. Results Educational materials were disseminated to 5594 patients, of whom 1512 voluntarily entered the mHealth component through the local information system; 7323 SMS were sent, and 1062 participants completed a follow-up survey after treatment. The mean age of patients was 37.36 years (SD 13.65), 61.24% were male, 98.54% were infected with. Plasmodium vivax and 95.90% received a short regimen of chloroquine plus primaquine (CQ + PQ 7 days), as per malaria case management guidelines in Brazil. From the 1062 surveyed participants 93.31% were considered adherent to the treatment. Most of the patients (95.20%) reported at least one adverse event. Headache, lack of appetite and nausea/vomiting were the most frequently reported adverse events by 77.31%, 70.90% and 56.78% of the patients respectively. A quarter of the patients reported anxiety or depression symptoms; 57 (5.37%) patients reported 5 to 6 warning symptoms of haemolytic anaemia including jaundice and dark urine in 44 (4.14%). Overall, three patients presenting symptoms of haemolytic anaemia attended a hospital and were diagnosed with G6PD deficiency, and one had ...