Community engagement among forest goers in a malaria prophylaxis trial: implementation challenges and implications
<p><strong>Background: </strong>Malaria transmission in Southeast Asia is increasingly confined to forests, where marginalized groups are exposed primarily through their work. Anti-malarial chemoprophylaxis may help to protect these people. This article examines the effect...
| Κύριοι συγγραφείς: | , , , , , , , , , , , , , , , |
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| Μορφή: | Journal article |
| Γλώσσα: | English |
| Έκδοση: |
BioMed Central
2023
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| _version_ | 1826310850244247552 |
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| author | Conradis-Jansen, F Tripura, R Peto, TJ Callery, JJ Adhikari, B Ean, M Jongdeepaisal, M Pell, C Khonputsa, P Murgia, R Sovannaroth, S Müller, O Cheah, PY Dondorp, AM von Seidlein, L Maude, RJ |
| author_facet | Conradis-Jansen, F Tripura, R Peto, TJ Callery, JJ Adhikari, B Ean, M Jongdeepaisal, M Pell, C Khonputsa, P Murgia, R Sovannaroth, S Müller, O Cheah, PY Dondorp, AM von Seidlein, L Maude, RJ |
| author_sort | Conradis-Jansen, F |
| collection | OXFORD |
| description | <p><strong>Background: </strong>Malaria transmission in Southeast Asia is increasingly confined to forests, where marginalized groups are exposed primarily through their work. Anti-malarial chemoprophylaxis may help to protect these people. This article examines the effectiveness and practical challenges of engaging forest-goers to participate in a randomized controlled clinical trial of anti-malarial chemoprophylaxis with artemether-lumefantrine (AL) versus a control (multivitamin, MV) for malaria in northeast Cambodia.</p>
<p><strong>Methods: </strong>The impact of engagement in terms of uptake was assessed as the proportion of people who participated during each stage of the trial: enrolment, compliance with trial procedures, and drug intake. During the trial, staff recorded the details of engagement meetings, including the views and opinions of participants and community representatives, the decision-making processes, and the challenges addressed during implementation.</p>
<p><strong>Results: </strong>In total, 1613 participants were assessed for eligibility and 1480 (92%) joined the trial, 1242 (84%) completed the trial and received prophylaxis (AL: 82% vs MV: 86%, p = 0.08); 157 (11%) were lost to follow-up (AL: 11% vs MV: 11%, p = 0.79); and 73 (5%) discontinued the drug (AL-7% vs MV-3%, p = 0.005). The AL arm was associated with discontinuation of the study drug (AL: 48/738, 7% vs 25/742, 3%; p = 0.01). Females (31/345, 9%) were more likely (42/1135, 4%) to discontinue taking drugs at some point in the trial (p = 0.005). Those (45/644, 7%) who had no previous history of malaria infection were more likely to discontinue the study drug than those (28/836, 3%) who had a history of malaria (p = 0.02). Engagement with the trial population was demanding because many types of forest work are illegal; and the involvement of an engagement team consisting of representatives from the local administration, health authorities, community leaders and community health workers played a significant role in building trust. Responsiveness to the needs and concerns of the community promoted acceptability and increased confidence in taking prophylaxis among participants. Recruitment of forest-goer volunteers to peer-supervise drug administration resulted in high compliance with drug intake. The development of locally-appropriate tools and messaging for the different linguistic and low-literacy groups was useful to ensure participants understood and adhered to the trial procedures. It was important to consider forest-goers` habits and social characteristics when planning the various trial activities.</p>
<p><strong>Conclusions: </strong>The comprehensive, participatory engagement strategy mobilized a wide range of stakeholders including study participants, helped build trust, and overcame potential ethical and practical challenges. This locally-adapted approach was highly effective as evidenced by high levels of trial enrolment, compliance with trial procedures and drug intake.</p> |
| first_indexed | 2024-03-07T07:58:06Z |
| format | Journal article |
| id | oxford-uuid:d1c7367c-0427-409d-b330-3cbaf26323dd |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T07:58:06Z |
| publishDate | 2023 |
| publisher | BioMed Central |
| record_format | dspace |
| spelling | oxford-uuid:d1c7367c-0427-409d-b330-3cbaf26323dd2023-09-05T15:30:27ZCommunity engagement among forest goers in a malaria prophylaxis trial: implementation challenges and implicationsJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:d1c7367c-0427-409d-b330-3cbaf26323ddEnglishSymplectic ElementsBioMed Central2023Conradis-Jansen, FTripura, RPeto, TJCallery, JJAdhikari, BEan, MJongdeepaisal, MPell, CKhonputsa, PMurgia, RSovannaroth, SMüller, OCheah, PYDondorp, AMvon Seidlein, LMaude, RJ<p><strong>Background: </strong>Malaria transmission in Southeast Asia is increasingly confined to forests, where marginalized groups are exposed primarily through their work. Anti-malarial chemoprophylaxis may help to protect these people. This article examines the effectiveness and practical challenges of engaging forest-goers to participate in a randomized controlled clinical trial of anti-malarial chemoprophylaxis with artemether-lumefantrine (AL) versus a control (multivitamin, MV) for malaria in northeast Cambodia.</p> <p><strong>Methods: </strong>The impact of engagement in terms of uptake was assessed as the proportion of people who participated during each stage of the trial: enrolment, compliance with trial procedures, and drug intake. During the trial, staff recorded the details of engagement meetings, including the views and opinions of participants and community representatives, the decision-making processes, and the challenges addressed during implementation.</p> <p><strong>Results: </strong>In total, 1613 participants were assessed for eligibility and 1480 (92%) joined the trial, 1242 (84%) completed the trial and received prophylaxis (AL: 82% vs MV: 86%, p = 0.08); 157 (11%) were lost to follow-up (AL: 11% vs MV: 11%, p = 0.79); and 73 (5%) discontinued the drug (AL-7% vs MV-3%, p = 0.005). The AL arm was associated with discontinuation of the study drug (AL: 48/738, 7% vs 25/742, 3%; p = 0.01). Females (31/345, 9%) were more likely (42/1135, 4%) to discontinue taking drugs at some point in the trial (p = 0.005). Those (45/644, 7%) who had no previous history of malaria infection were more likely to discontinue the study drug than those (28/836, 3%) who had a history of malaria (p = 0.02). Engagement with the trial population was demanding because many types of forest work are illegal; and the involvement of an engagement team consisting of representatives from the local administration, health authorities, community leaders and community health workers played a significant role in building trust. Responsiveness to the needs and concerns of the community promoted acceptability and increased confidence in taking prophylaxis among participants. Recruitment of forest-goer volunteers to peer-supervise drug administration resulted in high compliance with drug intake. The development of locally-appropriate tools and messaging for the different linguistic and low-literacy groups was useful to ensure participants understood and adhered to the trial procedures. It was important to consider forest-goers` habits and social characteristics when planning the various trial activities.</p> <p><strong>Conclusions: </strong>The comprehensive, participatory engagement strategy mobilized a wide range of stakeholders including study participants, helped build trust, and overcame potential ethical and practical challenges. This locally-adapted approach was highly effective as evidenced by high levels of trial enrolment, compliance with trial procedures and drug intake.</p> |
| spellingShingle | Conradis-Jansen, F Tripura, R Peto, TJ Callery, JJ Adhikari, B Ean, M Jongdeepaisal, M Pell, C Khonputsa, P Murgia, R Sovannaroth, S Müller, O Cheah, PY Dondorp, AM von Seidlein, L Maude, RJ Community engagement among forest goers in a malaria prophylaxis trial: implementation challenges and implications |
| title | Community engagement among forest goers in a malaria prophylaxis trial: implementation challenges and implications |
| title_full | Community engagement among forest goers in a malaria prophylaxis trial: implementation challenges and implications |
| title_fullStr | Community engagement among forest goers in a malaria prophylaxis trial: implementation challenges and implications |
| title_full_unstemmed | Community engagement among forest goers in a malaria prophylaxis trial: implementation challenges and implications |
| title_short | Community engagement among forest goers in a malaria prophylaxis trial: implementation challenges and implications |
| title_sort | community engagement among forest goers in a malaria prophylaxis trial implementation challenges and implications |
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