Abstract
After decades of successful artemisinin regimen in combating malaria, its effectiveness has decreased since parasite resistance to the treatment regimen has begun to appear. Adherence to artemisinin combination therapy (ACT) in a population is considered to be the key factor contributing to such resistance phenomenon. Although several studies have tried to demonstrate adherence to several ACT types in a population, only a limited number of studies demonstrated adherence to dihyrdroartemisinin + piperaquine (DHP) regimen. The present study was conducted in two localities representing low and high endemic areas in Indonesia. Active case detection (ACD) and passive case detection (PCD) have been applied to screen for malaria case in the localities. At day 3, patients were visited in the house to be interviewed using structured questionnaire. Capillary sample of each patient was also collected on Whatman® filter paper at day 60 to observe the piperaquine metabolite of the patients. 47 and 91 (out of 62 and 138) patients from Jambi and Sumba, respectively, were successfully enrolled in this study. In Jambi, the level of adherence was 66%, while that in Sumba was 79.1%. The associated factors of adherence in our study settings are patient age group (OR = 1.65 [CI: 0.73–3.73]) and patients' knowledge of malaria prevention measure (OR = 0.29 [CI: 0.09–0.9]). Our study suggested that the adherence to ACT medication among population in our study setting is considered to be less than 80%, which needs to be elevated to avoid the growing trend of treatment failure as seen globally. Additionally, our study found that metabolite at day 60 after prescription of piperaquine could be a potential marker for monitoring adherence to piperaquine drug in a population.
Highlights
Artemisinin is a class of antimalarial drugs belonging to a plan species called Artemisia annua [1]
Study Setting. is study used an observational design with follow-up following the completion day of DHP medication. e study was conducted between January and December 2018 on patients treated with DHP in two different localities representing low and high endemic areas in western and eastern parts of Indonesia. e first sampling area was Lembah Masurai subdistrict in Jambi Province, which is densely forested area located in western part of Indonesia. e second locality was Sumba Island, Nusa Tenggara Timur Province, which has a relatively low vegetation cover and is located in eastern part of Indonesia
It was previously described that a higher rate of treatment failure occurred when adherence level was lower compared to optimal adherence level [53]
Summary
Artemisinin is a class of antimalarial drugs belonging to a plan species called Artemisia annua [1]. After approximately thirty years of its first discovery, WHO recommended the medication of ACT to combat Plasmodium malaria which has been resistant to conventional antimalarial drugs [2]. Afterwards, in 2010, majority of the world has applied ACT as first-line treatment against malaria and more than half of countries applied ACT as a free-of-charge medication [3, 4]. After the first introduction of artemisinin-resistant parasites found in Cambodia in 2008, the effectiveness of ACT seems to be worrying [6–9]. Besides the development of genetic factors of the parasite due to continuous exposure from the drug, population adherence to ACT is one of the most important factors facilitating the parasite to develop resistance stage [10–12]. Nonadherence behavior can promote malaria parasite to undergo suboptimal dose of artemisinin and its partner drug and it will eventually become fitter, leaving beneficial genetic variation of the parasite [13, 14].
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