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

Autor: Macías Saint-Gerons D; Department of Medicine, University of Valencia, INCLIVA Health Research Institute and CIBERSAM, Valencia, Spain. dmacias.sg@gmail.com.; Unit of Medicines and Health Technologies (MT), Dep. of Health Systems and Services (HSS), Pan American Health Organization (PAHO/WHO), Washington, USA. dmacias.sg@gmail.com., Rodovalho S; Programa de Pós-Gradação Em Medicina Tropical, Universidade Do Estado Do Amazonas, Manaus, AM, Brazil.; Communicable Diseases and Environmental Determinants of Health (CDE), Pan American Health Organization (PAHO/WHO), Brasília, Brazil., Barros Dias ÁL; Programa de Pós-Gradação Em Medicina Tropical, Universidade Do Estado Do Amazonas, Manaus, AM, Brazil., Lacerda Ulysses de Carvalho A; Unit of Medicines and Health Technologies (MT), Dep. of Health Systems and Services (HSS), Pan American Health Organization (PAHO/WHO, Brasília, Brazil., Beratarrechea A; Institute of Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina., Monteiro WM; Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.; Universidade do Estado do Amazonas, Manaus, Brazil., Barata Machado M; State of Amazonas Health Surveillance Foundation, Amazonas State Health Secretariat, Manaus, Amazonas, Brazil., Fernandes da Costa C; State of Amazonas Health Surveillance Foundation, Amazonas State Health Secretariat, Manaus, Amazonas, Brazil., Yoshito Wada M; General-Coordination for Surveillance of Zoonoses and Vector-Borne Diseases, Secretariat of Health Surveillance, Ministry of Health, Manaus, Brazil., de Almeida MHMF; General-Coordination for Surveillance of Zoonoses and Vector-Borne Diseases, Secretariat of Health Surveillance, Ministry of Health, Manaus, Brazil., Silva de Matos Fonseca R; Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil., Mota Cordeiro JS; Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil., Antolini APR; Environmental Surveillance Management - Department of Health, Manaus, Amazonas, Brazil., Nepomuceno JA; Environmental Surveillance Management - Department of Health, Manaus, Amazonas, Brazil., Fleck K; Pharmacovigilance Office (GFARM), Brazilian Health Regulatory Agency (Anvisa), Brasília, Brazil., Simioni Gasparotto F; Pharmacovigilance Office (GFARM), Brazilian Health Regulatory Agency (Anvisa), Brasília, Brazil., Lacerda M; Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.; Instituto Leônidas & Maria Deane, Fiocruz, Manaus, Brazil., Rojas-Cortés R; Unit of Medicines and Health Technologies (MT), Dep. of Health Systems and Services (HSS), Pan American Health Organization (PAHO/WHO), Washington, USA., Pal SN; World Health Organization Headquarters, Geneva, Switzerland., Porrás AI; Unit of Medicines and Health Technologies (MT), Dep. of Health Systems and Services (HSS), Pan American Health Organization (PAHO/WHO), Washington, USA., Ade MP; Department of Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization (PAHO/WHO), Washington, USA., Castro JL; Unit of Medicines and Health Technologies (MT), Dep. of Health Systems and Services (HSS), Pan American Health Organization (PAHO/WHO), Washington, USA.
Jazyk: angličtina
Zdroj: Malaria journal [Malar J] 2022 Jan 29; Vol. 21 (1), pp. 28. Date of Electronic Publication: 2022 Jan 29.
DOI: 10.1186/s12936-022-04047-3
Abstrakt: 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 haemolysis. All of them recovered.
Conclusions: Under real world conditions, a multicomponent patient-oriented strategy using information and communication technologies allowed health care providers to reinforce treatment adherence and enhance safety surveillance of adverse events associated with regimens using primaquine. Active monitoring through phone surveys also reduced under-reporting of ADRs. This approach is low-cost, scalable and able to support prioritized activities of the national malaria programme.
(© 2022. The Author(s).)
Databáze: MEDLINE
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