Ethical considerations in deploying triple artemisinin-based combination therapies for malaria: An analysis of stakeholders' perspectives in Burkina Faso and Nigeria
Issued Date
2022-09-01
Resource Type
eISSN
19326203
Scopus ID
2-s2.0-85137730102
Pubmed ID
36083995
Journal Title
PLoS ONE
Volume
17
Issue
9 9
Rights Holder(s)
SCOPUS
Bibliographic Citation
PLoS ONE Vol.17 No.9 9 (2022)
Suggested Citation
Tindana P., Guissou R., Bolarinwa O.A., Tou F., de Haan F., Dhorda M., Dondorp A.M., Amaratunga C., Mokuolu O.A., Ouedraogo J.B., Cheah P.Y. Ethical considerations in deploying triple artemisinin-based combination therapies for malaria: An analysis of stakeholders' perspectives in Burkina Faso and Nigeria. PLoS ONE Vol.17 No.9 9 (2022). doi:10.1371/journal.pone.0273249 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/86477
Title
Ethical considerations in deploying triple artemisinin-based combination therapies for malaria: An analysis of stakeholders' perspectives in Burkina Faso and Nigeria
Other Contributor(s)
Abstract
Background Artemisinin-based combination therapies (ACTs) are the recommended treatment for uncomplicated Plasmodium falciparum malaria in all malaria endemic countries. Artemisinin resistance, partner drug resistance, and subsequent ACT failure are widespread in Southeast Asia. The more recent independent emergence of artemisinin resistance in Africa is alarming. In response, triple artemisinin-based combination therapies (TACTs) are being developed to mitigate the risks associated with increasing drug resistance. Since ACTs are still effective in Africa, where malaria is mainly a paediatric disease, the potential deployment of TACTs raises important ethical questions. This paper presents an analysis of stakeholders' perspectives regarding key ethical considerations to be considered in the deployment of TACTs in Africa provided they are found to be safe, well-tolerated and effective for the treatment of uncomplicated malaria. Methods We conducted a qualitative study in Burkina Faso and Nigeria assessing stakeholders' (policy makers, suppliers and end-users) perspectives on ethical issues regarding the potential future deployment of TACTs through 68 in-depth interviews and 11 focus group discussions. Findings Some respondents suggested that there should be evidence of local artemisinin resistance before they consider deploying TACTs, while others suggested that TACTs should be deployed to protect the efficacy of current ACTs. Respondents suggested that additional side effects of TACTs compared to ACTs should be minimal and the cost of TACTs to endusers should not be higher than the cost of current ACTs. There was some disagreement among respondents regarding whether patients should have a choice of treatment options between ACTs and TACTs or only have TACTs available, while ACTs are still effective. The study also suggests that community, public and stakeholder engagement activities are essential to support the introduction and effective uptake of TACTs. Conclusion Addressing ethical issues regarding TACTs and engaging early with stakeholders will be important for their potential deployment in Africa.