Ethical considerations in deploying triple artemisinin-based combination therapies for malaria: An analysis of stakeholders' perspectives in Burkina Faso and Nigeria.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2022
2022
Historique:
received:
07
02
2022
accepted:
04
08
2022
entrez:
9
9
2022
pubmed:
10
9
2022
medline:
14
9
2022
Statut:
epublish
Résumé
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. 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. 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 end-users 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. Addressing ethical issues regarding TACTs and engaging early with stakeholders will be important for their potential deployment in Africa.
Sections du résumé
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 end-users 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.
Identifiants
pubmed: 36083995
doi: 10.1371/journal.pone.0273249
pii: PONE-D-22-03780
pmc: PMC9462557
doi:
Substances chimiques
Antimalarials
0
Artemisinins
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0273249Subventions
Organisme : Wellcome Trust
ID : 220211
Pays : United Kingdom
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Malar J. 2019 Oct 11;18(1):338
pubmed: 31581941
Acta Trop. 2005 Sep;95(3):305-15
pubmed: 16098946
Nat Med. 2020 Oct;26(10):1602-1608
pubmed: 32747827
BMC Int Health Hum Rights. 2009 Oct 25;9:26
pubmed: 19852857
Malar Res Treat. 2011;2011:683167
pubmed: 22312571
Bull Soc Pathol Exot. 2009 Feb;102(1):31-5
pubmed: 19343918
Can J Public Health. 2002 Mar-Apr;93(2):101-3
pubmed: 11968179
Lancet. 2020 Apr 25;395(10233):1345-1360
pubmed: 32171078
Lancet. 2017 Dec 17;388(10063):2990
pubmed: 27998527
Wellcome Open Res. 2021 Apr 7;6:75
pubmed: 34458588
Malar J. 2021 Jan 19;20(1):48
pubmed: 33468147
Malar J. 2021 Feb 27;20(1):119
pubmed: 33639946
Lancet Infect Dis. 2021 Aug;21(8):1120-1128
pubmed: 33864801
Nat Commun. 2016 May 18;7:11553
pubmed: 27189525
BMC Public Health. 2022 Apr 30;22(1):864
pubmed: 35490212
Antimicrob Agents Chemother. 2019 Feb 26;63(3):
pubmed: 30559133
Lancet Infect Dis. 2021 Apr;21(4):e82-e92
pubmed: 33125913
PLoS Comput Biol. 2021 Mar 25;17(3):e1008850
pubmed: 33764971
Antimicrob Agents Chemother. 2021 Jan 20;65(2):
pubmed: 33168604
Wellcome Open Res. 2017 Sep 29;2:95
pubmed: 29062919
Malar J. 2021 Jul 19;20(1):320
pubmed: 34281562
Glob Bioeth. 2019 Dec 20;31(1):1-12
pubmed: 32002019
J Law Med Ethics. 2002 Summer;30(2):170-8
pubmed: 12066595
Malar J. 2006 Jul 31;5:65
pubmed: 16879742
Am J Trop Med Hyg. 2007 Dec;77(6 Suppl):193-7
pubmed: 18165492
Malar J. 2014 Aug 08;13:305
pubmed: 25107509
Br J Clin Pharmacol. 2022 Feb;88(2):374-382
pubmed: 32656850
Antimicrob Agents Chemother. 2021 May 18;65(6):
pubmed: 33753339
Trends Parasitol. 2021 Jan;37(1):15-24
pubmed: 33060063
Glob Bioeth. 2017 Dec 07;29(1):16-21
pubmed: 29249920
Int Health. 2021 Feb 24;13(2):188-195
pubmed: 33038893
Emerg Infect Dis. 2018 Apr;24(4):718-726
pubmed: 29553316
Int Health. 2016 Jul;8(4):235-8
pubmed: 27481834
Trans R Soc Trop Med Hyg. 2009 Apr;103 Suppl 1:S11-4
pubmed: 19084883
Malar J. 2010 May 27;9:144
pubmed: 20507555
Health Hum Rights. 2006;9(2):10-38
pubmed: 17265753
Wellcome Open Res. 2021 Jan 11;6:2
pubmed: 33824910
Am J Public Health. 2001 Nov;91(11):1776-82
pubmed: 11684600
PLoS One. 2021 Aug 31;16(8):e0256567
pubmed: 34464398
N Engl J Med. 2021 Sep 23;385(13):1163-1171
pubmed: 34551228
Malar J. 2007 May 29;6:72
pubmed: 17535417