Compliance with Primary Malaria Chemoprophylaxis: Is Weekly Prophylaxis Better Than Daily Prophylaxis?

Chaturaka Rodrigo; Senaka Rajapakse; Sumadhya Deepika Fernando

doi:10.2147/PPA.S255561

Compliance with Primary Malaria Chemoprophylaxis: Is Weekly Prophylaxis Better Than Daily Prophylaxis?

Patient Prefer Adherence. 2020 Nov 9:14:2215-2223. doi: 10.2147/PPA.S255561. eCollection 2020.

Authors

Chaturaka Rodrigo¹, Senaka Rajapakse², Sumadhya Deepika Fernando³

Affiliations

¹ Department of Pathology, School of Medical Sciences, UNSW, Sydney, NSW, Australia.
² Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
³ Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.

Abstract

Background: Chemoprophylaxis is an effective tool for individuals to minimize their risk of contracting malaria and serves an important public health role in preventing imported malaria. Yet, it is only effective if the traveller is fully compliant with the prescribed regimen. For many destinations, a choice of prophylactic agents is available, so historical compliance data can be helpful for both physicians and travellers to make an informed decision.

Methods: We analyzed the historical self-reported compliance data for six chemoprophylactic agents currently recommended by CDC for primary malaria chemoprophylaxis by searching PubMed, Embase, CINAHL, Web of Science, and Scopus for observational studies reporting on travelers within the last 25 years. The quality of data was graded as "good" or "poor" using the NIH quality assessment tool for cohort and cross-sectional studies. Cumulative compliance data were compiled for all studies (gross compliance) and the subgroup of studies with "good" quality evidence (refined compliance). Subgroup analyses were performed for weekly vs daily administered regimens, between military and civilian travelers, and across each prophylactic agent.

Results: Twenty-four eligible studies assessed compliance for mefloquine (n=20), atovaquone-proguanil (n=11), doxycycline (n=13), and chloroquine (n=3). No studies were found for primaquine or tafenoquine. Both gross and refined compliance were significantly better for weekly regimens than daily regimens (P<0.0001). Stopping chemoprophylaxis due to adverse events was significantly more for doxycycline (P<0.0001) compared to other drugs. Compliance was significantly worse in military travelers, but they were also more likely to be prescribed doxycycline.

Conclusion: Malaria chemoprophylaxis for a traveler should depend on prevailing resistance patterns at destination, current national guidelines, and patient preferences. However, when there is a choice, historical compliance data are useful to select a regimen that the traveler is more likely to comply with.

Keywords: atovaquone-proguanil; compliance; doxycycline; malaria; mefloquine; prophylaxis.

Publication types

Review

Grants and funding

CR is supported by an NHMRC (Australia) investigator grant (number: 1173666).