Perceptions of shorter radical cure Plasmodium vivax treatment regimens and their implementation: a qualitative study among stakeholders in Cambodia

BACKGROUND: Plasmodium vivax malaria remains a significant public health concern in the Asia Pacific, the Americas, and the Horn of Africa. Shorter, more effective treatment options for P. vivax malaria, including 7-day-high-dose primaquine and single-dose tafenoquine, are available and now included in global recommendations. However, the implementation of these options requires an understanding of their acceptability to inform implementation strategies and mitigate potential challenges. METHODS: Perceptions of policymakers, healthcare providers, and malaria service recipients regarding 7-day-high-dose primaquine and tafenoquine were explored through qualitative methods (interviews and focus group discussions) in the context of a pre-elimination setting in Cambodia. Data from 142 participants were analysed thematically through deductive and inductive coding and memo writing. RESULTS: Policymakers, programme officials, and healthcare providers identified the need for shorter treatment regimens in view of the low adherence and reduced effectiveness of longer treatment regimens. They attributed added value to these new interventions, associating better quality, increased effectiveness, and a decreased burden on the healthcare workers. For patients, the main purpose and value of shorter treatment options were reduced opportunity costs through faster recovery and being able to return to work sooner. The value attributed was contingent on the treatment options' adverse event profile, with some stakeholders being concerned about patients potentially experiencing more adverse events. However, patients themselves were willing to endure increased adverse events, provided they were for a shorter period and the shortened treatment enabled them to return to work more quickly. Policymakers were supportive but additional confidence-building through evidence generation is likely required. CONCLUSION: Acceptance of 7-day-high-dose primaquine and tafenoquine was high in the pre-elimination context of Cambodia. Based on this study's findings, the uptake of these new treatment options is likely but will require confidence-building through evidence generation for policymakers and enhanced monitoring of adverse events to increase acceptability.