Background: Poor adherence to unsupervised 14-day course of primaquine results in poor antirelapse effectiveness. In 2019, community health workers in Papua were trained to monitor adherence through home visits. In 2020, these home visits were replaced by phone calls from study nurses due to the Covid-19 pandemic. We investigated the feasibility and acceptability of the treatment monitoring by phone.
Methods: At five public health clinics, patients prescribed 14-day primaquine were called following a standardized protocol on days 2, 6, and 13 after starting treatment. Feasibility was assessed through a focus group discussion with the nurses responsible for the monitoring; acceptability was assessed through participant observation and informal conversations with purposefully selected patients and community members (N=11).
Results: Between 1st July and 31st December 2020, 9,887 malaria patients were screened, of whom 4265 (43.1%) were prescribed 14-day primaquine (0.25mg/kg). In total 2216 (52.0%) patients provided a phone number, of whom 69.7% (1,545) answered at least one call, and 39.2% (870) answered all three calls. Of the 56.1% (1,243) patients who could be contacted on day 13, 45.3% (563) stated to have 0 tablets remaining, 49.6% (617) had 0.25 to 13 tablets remaining; 25.9% (322) had a single dose remaining and were likely to take it following the call. Calling patients took <2 hours/day. Calls were more likely answered if the phone belonged to the patient or caregiver than to another household member. Patients preferred calls over home visits since i) nurses are regarded a legitimate source of health information, ii) calls could be received while being away from home, and iii) phone calls were perceived to take less time than a home visit.
Conclusion: Phone follow-up to monitor primaquine adherence is feasible and socially acceptable. Further studies are ongoing to quantify the cost effectiveness of the intervention on recurrent malaria.