Travellers’ adherence to atovaquone/proguanil malaria chemoprophylaxis after return from endemic areas
Background: According to current guidelines, atovaquone/proguanil (AP) malaria chemoprophylaxis is taken once daily during travel, and continued for seven days after return from malaria-endemic areas. However, pharmacokinetic data and studies on drug-sparing AP regimens suggest that AP could possibl...
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Elsevier
2025-03-01
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| Series: | Travel Medicine and Infectious Disease |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1477893925000183 |
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| author | Jenny Lea Schnyder David Cornelis Birkhoff Myrthe Celine Jarings Sabine Margot Hermans Martin Peter Grobusch Hanna Katrien de Jong |
| author_facet | Jenny Lea Schnyder David Cornelis Birkhoff Myrthe Celine Jarings Sabine Margot Hermans Martin Peter Grobusch Hanna Katrien de Jong |
| author_sort | Jenny Lea Schnyder |
| collection | DOAJ |
| description | Background: According to current guidelines, atovaquone/proguanil (AP) malaria chemoprophylaxis is taken once daily during travel, and continued for seven days after return from malaria-endemic areas. However, pharmacokinetic data and studies on drug-sparing AP regimens suggest that AP could possibly be discontinued upon return without loss of protection. Besides being more cost-effective, shorter AP regimens may enhance adherence. We aimed to investigate adherence to the current AP chemoprophylaxis regimen during the seven days post-travel, and travellers’ preferences for potential drug-sparing AP regimens. Methods: In this cross-sectional study, adult travellers, who were prescribed AP chemoprophylaxis during a pre-travel consultation between 01-12-2022 and 01-12-2023 at the Amsterdam UMC travel clinic, were send a post-travel online questionnaire. The primary outcome was the proportion of travellers non-adherent to AP during the seven days post-travel, defined as missing one tablet or more. Secondary outcomes were non-adherence during travel, reasons for non-adherence, and AP regimen preferences. Results: The questionnaire was completed by 62 % (382/614) of contacted travellers. Of the participants, 31 % (117/382) reported non-adherence during the seven days post-travel; during stay this was 16 % (58/382). Frequently reported reasons for non-adherence were: forgetfulness, low self-perceived malaria risk, and adverse effects. An alternative AP regimen discontinuing AP upon return was deemed most appealing and easy to adhere by 73 % (276/376) of participants. Conclusions: Non-adherence was high during the seven days after return. Travellers preferred an alternative AP chemoprophylaxis regimen, allowing them to discontinue upon return. Future research shall be conducted to investigate whether AP could be discontinued upon return. |
| format | Article |
| id | doaj-art-db36e2d50e394ec3b3088e5d73e546af |
| institution | Kabale University |
| issn | 1873-0442 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Travel Medicine and Infectious Disease |
| spelling | doaj-art-db36e2d50e394ec3b3088e5d73e546af2025-02-03T04:16:38ZengElsevierTravel Medicine and Infectious Disease1873-04422025-03-0164102812Travellers’ adherence to atovaquone/proguanil malaria chemoprophylaxis after return from endemic areasJenny Lea Schnyder0David Cornelis Birkhoff1Myrthe Celine Jarings2Sabine Margot Hermans3Martin Peter Grobusch4Hanna Katrien de Jong5Amsterdam UMC, Location University of Amsterdam, Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Public Health – Global Health, and Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam, the NetherlandsAmsterdam UMC, Location University of Amsterdam, Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Public Health – Global Health, and Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam, the NetherlandsAmsterdam UMC, Location University of Amsterdam, Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Public Health – Global Health, and Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam, the NetherlandsAmsterdam UMC, Location University of Amsterdam, Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Public Health – Global Health, and Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam, the Netherlands; Amsterdam UMC, Location University of Amsterdam, Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the NetherlandsAmsterdam UMC, Location University of Amsterdam, Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Public Health – Global Health, and Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam, the Netherlands; Masanga Medical Research Unit (MMRU), Masanga, Sierra Leone; Institute of Tropical Medicine, German Centre for Infection Research (DZIF), University of Tübingen, Tübingen, Germany; Centre de Recherches Médicales en Lambaréné (CERMEL), Lambaréné, Gabon; Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South AfricaAmsterdam UMC, Location University of Amsterdam, Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Public Health – Global Health, and Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam, the Netherlands; Corresponding author. Amsterdam UMC, location University of Amsterdam, Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.Background: According to current guidelines, atovaquone/proguanil (AP) malaria chemoprophylaxis is taken once daily during travel, and continued for seven days after return from malaria-endemic areas. However, pharmacokinetic data and studies on drug-sparing AP regimens suggest that AP could possibly be discontinued upon return without loss of protection. Besides being more cost-effective, shorter AP regimens may enhance adherence. We aimed to investigate adherence to the current AP chemoprophylaxis regimen during the seven days post-travel, and travellers’ preferences for potential drug-sparing AP regimens. Methods: In this cross-sectional study, adult travellers, who were prescribed AP chemoprophylaxis during a pre-travel consultation between 01-12-2022 and 01-12-2023 at the Amsterdam UMC travel clinic, were send a post-travel online questionnaire. The primary outcome was the proportion of travellers non-adherent to AP during the seven days post-travel, defined as missing one tablet or more. Secondary outcomes were non-adherence during travel, reasons for non-adherence, and AP regimen preferences. Results: The questionnaire was completed by 62 % (382/614) of contacted travellers. Of the participants, 31 % (117/382) reported non-adherence during the seven days post-travel; during stay this was 16 % (58/382). Frequently reported reasons for non-adherence were: forgetfulness, low self-perceived malaria risk, and adverse effects. An alternative AP regimen discontinuing AP upon return was deemed most appealing and easy to adhere by 73 % (276/376) of participants. Conclusions: Non-adherence was high during the seven days after return. Travellers preferred an alternative AP chemoprophylaxis regimen, allowing them to discontinue upon return. Future research shall be conducted to investigate whether AP could be discontinued upon return.http://www.sciencedirect.com/science/article/pii/S1477893925000183MalariaMedication adherenceAtovaquone-proguanilMalaroneAntimalarialsChemoprophylaxis |
| spellingShingle | Jenny Lea Schnyder David Cornelis Birkhoff Myrthe Celine Jarings Sabine Margot Hermans Martin Peter Grobusch Hanna Katrien de Jong Travellers’ adherence to atovaquone/proguanil malaria chemoprophylaxis after return from endemic areas Travel Medicine and Infectious Disease Malaria Medication adherence Atovaquone-proguanil Malarone Antimalarials Chemoprophylaxis |
| title | Travellers’ adherence to atovaquone/proguanil malaria chemoprophylaxis after return from endemic areas |
| title_full | Travellers’ adherence to atovaquone/proguanil malaria chemoprophylaxis after return from endemic areas |
| title_fullStr | Travellers’ adherence to atovaquone/proguanil malaria chemoprophylaxis after return from endemic areas |
| title_full_unstemmed | Travellers’ adherence to atovaquone/proguanil malaria chemoprophylaxis after return from endemic areas |
| title_short | Travellers’ adherence to atovaquone/proguanil malaria chemoprophylaxis after return from endemic areas |
| title_sort | travellers adherence to atovaquone proguanil malaria chemoprophylaxis after return from endemic areas |
| topic | Malaria Medication adherence Atovaquone-proguanil Malarone Antimalarials Chemoprophylaxis |
| url | http://www.sciencedirect.com/science/article/pii/S1477893925000183 |
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