Adherence to 7-day primaquine treatment for the radical cure of P. vivax in the Peruvian Amazon

Koen Peeters Grietens, Veronica Soto, Annette Erhart, Joan Muela Ribera, Elizabeth Toomer, Alex Tenorio, Tanilu Grande Montalvo, Hugo Rodriguez, Alejandro Llanos Cuentas, Umberto D'Alessandro, Dionicia Gamboa, Koen Peeters Grietens, Veronica Soto, Annette Erhart, Joan Muela Ribera, Elizabeth Toomer, Alex Tenorio, Tanilu Grande Montalvo, Hugo Rodriguez, Alejandro Llanos Cuentas, Umberto D'Alessandro, Dionicia Gamboa

Abstract

Despite being free of charge, treatment adherence to 7-day primaquine for the radical cure of Plasmodium vivax was estimated at 62.2% among patients along the Iquitos-Nauta road in the Peruvian Amazon. The principal reason for non-adherence was the perceived adverse effects related to local humoral illness conceptions that hold that malaria produces a hot state of body, which is further aggravated by the characteristically hot medical treatment. Notably, patients were willing to adhere to the first 3 days of treatment during which symptoms are most apparent and include the characteristic chills. Nevertheless, as symptoms abate, the perceived aggravating characteristics of the medication outweigh the perceived advantages of treatment adherence. Improving community awareness about the role of primaquine to prevent further malaria transmission and fostering a realistic system of direct observed treatment intake, organized at community level, can be expected to improve adherence to the radical cure of P. vivax in this area.

Figures

Figure 1.
Figure 1.
Map of the study area. This figure appears in color at www.ajtmh.org.
Figure 2.
Figure 2.
Schematic presentation of humoral illness and treatment conceptions.

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