Implementation of a novel malaria management strategy based on self-testing and self-treatment in remote areas in the Amazon (Malakit): confronting a-priori assumptions with reality

Muriel Suzanne Galindo, Yann Lambert, Louise Mutricy, Laure Garancher, Jane Bordalo Miller, José Hermenegildo Gomes, Alice Sanna, Cassio Peterka, Hedley Cairo, Helene Hiwat, Antoine Adenis, Mathieu Nacher, Martha Cecilia Suárez-Mutis, Stephen Vreden, Maylis Douine, Muriel Suzanne Galindo, Yann Lambert, Louise Mutricy, Laure Garancher, Jane Bordalo Miller, José Hermenegildo Gomes, Alice Sanna, Cassio Peterka, Hedley Cairo, Helene Hiwat, Antoine Adenis, Mathieu Nacher, Martha Cecilia Suárez-Mutis, Stephen Vreden, Maylis Douine

Abstract

Background: A novel strategy to combat malaria was tested using a methodology adapted to a complex setting in the Amazon region and a hard-to-reach, mobile community. The intervention strategy tested was the distribution, after training, of malaria self-management kits to gold miners who cross the Surinamese and Brazilian borders with French Guiana to work illegally in the remote mining sites in the forest of this French overseas entity.

Main text: This article aims at presenting all process and implementation outcomes following the Conceptual Framework of Implementation Fidelity i.e. adherence, including content and exposure, and moderators, comprising participant responsiveness, quality of delivery, facilitation strategies, and context. The information sources are the post-intervention survey, data collected longitudinally during the intervention, a qualitative study, data collected during an outreach mission to a remote gold mining site, supervisory visit reports, in-depth feedback from the project implementers, and videos self-recorded by facilitators based on opened ended questions. As expected, being part of or close to the study community was an essential condition to enable deliverers, referred to as "facilitators", to overcome the usual wariness of this gold mining population. Overall, the content of the intervention was in line with what was planned. With an estimated one third of the population reached, exposure was satisfactory considering the challenging context, but improvable by increasing ad hoc off-site distribution according to needs. Participant responsiveness was the main strength of the intervention, but could be enhanced by reducing the duration of the process to get a kit, which could be disincentive in some places. Regarding the quality of delivery, the main issue was the excess of information provided to participants rather than a lack of information, but this was corrected over time. The expected decrease in malaria incidence became a source of reduced interest in the kit. Expanding the scope of facilitators' responsibilities could be a suitable response. Better articulation with existing malaria management services is recommended to ensure sustainability.

Conclusions: These findings supplement the evaluation outcomes for assessing the relevance of the strategy and provide useful information to perpetuate and transfer it in comparable contexts.

Trial registration: ClinicalTrials.gov. NCT03695770 . 10/02/2018 "Retrospectively registered".

Keywords: Border malaria; Implementation outcomes; Mining population; Process evaluation; Remote health.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Logic model of the Malakit intervention before the start of the Malakit study [–, , –, –31, 35, 36]. Source: created by the authors
Fig. 2
Fig. 2
Principle of the Malakit intervention in Suriname and Brazil (April 2018-March 2020). Source: created by the authors
Fig. 3
Fig. 3
Map of the distribution sites of the Malakit intervention in Suriname and Brazil (April 2018-March 2020). Source: created by the authors
Fig. 4
Fig. 4
Poster illustrating the effect of the ACT on the malaria over time and the mechanism of resistance, material used during the training of participants of the Malakit intervention in Suriname and Brazil (April 2018-March 2020). Source: created by the authors

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