Women reported positive attitudes toward -SP plus and limited side effects.
Health workers and policymakers expressed concerns about the potential barriers related to additional tablets and a three-day regimen compared to SP alone.
Most women perceived SP plus DP as effective, with many not experiencing malaria or illness during pregnancy.
Participation in the trial provided broader healthcare benefits, encouraging antenatal clinic attendance.
The involvement of health workers and community members positively influenced the perceived acceptability of the IPTp regimen.
Simplified
BACKGROUND: In moderate-to-high malaria transmission regions, the World Health Organization recommends (IPTp) with sulfadoxine-pyrimethamine (SP) alongside insecticide-treated bed nets to reduce the adverse consequences of pregnancy-associated malaria. Due to high-grade Plasmodium falciparum resistance to SP, novel treatment regimens need to be evaluated for IPTp, but these increase pill burden and treatment days. The present qualitative study assessed the acceptability of IPTp-SP plus (DP) in Papua New Guinea, where IPTp-SP was implemented in 2009.
METHODS: Individual in-depth interviews (IDIs) and focus group discussions were conducted at health facilities where a clinical trial evaluated IPTp-SP plus DP (three-day regimen) versus IPTp-SP plus DP-placebo. IDIs were conducted with: (1) trial participants at different stages of engagement with ANC and IPTp, e.g. first antenatal clinic visit, subsequent antenatal clinic visits and postpartum; (2) local health workers (nurses, community health workers, midwives, health extension officers, doctors); and (3) representatives of district, provincial and national health authorities involved in programming ANC and IPTp. Focus group discussions comprised pregnant women only, including those engaged in the clinical trial and those receiving routine ANC outside of the trial. All interviews were audio recorded and transcribed. Transcripts were analysed using inductive and deductive thematic analysis applying a framework assessing: affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness, and self-efficacy.
RESULTS: Women expressed positive feelings and attitudes towards SP plus DP/DP-placebo; reported limited side effects; and found the size, number, colour, and taste of study medicines acceptable. Health workers and policymakers were concerned that, compared to SP alone, additional tablets, frequency (three-day regimen), and tablet size might be barriers to acceptability for users outside a non-trial setting. There was a high perceived effectiveness of SP plus DP; most women reported that they did not get malaria or felt sick during pregnancy. Broader healthcare benefits received through trial participation and the involvement of health workers, relatives and community members in the clinical trial enabled antenatal clinic attendance and perceived acceptability of this IPTp regimen.
CONCLUSIONS: In the trial context, IPTp-SP plus DP was acceptable to both users and providers. Healthcare providers were concerned about the realities of acceptability and adherence to SP plus DP outside a clinical trial setting.
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Declarations. Ethics approval and consent to participate: Ethical approvals for this study were obtained from the Charles Darwin University Human Research Ethics Committee (H22094), the Human Research Committee of the Northern Territory Department of Health and Menzies School of Health Research (2021-4107), the PNG IMR Institutional Review Board (2113), the Madang Provincial Health Authority Research Ethics Committee (04.21), and Medical Research Advisory Committee of PNG National Department of Health (22.10). All participants provided written informed consent for this study. Women involved in the parent trial also provided written informed consent, independent of participation in the clinical trial. Methods used in participants recruitment, data collection, storage, processing, and analysis were carried out according to the Declaration of Helsinki, the Principles of Good Clinical Practice and PNG regulatory guidelines. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.
