title: Exploring provider and community responses to the new malaria diagnostic and treatment regime in Solomon Islands.
abstract: BACKGROUND
  Improvements in availability and accessibility of artemisinin-based combination therapy (ACT) for malaria treatment and the emergence of multi-drug-resistant parasites have prompted many countries to adopt ACT as the first-line drug. In 2009, Solomon Islands (SI) likewise implemented new national treatment guidelines for malaria. The ACT, Coartem® (artemether-lumefantrine) is now the primary pharmacotherapy in SI for Plasmodium falciparum malaria, Plasmodium vivax malaria or mixed infections. Targeted treatment is also recommended in the new treatment regime through maintenance of quality microscopy services and the introduction of Rapid Diagnostic Tests (RDTs). Ascertaining the factors that influence community and provider acceptance of and adherence to the new treatment regime will be vital to improving the effectiveness of this intervention and reducing the risk of development of drug resistance.
  
  
  METHODS
  In order to understand community and prescriber perceptions and acceptability of the new diagnostic and treatment interventions, 12 focus group discussions (FGDs) and 12 key informant interviews (KII) were carried out in rural and urban villages of Malaita Province, Solomon Islands four months subsequent to roll out of these interventions.
  
  
  RESULTS
  Lack of access to microscopy or distrust in the accuracy of diagnostic tools were reported by some participants as reasons for the ongoing practice of presumptive treatment of malaria. Lack of confidence in RDT accuracy has negatively impacted its acceptability. Coartem® had good acceptability among most participants, however, some rural participants questioned its effectiveness due to lack of side effects and the larger quantity of tablets required to be taken. Storing of left over medication for subsequent fever episodes was reported as common.
  
  
  CONCLUSIONS
  To address these issues, further training and supportive supervision of healthcare workers will be essential, as will the engagement of influential community members in health promotion activities to improve acceptability of RDTs and adherence to the new treatment regime. Exploring the extent of these issues beyond the study population must be a priority for malaria programme managers. Practices such as presumptive treatment and the taking of sub-curative doses are of considerable concern for both the health of individuals and the increased risk it poses to the development of parasite resistance to this important first-line treatment against malaria.
authors.affiliation: The University of Queensland, School of Population Health, Pacific Malaria Initiative Support Centre, Australian Centre for International and Tropical Health, Brisbane, Australia. r.wijesinghe@uq.edu.au
authors.forename: Rushika S
authors.initials: RS
authors.lastname: Wijesinghe
authors.forename: Jo-An M
authors.initials: JA
authors.lastname: Atkinson
authors.forename: Albino
authors.initials: A
authors.lastname: Bobogare
authors.forename: Lyndes
authors.initials: L
authors.lastname: Wini
authors.forename: Maxine
authors.initials: M
authors.lastname: Whittaker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000962:Antimalarials / Q000627:therapeutic use; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000627:therapeutic use*; D002648:Child; D004338:Drug Combinations; D004983:Ethanolamines / Q000627:therapeutic use*; D005260:Female; D005449:Fluorenes / Q000627:therapeutic use*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D016778:Malaria, Falciparum / Q000175:diagnosis* / Q000188:drug therapy*; D016780:Malaria, Vivax / Q000175:diagnosis* / Q000188:drug therapy*; D008297:Male; D008542:Melanesia; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012424:Rural Population; D014505:Urban Population; D055815:Young Adult
chemical_list: D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes