title: Adherence to malaria prophylaxis among Peace Corps Volunteers in the Africa region, 2013.
abstract: BACKGROUND
  Although malaria can be prevented with prophylaxis, it is diagnosed in over 100 Africa-region Peace Corps Volunteers annually. This suggests that prophylaxis non-adherence is a problem in these non-immune travelers.
  
  
  METHODS
  We investigated Volunteers' knowledge, attitudes, and practices regarding prophylaxis using an internet-based survey during August 19-September 30, 2013. Adherence was defined as taking doxycycline or atovaquone-proguanil daily, or taking mefloquine doses no more than 8 days apart.
  
  
  RESULTS
  The survey was sent to 3248 Volunteers. Of 781 whose responses were analyzed, 514 (73%) reported adherence to prophylaxis. The most common reasons for non-adherence were forgetting (n = 530, 90%); fear of long-term adverse effects (LTAEs; n = 316, 54%); and experiencing adverse events that Volunteers attributed to prophylaxis (n = 297, 51%). Two hundred fourteen (27%) Volunteers reported not worrying about malaria. On multivariate analysis controlling for sex and experiencing adverse events Volunteers attributed to prophylaxis, the factor most strongly associated with non-adherence was being prescribed mefloquine (OR 5.4, 95% confidence interval 3.2-9.0).
  
  
  CONCLUSIONS
  We found moderate adherence and a prevailing fear of LTAEs among Volunteers. Strategies to improve prophylaxis adherence may include medication reminders, increasing education about prophylaxis safety and malaria risk, and promoting prompt management of prophylaxis side effects.
authors.affiliation: U.S. Centers for Disease Control and Prevention, Center for Global Health/Malaria Branch, 1600 Clifton Rd NE, MS A06, Atlanta, GA 30333, USA. Electronic address: klandman@gmail.com.
authors.forename: Keren Z
authors.initials: KZ
authors.lastname: Landman
authors.affiliation: U.S. Centers for Disease Control and Prevention, Center for Global Health/Malaria Branch, 1600 Clifton Rd NE, MS A06, Atlanta, GA 30333, USA. Electronic address: ktan@cdc.gov.
authors.forename: Kathrine R
authors.initials: KR
authors.lastname: Tan
authors.affiliation: U.S. Centers for Disease Control and Prevention, Center for Global Health/Malaria Branch, 1600 Clifton Rd NE, MS A06, Atlanta, GA 30333, USA. Electronic address: parguin@cdc.gov.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Arguin
mesh_terms: D000349:Africa; D000962:Antimalarials / Q000627:therapeutic use*; D053626:Atovaquone / Q000009:adverse effects / Q000627:therapeutic use; D003625:Data Collection; D004318:Doxycycline / Q000009:adverse effects / Q000627:therapeutic use; D004338:Drug Combinations; D005260:Female; D006801:Humans; D020407:Internet; D008288:Malaria / Q000517:prevention & control*; D008297:Male; D055118:Medication Adherence; D015767:Mefloquine / Q000009:adverse effects / Q000627:therapeutic use; D054704:Peace Corps; D065129:Pre-Exposure Prophylaxis; D002727:Proguanil / Q000009:adverse effects / Q000627:therapeutic use; D011795:Surveys and Questionnaires; D014481:United States; D014838:Volunteers
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; C109496:atovaquone, proguanil drug combination; D004318:Doxycycline; D002727:Proguanil; D015767:Mefloquine; D053626:Atovaquone
keywords: Malaria chemoprophylaxis; Malaria in long-term travelers; Malaria prevention