Acceptability of dihydroartemisinin-piperaquine as malaria intermittent preventive treatment for pregnant women living with HIV in Southern Mozambique

Abstract

Background

HIV-infected pregnant women (HIVPW) are especially susceptible to malaria infection. However, HIVPW cannot receive the recommended malaria Intermittent Preventive Treatment (IPTp) with sulphadoxine-pyrimethamine due to potential adverse reactions with cotrimoxazole, which is given to HIV-infected individuals to prevent opportunistic infections. Within the scope of a clinical trial to evaluate the safety and efficacy of dihydroartemisinin-piperaquine (DHA-PPQ) as IPTp in HIVPW, we aimed to explore pregnant women’s acceptability of DHA-PPQ in the Manhiça District Hospital, Mozambique.

Methods

A qualitative study was conducted from December-2019 to October-2020 including 44 HIVPW participating in the clinical trial, 35 HIV-uninfected pregnant women attending the antenatal care clinic and eight health care providers (HCPs). Information was obtained through semi-structured and in-depth interviews. The interviews were recorded, transcribed, coded, and a combination of content and thematic analysis was performed.

Results

All the HIVPW took monthly doses of DHA-PPQ until delivery. They stated that the main motivation for accepting DHA-PPQ was the belief that guidance from healthcare providers should not be refused. Despite some HIVPW reporting vertigo, vomiting, and malaise after taking DHA-PPQ, they expressed willingness to use it in a future pregnancy, believing it contributed to a healthy outcome. Pregnant women and HCPs indicated that factors supporting DHA-PPQ acceptability include information on the benefits of IPTp, testimonials from women who have previously taken DHA-PPQ, and home delivery of DHA-PPQ by HCPs. The perception that home dispensing of DHA-PPQ (a medication administered only for HIVPW) could affect measures taken to ensure HIV-infection confidentiality was not found to be a potential barrier to DHA-PPQ acceptability when delivered in HIVPW’s homes.

Conclusion

The acceptability of DHA-PPQ among HIVPW appears to be influenced more by trust in healthcare providers rather than by the perceived benefits of the medication itself. Leveraging this trust to enhance awareness and understanding of DHA-PPQ’s benefits could further improve its acceptability. Moreover, further implementation research focused on acceptability in a real-world environment is essential to deepen the understanding of DHA-PPQ acceptability beyond the clinical trial setting, and inform policy decisions accordingly.