在布基纳法索和尼日利亚部署三药联合疗法治疗疟疾的伦理考虑：利益攸关方观点分析。
Ethical considerations in deploying triple artemisinin-based combination therapies for malaria: An analysis of stakeholders' perspectives in Burkina Faso and Nigeria.
机构信息
Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana.
Institut de Recherche en Sciences de la Sante, Bobo-Dioulasso, Burkina Faso.
出版信息
PLoS One. 2022 Sep 9;17(9):e0273249. doi: 10.1371/journal.pone.0273249. eCollection 2022.
BACKGROUND
Artemisinin-based combination therapies (ACTs) are the recommended treatment for uncomplicated Plasmodium falciparum malaria in all malaria endemic countries. Artemisinin resistance, partner drug resistance, and subsequent ACT failure are widespread in Southeast Asia. The more recent independent emergence of artemisinin resistance in Africa is alarming. In response, triple artemisinin-based combination therapies (TACTs) are being developed to mitigate the risks associated with increasing drug resistance. Since ACTs are still effective in Africa, where malaria is mainly a paediatric disease, the potential deployment of TACTs raises important ethical questions. This paper presents an analysis of stakeholders' perspectives regarding key ethical considerations to be considered in the deployment of TACTs in Africa provided they are found to be safe, well-tolerated and effective for the treatment of uncomplicated malaria.
METHODS
We conducted a qualitative study in Burkina Faso and Nigeria assessing stakeholders' (policy makers, suppliers and end-users) perspectives on ethical issues regarding the potential future deployment of TACTs through 68 in-depth interviews and 11 focus group discussions.
FINDINGS
Some respondents suggested that there should be evidence of local artemisinin resistance before they consider deploying TACTs, while others suggested that TACTs should be deployed to protect the efficacy of current ACTs. Respondents suggested that additional side effects of TACTs compared to ACTs should be minimal and the cost of TACTs to end-users should not be higher than the cost of current ACTs. There was some disagreement among respondents regarding whether patients should have a choice of treatment options between ACTs and TACTs or only have TACTs available, while ACTs are still effective. The study also suggests that community, public and stakeholder engagement activities are essential to support the introduction and effective uptake of TACTs.
CONCLUSION
Addressing ethical issues regarding TACTs and engaging early with stakeholders will be important for their potential deployment in Africa.
背景
在所有疟疾流行国家，青蒿素为基础的联合疗法（ACTs）是治疗无并发症恶性疟原虫疟疾的推荐疗法。青蒿素耐药性、联合用药耐药性以及随后的 ACT 失败在东南亚广泛存在。最近，非洲青蒿素耐药性的独立出现令人震惊。为应对这一情况，正在开发三药青蒿素为基础的联合疗法（TACTs）以降低与耐药性增加相关的风险。由于 ACTs 在疟疾主要为儿科疾病的非洲仍然有效，因此 TACTs 的潜在部署引发了重要的伦理问题。本文介绍了利益攸关方对在非洲部署 TACTs 时需要考虑的关键伦理问题的观点，前提是 TACTs 被发现对治疗无并发症疟疾安全、耐受良好且有效。
方法
我们在布基纳法索和尼日利亚进行了一项定性研究，通过 68 次深入访谈和 11 次焦点小组讨论，评估了利益攸关方（决策者、供应商和最终用户）对 TACTs 未来潜在部署的伦理问题的看法。
结果
一些受访者表示，在考虑部署 TACTs 之前，应该有当地青蒿素耐药性的证据，而另一些受访者则表示，应该部署 TACTs 以保护当前 ACTs 的疗效。受访者认为，与 ACTs 相比，TACTs 的额外副作用应该最小，而最终用户使用 TACTs 的成本不应高于当前 ACTs。受访者对患者在 ACTs 仍然有效的情况下是否应该有选择 ACTs 和 TACTs 之间的治疗方案的选择，或者只能使用 TACTs 存在一些分歧。该研究还表明，社区、公众和利益攸关方的参与活动对于支持 TACTs 的引入和有效采用至关重要。
结论
解决 TACTs 的伦理问题并尽早与利益攸关方接触，对于 TACTs 在非洲的潜在部署将是重要的。
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