Community engagement among forest goers in a malaria prophylaxis trial: implementation challenges and implications

Area of Science:

• Clinical Trials and Public Health
• Tropical Medicine and Infectious Diseases

Background:

• Malaria transmission in Southeast Asia is increasingly concentrated in forest environments.
• Marginalized forest-going populations face significant exposure risks.
• Anti-malarial chemoprophylaxis is a potential protective measure for these groups.

Purpose of the Study:

• To evaluate the effectiveness of engaging forest-goers in a randomized controlled trial (RCT).
• To assess the practical challenges of implementing anti-malarial chemoprophylaxis in this population.
• To compare artemether-lumefantrine (AL) versus multivitamin (MV) prophylaxis.

Main Methods:

• Assessed engagement through trial participation rates (enrolment, compliance, drug intake).
• Recorded details of engagement meetings, participant feedback, and decision-making processes.
• Documented implementation challenges and strategies.

Main Results:

• High trial enrolment (92%) and completion (84%) rates were achieved.
• Artemether-lumefantrine (AL) was associated with higher drug discontinuation (7% vs 3%) compared to multivitamin (MV).
• Females and individuals without prior malaria history were more likely to discontinue drugs.
• A participatory engagement strategy involving local stakeholders and tailored communication was crucial.

Conclusions:

• A comprehensive, participatory engagement strategy successfully mobilized stakeholders and built trust.
• This locally-adapted approach overcame ethical and practical challenges, leading to high trial enrolment and adherence.
• The strategy demonstrated effectiveness in engaging marginalized forest-going populations in malaria prevention research.