Low-Dose Prophylaxis in Haemophilia: Experiences and Lessons From Resource-Limited Countries in Asia and Africa

In resource-limited settings, implementing standard-dose prophylaxis for haemophilia remains challenging due to high treatment costs, limited access to clotting factor concentrates and incomplete insurance coverage. To overcome these barriers, low-dose prophylaxis (LDP) has emerged as a practical and cost-effective approach to reduce bleeding frequency and prevent long-term joint damage. This paper compares the implementation and outcomes of LDP programmes across five countries-Thailand, Indonesia, Malaysia, Vietnam and Senegal-representing diverse healthcare and socioeconomic contexts. In these nations, LDP consistently lowered annual bleeding rates (ABRs) and annual joint bleeding rates (AJBRs) by 70%-90%, improved joint health (HJHS) and enhanced quality of life (HRQoL). Vietnam and Malaysia incorporated LDP into national guidelines and combined it with extended half-life (EHL) factor concentrates and emicizumab. Thailand moved toward pharmacokinetic-guided, individualised prophylaxis, while Indonesia focused on a nationwide paediatric rollout. Senegal demonstrated the feasibility of LDP in sub-Saharan Africa through the World Federation of Hemophilia (WFH) Humanitarian Aid Program. These experiences confirm that low-dose and hybrid prophylaxis models-supported by adaptive policies and humanitarian partnerships-provide sustainable, equitable solutions for haemophilia care in low- and middle-income countries, bridging the gap between on-demand therapy and full individualised prophylaxis.