Background
Methods
Research design
Expert panelists
Software, data security and ethical approval
Delphi procedure, data collection and data analysis
First round
Second round
Results
Round 1 | Round 2 | |||
---|---|---|---|---|
N | % | N | % | |
Gender | ||||
Male | 36 | 68% | 31 | 72% |
Female | 17 | 32% | 12 | 28% |
Years of relevant work experience | ||||
5–10 years | 4 | 8% | 4 | 9% |
> 10—20 years | 16 | 30% | 12 | 28% |
> 20 years | 33 | 62% | 27 | 63% |
Affiliationa | ||||
Academic institution | 22 | 42% | 18 | 42% |
Research institution | 10 | 19% | 9 | 21% |
Government agency | 6 | 11% | 6 | 14% |
Non-governmental organization | 12 | 23% | 11 | 26% |
Donor agency | 5 | 9% | 3 | 7% |
UN Agency | 4 | 8% | 4 | 9% |
Private sector | 3 | 6% | 2 | 5% |
Other | 4 | 8% | 4 | 9% |
Area of worka | ||||
Health economics | 3 | 6% | 3 | 7% |
Regulation | 3 | 6% | 2 | 5% |
Market access | 4 | 8% | 3 | 7% |
Malaria treatment | 33 | 62% | 30 | 70% |
Drug development | 10 | 19% | 8 | 19% |
Supply chains | 4 | 8% | 3 | 7% |
Drug resistance research | 24 | 45% | 20 | 47% |
Policy making | 12 | 23% | 9 | 21% |
Other | 7 | 13% | 4 | 9% |
Affiliated to the DeTACTb project | ||||
No | 42 | 79% | 32 | 74% |
Yes | 11 | 21% | 11 | 26% |
Country of residencec | ||||
Australia | 3 | 6% | 2 | 5% |
Bangladesh | 1 | 2% | 1 | 2% |
Belgium | 1 | 2% | 1 | 2% |
Brazil | 1 | 2% | - | - |
Cambodia | 4 | 8% | 4 | 9% |
China | 2 | 4% | 2 | 5% |
France | 1 | 2% | 1 | 2% |
Germany | 1 | 2% | 1 | 2% |
Indonesia | 3 | 6% | 2 | 5% |
Kenya | 1 | 2% | 1 | 2% |
Lao PDR | 2 | 4% | 2 | 5% |
Myanmar | 5 | 9% | 4 | 9% |
Nigeria | 1 | 2% | 1 | 2% |
Philippines | 1 | 2% | - | - |
Portugal | 1 | 2% | 1 | 2% |
Switzerland | 5 | 9% | 5 | 12% |
Thailand | 10 | 19% | 8 | 19% |
UK | 1 | 2% | 1 | 2% |
USA | 8 | 15% | 5 | 12% |
Vietnam | 1 | 2% | 1 | 2% |
First-round results
Advantages | Explanation | N |
---|---|---|
Protecting antimalarial drug compounds | TACTs could protect antimalarial drug compounds by preventing parasites from becoming resistant or attaining higher levels of resistance | 35 |
Improving efficacy | TACTs could provide improved antimalarial efficacy and avoid treatment failure | 34 |
Delaying spread of drug resistance | TACTs could prevent or delay the spread of multidrug resistance both locally and to other regions and continents | 22 |
Less frequent policy shifts | TACTs could require less frequent policy shifts and regulatory procedures, which are both time and resource intensive | 17 |
Consistent communication messages | TACTs could allow consistent communication to health workers and patients in terms of work instructions, training and information dissemination | 16 |
Less logistic disruption | TACTs could result in less frequent logistical and operational disruptions in terms of planning, procurement, import, storage and distribution | 15 |
Accelerating malaria elimination | TACTs could accelerate malaria elimination strategies in Southeast Asia | 11 |
Patient/prescriber preference | TACTs’ three-drug compound regimen could be preferred by health workers and patients over the two-drug compound ACT regimen | 3 |
Reducing pressure on surveillance systems | TACTs could mitigate the pressure of monitoring resistance and drug efficacy levels in areas of resistance | 3 |
Reducing malaria transmission | TACTs could contribute to overall reductions in malaria transmission and infections | 3 |
Scaling up production/cost reduction | TACTs could be profitable for pharmaceutical companies by enabling the scale-up of antimalarial drug production and associated cost reductions | 2 |
Regional solution | TACTs could provide a regional solution instead of a solution that needs to be tailored to individual countries | 2 |
Effectivity on vivax malaria | TACTs could contribute in the battle against vivax and other types of malaria and could provide more time to focus on these other types of malaria | 1 |
Prophylactic effect | TACTs could have a malaria prophylactic effect | 1 |
Reduced pill intake | TACTs could reduce the number of pills and/or the days of treatment compared to current ACTs | 1 |
Disadvantages | Explanation | n |
---|---|---|
More expensive | TACTs could be more expensive than current ACTs | 36 |
Additional side effects | TACTs could cause additional side-effects such as vomiting, fatigue and headache | 25 |
Unavailability of FDC TACTs | TACTs are not yet available in fixed-dose combinations (FDCs) and FDC product-development timelines could be long | 17 |
Losing drug compounds | TACTs could jeopardize the efficacy of current drug compounds and increase the speed of resistance spreading | 14 |
Toxicity/safety risks | TACTs could increase safety risks, (cardio)toxic effects and negative drug-drug interactions | 14 |
Increasing pill burden | TACTs could have an increased pill burden which may increase the risk of non-compliance | 13 |
Implementation time and costs | TACTs rollout and implementation could be time and resource intensive | 11 |
Limited evidence available | TACTs’ safety and efficacy are not yet scientifically proven | 11 |
Small market size | TACTs could be considered unattractive for pharmaceutical companies because of the limited market size for antimalarials in Southeast Asia | 6 |
Limited timeframe for use | TACTs timeframe for use could be too narrow to warrant the investments in the context of increasing drug resistance and receding falciparum malaria | 5 |
Pharmacovigilance requirements | TACTs implementation could require increased investments in pharmacovigilance systems | 3 |
Reducing sense of urgency | TACTs deployment could reduce the sense of urgency in discovering new drug compounds | 2 |
Limited efficacy | TACTs could have limited clinical response when the individual drug compounds are already failing | 1 |
Limiting credibility of ACTs | TACTs deployment in Southeast Asia could reduce the perceived credibility of ACTs elsewhere | 1 |
Multiple TACTs required | TACTs could not be a 'one size fits all' solution, instead multiple TACTs are required because of a variety in drug resistance profiles | 1 |
Implementation barriers | Explanation | n |
---|---|---|
Intensified prescriber training | Intensifying training requirements for correct TACTs prescription | 27 |
Donor funder support | Obtaining support by donor funders to cover TACTs implementation costs and potential price increases | 24 |
National policy support | Obtaining support from national malaria control programs and other national decision makers | 24 |
WHO and global policy support | Obtaining support from the WHO and other global decision makers | 19 |
Availability of fixed-dose combination (FDC) TACTs | Ensuring timely development and production of fixed-dose combination (FDC) for TACTs | 17 |
Community acceptance | Ensuring community acceptance by providing clear communication and tackling potential misconceptions about TACTs | 12 |
Collecting safety and efficacy data | Collecting sufficient efficacy and safety data to support the introduction of TACTs | 11 |
Supply chain logistics | Adapting import, procurement and supply routes for the introduction of TACTs | 11 |
Regulatory approval | Obtaining timely regulatory approval for introducing TACTs in Southeast Asia | 11 |
Set up surveillance systems | Setting up surveillance systems to monitor drug resistance and adherence to TACTs | 9 |
Private sector engagement | Engaging the (informal) private sector in TACTs deployment and creating demand beyond official programs | 5 |
Set up pharmacovigilance systems | Setting up a pharmacovigilance system for TACTs | 4 |
Stockpile management | Managing stockpiles for countries that still have ACT stocks or contract deals with ACT producers | 3 |