How Patients Take Malaria Treatment: A Systematic Review of the Literature on Adherence to Antimalarial Drugs

BackgroundHigh levels of patient adherence to antimalarial treatment are important in ensuring drug effectiveness. To achieve this goal, it is important to understand levels of patient adherence, and the range of study designs and methodological challenges involved in measuring adherence and interpreting results. Since antimalarial adherence was reviewed in 2004, there has been a major expansion in the use of artemisinin-based combination therapies (ACTs) in the public sector, as well as initiatives to make them more widely accessible through community health workers and private retailers. These changes and the large number of recent adherence studies raise the need for an updated review on this topic.ObjectiveWe conducted a systematic review of studies reporting quantitative results on patient adherence to antimalarials obtained for treatment.ResultsThe 55 studies identified reported extensive variation in patient adherence to antimalarials, with many studies reporting very high adherence (90–100%) and others finding adherence of less than 50%. We identified five overarching approaches to assessing adherence based on the definition of adherence and the methods used to measure it. Overall, there was no clear pattern in adherence results by approach. However, adherence tended to be higher among studies where informed consent was collected at the time of obtaining the drug, where patient consultations were directly observed by research staff, and where a diagnostic test was obtained.ConclusionVariations in reported adherence may reflect factors related to patient characteristics and the nature of their consultation with the provider, as well as methodological variations such as interaction between the research team and patients before and during the treatment. Future studies can benefit from an awareness of the impact of study procedures on adherence outcomes, and the identification of improved measurement methods less dependent on self-report.**背景** 患者对抗疟治疗的高依从性对于保障药物疗效至关重要。为达成这一目标，明晰患者依从性水平，以及抗疟依从性测量与结果解读中涉及的各类研究设计与方法论挑战，均具有重要意义。自2004年抗疟依从性相关综述发表以来，公共部门对青蒿素联合疗法（artemisinin-based combination therapies, ACTs）的使用规模大幅扩张，同时也推出了通过社区卫生工作者与私营零售商更广泛推广该疗法的相关举措。这些变化以及近年大量涌现的依从性相关研究，凸显了对该主题开展更新版综述的必要性。 **研究目标** 本研究针对报告了治疗用抗疟药患者依从性定量结果的相关研究开展系统综述。 **研究结果** 纳入的55项研究显示，患者对抗疟药的依从性存在显著差异：多项研究报告了极高的依从性（90%~100%），另有部分研究发现依从性不足50%。基于依从性的定义与测量方法，本研究归纳出5大类核心的依从性评估路径。总体而言，不同评估路径下的依从性结果并未呈现明确的统一规律。但在以下几类研究中，患者依从性往往更高：在领取药物时已获取知情同意的研究、由研究人员直接观察患者问诊过程的研究，以及开展了诊断检测的研究。 **研究结论** 报告中依从性的差异，可能反映了与患者特征、患者与医疗服务提供者的问诊性质相关的因素，也可能源于方法论层面的差异，例如研究团队在治疗前及治疗期间与患者的互动方式等。未来的研究若能意识到研究流程对依从性结果的影响，并开发出更少依赖自我报告的优化测量方法，将有助于提升相关研究的质量。