Discussion
malaria illness, malaria, dizziness, VHV, nausea,, hypertension
MALARIA, SIDE EFFECTS, EVENTS, HYPERTENSION, COMPLICATIONS
RDA has the potential to minimize limitations in diagnostic sensitivity, particularly in near elimination settings like Thailand. This qualitative study found that RDA targeting within and around the household and forest-going travellers was generally accepted among the individuals interviewed in border and forest-fringe areas that participated and the HPH staff and VHVs who implemented RDA. Participation in RDA was largely driven by: 1) a fear of contracting malaria; 2) the individual- and community-level prophylactic protection of the malaria medicines; and 3) the increased access to health care from HPH and VHV staff. Implementing RDA was noted to be largely feasible; however, more training for the VHVs, additional malaria personnel and resources, and a transfer of roles for malaria activities from the HPH to the VHV staff to optimize public health operations were perceived important by the study participants interviewed. Study participants highlighted the importance of monitoring the side effects of the malaria medicines for their safety, particularly if underlying health conditions exist. Study participants also noted the need for more community and healthcare provider education (particularly for VHVs) and sensitization related to the purpose of RDA due to concerns raised about being asked to take malaria medicines without having illness.The effectiveness of an intervention such as RDA primarily depends on target population coverage, strong community engagement, and adherence to the full treatment course [Some participants questioned why they were asked to take medicines without signs of malaria illness, while others noted underlying conditions such as hypertension and were worried about contraindications with the medicines. Taking prophylaxis is common practice for immune naïve individuals traveling to areas with known malaria transmission, [In To alleviate safety concerns and increase participant safety, a rigorous pharmacovigilance program will be important. A patient-centered approach focusing on the management of those participating in RDA and any complications or side effects from the medicines to improve the safety of those individuals is critical [Mobile health (mHealth) platforms are increasingly providing evidence that they can improve treatment adherence and support health workers [Side effects experienced from taking the malaria medicines plays an important role in the acceptability of a drug-based intervention. In this study, one-third of participants did not complete the full course of malaria medicines due to side effects, which included dizziness, nausea, vomiting, and weakness, similar to side effects reported from taking anti-malarial medications [There were some limitations of our study. First, recall bias could have affected the quality of the feedback provided by study participants since interviews were conducted at the end of the 12 months long RCT. We tried to mitigate recall bias by conducting the KIIs and FGDs immediately after the RCT ended. Furthermore, study participants were chosen in the two highest burden provinces where most RDA events occurred so they would have more experience conducting or receiving RDA activities. Selection bias may have been introduced by including only key public health staff and household members in study areas who agreed to participate in RDA and in the interviews. Overall, refusals to enroll in the RCT were very low (2.2%), so this may not have much impact on the findings. Additionally, the views and opinions of study participants may not completely reflect all public health staff and/or high-risk populations in the community since this study population was purposively sampled. Due to the COVID-19 pandemic and travel restrictions, interviews were conducted remotely via Despite the limitations, the results from this qualitative study support RDA to be programmatically feasible and acceptable in the communities involved if RDA is found to be an effective strategy to reduce malaria transmission. The RCT study activities were conducted through the national malaria program, including the district health offices, HPHs, and VHVs to ensure that RDA could be replicated if it was deemed acceptable by those participating in it. Further, this study adds to a limited evidence base for the acceptability and feasibility of implementing RDA, and particularly in 