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Scientific title: Qualitative study to understand perceptions of malaria and malaria treatment amongst HIV positive individuals enrolled in an antimalarial drug trial in Muheza, Tanzania

What did we know before this research?

In many malaria-endemic countries HIV/AIDS continues to spread, therefore an increasing number of patients need treatment for both infections at the same time.

The WHO and ministries of health in many endemic countries recommend the use of artemisinin-based combination therapy (ACT) for malaria and antiretroviral combination treatments (ART) for HIV/AIDS.

Such treatments have become increasingly available and research is being conducted into the clinical implications of taking ACT and ART concomitantly.

What does this study add?
Thus far, social science research has focused either on people’s perceptions and experiences of HIV and antiretroviral drugs, or of malaria and antimalarial drugs. A gap remains in knowledge of how HIV-positive people understand and experience malaria and its treatment, as well as how these may affect their behaviour to prevent and seek treatment.

Understanding these perceptions better will help identify ways to improve the management of cases of HIV and malaria co-infection.

This is a qualitative study with participants of the InterACT trial, other HIV-positive people and members of trial and hospital staff. The aim of the study is to explore their perceptions of taking malaria treatment at the same time as anti-retroviral therapy (ART) for HIV infection. We also explored how participants experienced and understood their engagement in the InterACT trial.

The research team
Principal Investigators:

Dr. Lasse Vestergaard, University of Copenhagen

Dr Clare Chandler, London School of Hygiene & Tropical Medicine

Dr. Martha Lemnge, Director, National Institute of Medical Research, Tanga Centre, Tanga, Tanzania
Other Investigators

Dr. Peter Mangesho, National Institute of Medical Research, Amani Centre, Muheza, Tanzania
Ms Joanna Reynolds, London School of Hygiene & Tropical Medicine

Latest on this research
The study is now complete. Key findings include that HIV-positive people saw malaria as potentially more harmful to them due to their HIV status. However, this did not seem to translate into an increased effort to prevent malaria, as the disease was often seen as ‘unavoidable’.

Our results suggest that health workers’ advice may play an important role in encouraging patients to take both malaria and HIV treatment simultaneously. Overall, patients felt that taking antimalarial and antiretroviral treatment at the same time was unproblematic and generally reported a high adherence to medication. Nevertheless, some patients perceived the combined treatment as too strong and said that they took the different drugs at different times to avoid harm to the body.

We have found that the social and material dynamics of the trial may have influenced participants’ attitudes towards taking both treatments simultaneously. They perceived the trial as a ‘project’ that provided enhanced care to those participating.

Overall, this study indicates that the dynamics between health workers, patients and broader social and economic conditions influence patients’ perceptions of taking treatment for both HIV and malaria at the same time, as well as adherence to treatment regimes. Further support is needed to help HIV-positive people manage the perceived risks around contracting malaria and encourage them to prevent malaria infection. Managing cases of co-infection may also be improved if health workers communicate better with patients about the instructions to take treatment in the context of their daily lives.

In 2012 the research team held several dissemination and discussion events with hospital staff, trial staff and local researchers in Tanga region.