Office of Global Health and HIV (OGHH) Office of Overseas Programming & Training Support (OPATS) Health Malaria Case Management and Care Seeking Malaria Training Package

Drugs Currently in Use – ACTs – Artemisinin Combination Therapies – Sulfadoxine-Pyrimthamine – Quinine – Quinolines – Artemisinin Monotherapies

How Does Resistance Work? Wild population of parasites Drug Day 1 Drug Day 2Drug Day 3 If the individual stops taking the drug at this point, the parasite population rebuilds with a greater ratio of mutants Note the small number of naturally occurring (resistant) mutants If the individual takes the full course of drugs, the immune system is able to kill off even the resistant mutants

Drivers of Resistance  Over-prescription  Patients not taking the full dose  Poor-quality medications  Counterfeit medications

RDTs vs. Microscopy RDT Quick Requires little training Can be done in the field Provides a two-week diagnostic window Binary, not quantitative Microscopy Requires a trained microscopist Requires a lab with electricity Provides a point diagnosis Allows for quantitation of the infection

National Treatment Protocol for Community Health Workers  [insert key points for your national protocol here]

Small Group Instructions In the next five minutes, prepare a one-minute response to your assigned situation that includes: 1)Possible negative impacts if the situation continues 2)Your suggested solution 3) How you would explain the negative impacts and possible solution to your CHW to help him or her really understand the strategy. Remember to elect a presenter!

Different Approaches to Treatment  Mass Test and Treat (MTAT)  Mass Screen and Treat (MSAT)  Mass Drug Administration (MDA)  Reactive Case Detection (RACD)  Proactive Case Detection (PACD)  Seasonal Malaria Chemoprevention (SMC)

Administering a Rapid Test 1) Put on gloves 2) Alcohol swab to the finger 3) Use the lancet to pierce the finger and draw blood 4) Carefully put the lancet to the side and cap

Administering a Rapid Test 5) Use paddle to take blood from finger to the RDT 6) Apply reagent to RDT—make sure you read the fine print about the number of drops, as every RDT manufacturer is different 7) Apply Band-Aid 8) Take off gloves without touching the outside (pinch-the-wrist technique)

Care Seeking  Even in communities where there is no financial or access barrier—where malaria treatment is free and available in the village— not all sick individuals seek care; of those that do, not all seek care in a timely fashion.  Why do you think it is that people do not always seek care at the first sign of fever?

 A useful framework for thinking about the impact of groups on an individual’s Intention to Change Socio-Ecological Model: A Framework for community-based programs

The Health Belief Model A useful framework for thinking about the impact of individual psychological factors on an individual’s Intention to Change

Comprehensive Behavior Change Model Social Ecosystem Health Belief Physical Ecosystem Agency INTENTION TO CHANGE ABILITY TO CHANGE HEALTH IMPACT BEHAVIOR CHANGE A useful framework for thinking about how group dynamics interact with psychological factors and the physical environment to influence both an individual’s Intention to Change and his or her Ability to Change

PECADOM+  Describe the PECADOM+ approach and how it was different from the existing PECADOM program.  What were the key elements of the PECADOM+ program?  What type of program is it? (MDA, MSAT, MTAT, SMC, Reactive, Proactive, etc.)  What were the key results?

Not so fast…  If we do sweeps every Friday, what happens to someone who falls sick on Tuesday?  Do they seek care?  Do they wait for the sweep?  Could this be counterproductive?

Comprehensive Behavior Change Model Social Ecosystem Health Belief Physical Ecosystem Agency INTENTION TO CHANGE ABILITY TO CHANGE HEALTH IMPACT BEHAVIOR CHANGE SUSTAINABILITY Feedback loop wherein individuals form habits and visibility of changed behaviors and improved health status reshapes social ecosystems and influences individual health beliefs

Challenges of PECADOM+  What will be most challenging in your community or region?