Preferences for long-acting injectables for malaria chemoprevention: a survey amongst healthcare providers in six African countries

Chemotherapy for malaria prevention can be compromised by non-adherence, due to frequent dosing and complex drug regimens. A long-acting injectable (LAI) product that requires a single injection providing protection for several months is under development. This study aimed to assess the acceptability and importance of various attributes of a future LAI for malaria prevention from the perspective of the healthcare providers involved in administration of the injection. Face-to-face interviews were conducted across six malaria-endemic countries with healthcare providers (nurses, physicians and health centre managers) who had administered or supervised administration of ≥5 intramuscular (IM) injections in the last month. The mixed-method survey instrument consisted of a discrete choice experiment (DCE) to assess trade-offs between attributes of an LAI specifically for use in prevention of malaria among children 2–10 years of age. Respondents also indicated their preferences for an LAI with a 3-month duration of protection versus oral standard-of-care, and for specific LAI attributes by chemoprevention intervention type (intermittent preventive treatment in pregnancy, intermittent preventive treatment in school-aged children, mass drug administration in children and adults, perennial malaria chemoprevention in children ≤2 years of age, and seasonal malaria chemoprevention in children <5 years of age). Findings were supplemented with open-ended questions to examine stakeholders perceptions of LAIs characteristics. In the DCE, for children 2–10 years of age, duration of protection was the most discriminant attribute (6 or 9 months vs 3 months). Respondents (N = 242) also preferred fewer injections (1 vs 2 injections) and lower volume (0.5 mL vs 1 or 2 mL). There was a strong preference for IM over subcutaneous (SC) administration, with little difference between location of IM administration (deltoid, gluteal or thigh). Across intervention types and age groups, the 3-month LAI was preferred to oral standard of care by 76–86% of respondents. The preferred site of injection varied by intervention, but preference for SC administration was low across all intervention types (2–7%). A median of 2.0 injections per year was considered most acceptable. These findings suggest that an IM-administered LAI with duration of protection of 3 months may be acceptable across chemoprevention intervention types and preferable to orally administered drugs. These insights will inform further product development.