REGIONAL VIVAX RADICAL CURE COUNSELING GUIDE
The purpose of this regional guide is to equip National Malaria Program (NMP) and Civil Society Organization (CSO) leaders across the Greater Mekong Subregion to use best practices related to community level counseling to promote vivax radical cure malaria treatment adherence and care for side effects among patients diagnosed with vivax. This guide is designed to be used by NMP and CSOs managing community level health workers to complement training tools already in use. For this reason, the regional guide does not cover all aspects of malaria messaging or go into depth regarding interpersonal counseling best practices, as it is understood that these components are covered by routine trainings involved in elimination programming. As a regional guide, material presented in these slides is designed to be tailored by NMP and CSO partners, considering local guidelines and insights from local communities at risk of vivax malaria, before integrating into trainings, post-training supervision tools and job aides targeting outreach workers affiliated with the public health system and CSO networks as well as community pharmacists involved in elimination.
The regional vivax radical cure counseling guide is designed as an adaptable template that National Malaria Program and CSO partners can tailor considering national guidelines and local community needs and preferences. The CSO Platform encourages partners to adapt, translate and field test mock-up counseling materials included in this regional guide as needed for their local context. Highlighted sections are important for local adaptation before using the guide to ensure consistency with national guidelines and community insights. To save partners time and resources, we offer illustrated answers to frequently asked questions about vivax as well as counseling tips to promote adherence and care for side effects—content has been designed to be an easy, open-access guide to feed into locally-specific tools.
How to use this guide
Vivax radical cure counseling at community level
This regional guide includes three sections:
Answering Frequently Asked Questions (FAQ)
Motivating Radical Cure Treatment Adherence
Motivating Care for Side Effects
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2
3
Health
Facility
But first a few tips to help community health workers show empathy during counseling:
LISTEN & REFLECT
REINFORCE MOTIVATION
When counseling a vivax patient use ”you” or other personalized statements to emphasize what you hear. For example, you might say:
“Let me see if I understand. You want to start treatment, but you are worried this may limit your ability to work. Is that right?”
Emphasize the positive, recognize the value of your patient’s perspective. Support and encourage! For example, you might say:
“I appreciate you for being honest about the challenges you are facing taking your vivax radical cure medication. I believe you can overcome these with support”
ASK QUESTIONS
Use open-ended questions to better understand the patient’s perspective. For example:
“What makes it difficult to take your meds everyday?”
“How can we support you to overcome those difficulties?”
Answering FAQ about vivax malaria�The following slides include questions (Q) and answers (A) to issues frequently raised at community level.
Q1: What is vivax malaria?
A1: Vivax malaria is caused by a protozoal parasite.
Clearing the parasite from the liver is the only way to prevent relapses.
This is why it is so important to help every client diagnosed with vivax malaria to complete the full radical cure treatment.
For more information about vivax transmission, diagnosis and treatment, refer to national guidelines in your country.
Q2: How do I help people in my community complete radical cure for vivax malaria?
A2: TEST BEFORE�TREATMENT
Clients who self-treat before vivax diagnosis and G6PD testing from a trained health worker are at risk for
serious health complications which also may bring other hardships for them and their family.
It is much better to visit a health facility for diagnosis before treatment to avoid relapse and other serious health complications.
A2 Continued: After someone tests positive for vivax using a rapid test, they need to be screened for “Glucose-6-phosphate dehydrogenase deficiency” also known as G6PD deficiency before they can start treatment.
G6PD deficiency is a genetic condition that happens when the body does not produce enough G6PD to help blood cells work optimally.
You can help community members understand why G6PD deficiency testing is needed before they start radical cure treatment by explaining that a different treatment regimen is needed in cases of G6PD deficiency.
Rapid test
Treatment according to national guidelines
Vivax diagnosis
G6PD deficiency testing
Q3: How should vivax radical cure treatment be taken?
Together with food
On an empty stomach
or
A3: Taking radical cure treatment together with a snack or meal�can help reduce stomach irritation. Eating something like a piece of fruit or a small bowl of rice together with medicine is recommended.
Q4: Is vivax radical cure treatment safe for everyone?
A4: As long as patients are not G6PD deficient, vivax radical cure treatment is recommended for all adults and children older than five years of age. (update according to national guidelines.)
For G6PD deficient patients, pregnant women and children younger than 5 years, a different treatment regimen will be recommended by a trained provider at the nearest health facility.
It is important to encourage every patient to have their G6PD level tested before starting vivax radical cure treatment.
Q5: As soon as a vivax patient feels completely healthy can they stop taking medication after a few days?
A5: It is critical that all
of radical cure treatment are completed - even if someone feels better before completing of treatment. Update based on national guidelines.
Completing 7 days of treatment is the only way to completely cure the parasite that causes vivax. With full cure your patient will be relieved knowing that vivax malaria will not cause more serious, longer-term health or other hardships.
7 days
7 days
Q6: What to do if your patient forgets to take 1 or 2 days of vivax radical cure treatment?
A6: To be added based on national guidelines.
ENCOURAGING VIVAX RADICAL CURE TREATMENT ADHERENCE
HOW TO EXPLAIN WHY IT IS IMPORTANT THAT PATIENTS COMPLETE VIVAX RADICAL CURE TREATMENT
The only way a person can clear the parasites that cause vivax malaria from their body is to complete the full recommended treatment course. In your country, the recommended treatment for vivax is
This is why it is critical that you help patients diagnosed with vivax complete the full 7 days of radical cure treatment.
7 days of low dose primaquine
If a patient only takes part of the recommended course, the vivax parasites can stay hidden in their liver and enter their blood several months later.
This can cause serious, prolonged health risks and financial challenges for families.
TIPS TO HELP PATIENTS REMEMBER TO COMPLETE VIVAX TREATMENT
What is something your client does every day?
For example: eat breakfast/dinner, brush teeth, watch/listen to a daily news/entertainment, etc.
Is it possible to place a string or another visual reminder close to the place where the patient eats or brushes teeth as a visual reminder to take daily medication?
If using a smartphone, you can help your client schedule an automated reminder
WHO CAN HELP PATIENT REMEMBER TO COMPLETE VIVAX RADICAL CURE TREATMENT?
To be updated according to national guidelines and local context
Who will the patient see every day for the next 7 days? Family, neighbors, others s/he goes to the forest with?
Does the patient need/want help asking for help remembering to complete treatment?
How can you help plan reminders and support from family or others in the community?
ASK….”WHAT THINGS MIGHT PREVENT YOU FROM COMPLETING YOUR TREATMENT?”
“How can we plan to address these risks, to help you recover fully from vivax so that you can enjoy life without worry about recurring vivax malaria?”
What will you do if you travel (to the forest, to another town) in the next 7 days?
Can we talk about a way for you to remember to pack your medication? Probe: specific plan for ensuring medicine is placed in the bag/something s/he will travel with.
HOW TO HELP PATIENTS OVERCOME CHALLENGES TO TREATMENT ADHERENCE?
FOLLOW-UP VISIT COUNSELING TIPS TO OVERCOME COMMON BARRIERS TO ADHERENCE ON
BARRIERS | PROBING QUESTIONS TO ASSESS BARRIERS |
Knowledge gap | Can you tell me the name/s of your vivax medicine? What is your schedule/plan to take your medicine (e.g., what time of day, how many pills each day and for how many days)? |
Side effects | Do you understand what to do if you experience side effects? Probe: contact outreach worker or visit health facility vs stop treatment without medical advice. |
Forgot | Have you missed any days of treatment since you started treatment? Ask to see medicine and count pills vs days. What is your plan to ensure you complete treatment going forward? |
Felt better | What do you think the benefits of completing recommended full dose of primaquine is, even if you feel better/well before you complete treatment? |
DAYS 1-7
BARRIERS | PROBING QUESTIONS TO ASSESS BARRIERS |
Travel | Is it possible that travel might make it difficult for you to finish treatment? How can you ensure that you remember to take the full treatment even if/when you travel? |
Substance use | Do you use alcohol? Do you feel this may affect your ability to remember to take your medicine? Do you think you could abstain until you complete your vivax treatment? What other solution can we find? |
Depression | How is your mood? Have you been feeling sad or confused? Would you like to talk about your feelings with me or someone else you trust? Can we talk about how to help you complete your treatment even on days when you feel low? |
Perceived benefits | What do you see as the benefits to completing treatment for –for you individually? |
FOLLOW-UP VISIT COUNSELING TIPS TO OVERCOME COMMON BARRIERS TO ADHERENCE ON
DAYS 1-7
ADHERENCE COUNSELING TIPS
DAYS 1 & 3
BARRIERS
PROBING QUESTIONS TO ASSESS BARRIERS
Knowledge gap
Can you tell me what your vivax radical cure medicine looks like (color, tablet size)? What is your schedule/plan to take your medicine e.g., what time of day, how many pills each day and for how many more days?
ADHERENCE COUNSELING TIPS
DAYS 1, 3 & 7
BARRIERS
PROBING QUESTIONS TO ASSESS BARRIERS
Side effects
Do you understand what to do if you experience side effects? Probe: contact outreach worker or visit health facility vs stop treatment without medical advice.
ADHERENCE COUNSELING TIPS
DAYS 3-7
BARRIERS
PROBING QUESTIONS TO ASSESS BARRIERS
Forgot
Ask to see blister and count # pills taken compared to # days since starting. ASK:
Have you missed any days of since you started treatment?
What is your plan to complete the rest of your treatment?
ADHERENCE COUNSELING TIPS
DAYS 1 & 3
BARRIERS
PROBING QUESTIONS TO ASSESS BARRIERS
Felt better & didn’t see the need to continue medication
What do you think the benefits of completing recommended full dose of vivax radical cure treatment is, even if you feel better/well before you complete treatment?
ADHERENCE COUNSELING TIPS
DAYS 1 & 3
BARRIERS
PROBING QUESTIONS TO ASSESS BARRIERS
Travel
Is it possible that travel might make it difficult for you to finish treatment? How can you ensure that you remember to take the full treatment even if/when you travel?
ADHERENCE COUNSELING TIPS
DAYS 3 & 7
BARRIERS
PROBING QUESTIONS TO ASSESS BARRIERS
Substance use
Do you think alcohol use could affect your ability to remember to take your medicine? Do you think you could abstain until you complete your vivax radical cure treatment? What other solution can we find?
ADHERENCE COUNSELING TIPS
DAYS 1-7
BARRIERS
PROBING QUESTIONS TO ASSESS BARRIERS
Perceived benefit
What do you see as the benefits to completing vivax radical cure treatment for –for you individually? For your family? Add probes based on insights from your community about the benefits most likely to resonate & motivate.
MOTIVATING�CARE FOR SIDE �EFFECTS
HOW DO COMMUNITY HEALTH WORKERS KNOW WHETHER A VIVAX RADICAL CURE PATIENT NEEDS TO VISIT THE NEAREST HEALTH FACILITY TO SEEK ADVICE ABOUT SIDE EFFECTS EXPERIENCED WHILE TAKING RADICAL CURE MEDICATION?
Patients whose urine turns red or dark brown need to be encouraged and assisted to seek care from a health facility immediately. This is the most common sign of serious anaemia—a possible adverse event associated with treatment for vivax.
Patients who experience red or dark brown urine or fatigue, shortness of breath, back pain, yellow skin or yellowed eye whites, rapid heart rate, fever, nausea or vomiting and/or pale skin color, need to see a doctor at a health facility.
If you are not able to accompany the client physically to the nearest health facility, you should contact the health facility or your supervisor by phone to ensure the patient’s symptoms are reported and advice is provided as soon as possible to prevent more serious health issues.
HOW & WHEN TO ENCOURAGE PATIENTS�TO SEEK CARE FOR SIDE EFFECTS
If you experience difficulties reaching someone at the nearest facility, do not give up.
Remember that it is your responsibility to serve as an advocate for your community members’ health, that includes physically accompanying clients to the health facility if needed and feasible. Contact these hotlines or backups if you experience challenges securing advice from the nearest health facility:
local contacts to be added by NMP or CSOs
WHAT TO DO IF YOU OR YOUR PATIENT HAS TROUBLE CONTACTING A PROVIDER AT A HEALTH FACILITY FOR ADVICE?
Explain that seeking care today can prevent bigger challenges tomorrow.
Explain that side effects may not be a sign of a serious health risk, but best to be safe and check with the health facility for peace of mind. Add specific benefits based on insights from your community members about what matters most to them (hint: this may not be directly related to health i.e. ability to produce more on the farm, ability to help children thrive, etc.
TIPS!
How to encourage a vivax radical cure patient to seek care for side effects at the nearest health facility
Ask the patient to tell you 3 things that matter most in her/his life.
You can give examples from your own life –for example, my daughter, my farm, etc. add details based on insights from your community about factors most likely to motivate them to complete radical cure and get advice at a health facility to ensure side effects are not serious.
Explain that the best way to protect the people and things that matter most (replace with specific insights from your community) is to seek care from a health facility for serious side effects.
3
TIPS!
How to encourage a vivax radical cure patient to seek care from a health facility
Reassure the patient that s/he is not alone, you are there to help them through this. If they seem anxious, remind them that relief lies ahead, after visiting the nearest health facility.
If the patient has concerns about time or lost earnings/costs required to visit the health facility, contact your supervisor about travel support to enable the patient to achieve full cure including safe an appropriate management of side effects.
TIPS!
How to encourage a vivax radical cure patient to seek care from a health facility
ACKNOWLEDGEMENTS
This regional guide was developed by Josselyn Neukom (RAI3 Steering Committee CSO Representative) and Phuong Nguyen Bich (Graphic Designer) both based in Viet Nam, on behalf of the Malaria Free Mekong, a platform representing civil society organizations and communities in the Greater Mekong Subregion and ALIGHT, CSO platform host.
The guide creation team and CSO platform deeply appreciates reviewer feedback from Sokha Thoang, Yom Meu, Rattanak Soun and Lieven Vernaeve from Malaria Consortium in Cambodia, Wilasinee Katenoi from Alight in Thailand, Korakod Intaphad from Raks Thai Foundation in Thailand and Caroline Lynch from MMV.
For assistance tailoring parts of the regional guide to your local context, please contact Shree Acharya for additional support: ShreehariA@wearealight.org