DOI : https://doi.org/10.56338/mppki.v9i10.10243

Culturally Tailored Adherence-Support Intervention for 14-Day Primaquine Treatment in Plasmodium vivax Malaria

Muhamad Sahiddin (1), Erich Christian Wayangkau (2), Isak Jurun Hans Tukayo (3), Nasrah (4), Asrianto (5)
(1) Department of Nursing, Politeknik Kesehatan Jayapura, Papua, Indonesia
(2) Faculty of Public Health, Universitas Cenderawasih, Papua, Indonesia
(3) Department of Nursing, Politeknik Kesehatan Jayapura, Papua, Indonesia
(4) Department of Nursing, Politeknik Kesehatan Jayapura, Papua, Indonesia
(5) Department of Medical Laboratory Technology, Politeknik Kesehatan Jayapura, Papua, Indonesia
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Sahiddin, M., Erich Christian Wayangkau, Tukayo, I. J. H., Nasrah, & Asrianto. (2026). Culturally Tailored Adherence-Support Intervention for 14-Day Primaquine Treatment in Plasmodium vivax Malaria. Media Publikasi Promosi Kesehatan Indonesia, 9(10), 1767–1778. https://doi.org/10.56338/mppki.v9i10.10243
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Introduction: Plasmodium vivax is a major cause of recurrent malaria in Papua, Indonesia, because dormant liver hypnozoites can trigger relapses. Adherence to radical cure with 3-day dihydroartemisinin–piperaquine (DHP) plus 14-day primaquine is essential for relapse prevention but is often hindered by sociocultural factors, risk perception, and treatment duration. This study evaluated a culturally tailored adherence-support intervention centred on an adherence card developed from a Papuan emic perspective to improve adherence among patients with P. vivax malaria.


Methods: A cluster-randomised controlled trial was conducted in six primary health centres in Jayapura City (three intervention clusters and three control clusters) from February to June 2025. A total of 278 participants were recruited from the randomised PHC clusters; 137 participants were in the intervention clusters and received the culturally tailored adherence-support intervention, including the adherence card, education, medication monitoring, and cadre follow-up, while 141 participants in the control clusters received standard malaria services. Adherence was assessed using pill count and self-report, with intention-to-treat (ITT) as the primary analysis. Intervention effects were expressed as cluster-adjusted risk ratios (RRs), and factors associated with 14-day primaquine adherence were explored using cluster-adjusted regression analysis.


Results: In the intention-to-treat analysis, full adherence to the complete DHP and 14-day primaquine regimen, confirmed by pill count and self-report, was higher in the intervention group than in the control group (85.0% vs 44.4%; RR = 1.91; 95% CI: 1.07–3.41; p = 0.039). In the exploratory cluster-adjusted analysis of 14-day primaquine adherence, study arm was the only factor significantly associated with adherence after adjustment (aOR = 7.04; 95% CI: 1.41–35.18; p = 0.028).


Conclusion: The culturally tailored adherence-support intervention improved full adherence to the DHP and 14-day primaquine regimen among patients with P. vivax malaria in the participating PHCs in Jayapura. The findings support further evaluation of this intervention in other settings.

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