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Advancing and Optimizing Malaria Therapy with the Promise of Multiple First Line Options

Source: TropIKA

Title of the session: Advancing and Optimizing Malaria Therapy with the Promise of Multiple First Line Options

Date: 2nd November 2009

Agenda item: Symposium 44

Session theme: Advancing and Optimizing Malaria Therapy with the Promise of Multiple First Line Options

Meeting room: Lake Turkana

Chair(s): Wilfred Mbacham, The Biotechnology Centre, University of Yaounde, Cameroon

Presenters:

• Maciej F. Boni, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam – Presentation

• Prachant Yadav, MIT-Zaragoza International Logistic Program, Zaragoza, Spain – Presentation

• Modest Mulenga, Tropical Diseases Research Centre, Ndola, Zambia – Presentation

• Ambrose Talisuna, Uganda Malaria Surveillance Project, Kampala, Uganda – Presentation

• Florence Manguyu, University of Nairobi, Nairobi, Kenya – Presentation

TropIKA rapporteur: Elizabeth V. M. Kigondu

Major topics:

• Multiple First-Line Tretments (MFT): Why is it critical and how can it be implemented?
• Latest Advancements in the treatment of Uncomplicated Malaria from a Public Health Perspective
• High Quality Malaria Treatments – Why does it matter and how can it be ensured?
• The Informed Patient, Caregiver and Provider: How can we promote better treatment outcomes?

Keywords:

• Multiple first line therapy (MFT)
• single first line therapy (SFT)
• High Quality Malaria Treatment
• Training

Scope: The scope was narrowed down to advancing and optimizing malaria therapy using MFTs.

REPORT ON ORIGINAL SESSION

Overview

In the process of advancing and optimizing malaria therapy, it is highly recommended that multiple first line therapy (MFT) is implemented to effectively treat malaria. As compared to single first line therapy (SFT), MFT, which allows for the availability and use of more than one ACT in a health system, is able to delay development of resistance; it slows down the spread of resistance and reduces clinical burden and failed treatments. Once health policies have adopted MFT the next step is to ensure that the cost of drugs is subsidized , ensure that they are easily available and the quality of the drugs both in the public and private sectors is high to ensure that the treatment does not fail. To be able to achieve this, training is of great essence and this includes training the patients, the caregivers, heads of households, community health workers, community leaders, health care providers, political and administrative leaders, partners – eg NGOs, industry. The training should mainly focus on the causes of malaria, those that are most vulnerable (children under 5 years, pregnant women), prevention measures, diagnosis and treatment. In conclusion, all the mentioned efforts have been achieved by some countries but most of them have to work hard to embrace them and implement them.

CONTEXT AND ISSUE

In general, the main research questions that are being addressed have to do with how can malaria treatment be optimized? This is due to the fact that drug resistance has been a major problem. Artemisinin Combination Therapy is now the recommended first line treatment for malaria. However, studies indicate that multiple first line therapy (MFT) is an effective way of treating malaria. As compared to single first line therapy (SFT), MFT is able to delay development of resistance; it slows down the spread of resistance and reduces clinical burden and failed treatments. Over reliance on a single drug exerts drug pressure on the parasites leading to development of resistance. Other studies also indicated that the cycling method, whereby a drug is introduced and after a given period it is withdrawn to avoid resistance, is not as cost effective as MFT. MFT was also found to change the health seeking behavior of patients.

The main challenge in implementation of MFT is being able to bring together all the stakeholders together to be able embrace it. It can only be achieved through a networked partnership model which should ensure that health policies have adapted MFT, ensure that the cost of drugs is subsidized, ensure that they are easily available and the quality of the drugs both in the public and private sectors is high by withdrawing substandard drugs, to avoid treatment failure.

Key facts and figures

Malaria deaths are very high especially in children under 5 years and expectant mothers. Drug resistance has also posed a big problem in the control of the disease. In most cases, many people are misinformed and have not been working together to eradicate the disease. Various government health policies do not address the malaria problem correctly due to fear of adopting new methods of prevention and control.

Initiatives on the ground; experience/s derived

Various studies have been carried out to determine optimal methods of treatment. Some of these include comparisons of MFT and SFT where MFT was found to be effective. A comparison of the Cycling Model to the MFT was also carried out and the latter was also found to be effective. In the studies there was a change in treatment seeking behavior where more patients seeking treatment were recorded for MFT at subsidized costs. Study in some East African countries including Malawi, Tanzania, Uganda, Kenya, established that there are very few quality anti-malarials mainly the artemisinin based drugs in the market and recommendations were made to get rid of the substandard drugs to ensure that patients have access to quality antimalarials.

Research Findings

• MFT is the most effective malaria treatment compared to the others.

• To be able to implement MFT, stakeholders should work in a networked partnership to be able to adopt the best practices.

• Training is of great importance to all the stakeholders to achieve the above.

Lessons learned

• To be able to implement MFT, stakeholders should work in a networked partnership to be able to adopt the best practices.

• Subsidized costs of the best malaria treatments can lead to higher patients seeking treatment and more products hence more profit in the market.

• Training is of great importance to all the stakeholders to achieve the above.

Issues raised, obstacles, difficulties

• Health policies are usually a hindrance to implementation of the best practices.

• The cost of MFT may be high if it is not well practiced.

• Lack of proper information can be a hindrance to implementation of the best malaria treatment.

FINDINGS AND CONCLUSIONS

From formal presentations

Public health Implications

The discussion generally concluded that, if the best malaria treatment practices are adapted as highlighted above, the problem of drug resistance will be reduced, more patients will seek treatment and will have access to affordable, safe, efficacious anti-malarials hence decreasing the malaria burden.

Policy Impact

Development of proper health policies can be achieved if the findings in the above discussions are passed on to the policy makers.

From open discussions/debates

1. The low visibility of MFT in practice
2. The higher cost of Cycling option to MFT
3. How to translate the findings of these studies into policy.
4. Potential for resistance as known in tuberculosis despite multiple combinations

Identified conclusions

Main points of agreement

• Drug resistance is a problem and should be addressed through the best malaria treatment methods.

• Most anti-malarial drugs in the market are substandard and should therefore be replaced by high quality drugs

• The cost of malaria treatment is in most cases not affordable and should therefore be addressed by the various stakeholders.

• Lack of proper information has been a big drawback and this should be addressed by carrying out training.

Main points of divergence

• MFT is much cheaper or more expensive than SFT.

• MFT is likely or not to experience resistance like other forms of treatment.

• MFT is likely or not to be introduced into health policies by policy makers.

Recommendations

• To be able to implement MFT, stakeholders should work in a networked partnership Costs for the best malaria treatments should be subsidized and high quality malaria treatment should be implemented to be able to have more people seeking treatment and leading to more products in the market hence more profit.

• Training is of great importance to all the stakeholders to achieve the above.

Personal observations from rapporteur

The audience was quite receptive to the recommendations by the presenters.

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