Background: The containment of artemisinin resistance in Myanmar, historically an antimalarial resistance gateway to the India sub-continent and beyond, is crucial to global malaria control and elimination. Resistance containment relies on removal of oral artemisinin monotherapy (oral AMT), rapid infection detection and use of quality-assured artemisinin combination therapy (QA ACT) indicated for P. falciparum and chloroquine plus primaquine indicated for P. vivax.
Methods: A 2015 outlet survey was conducted in the private sector within 4 domains: intervention and comparison areas in eastern/central Myanmar for the Artemisinin Monotherapy Replacement Project (AMTR) in operation since 2012; western border areas with India; and the Bangladesh border / Rakhine region. A sample of 28,664 private outlets was screened for availability of malaria testing and treatment, and an audit was completed for all available antimalarials and malaria rapid diagnostic tests (RDTs) across 4,064 outlets (Figure 1).
Results: Availability and distribution of oral AMT is a serious problem throughout Myanmar, with particularly urgent need to address this problem in India border areas. It’s distribution, especially at sub-optimal dosing is likely to further exacerbate the spread of artemisinin resistance in Myanmar. Access to QA ACT treatment is low across domains with the exception of higher availability in AMTR program areas. There is urgent need for rapid national scale-up and strengthening of strategies, including those used by the private sector AMTR program, to rid oral AMT from the market, and increase access to QA ACT. Policy changes that ban the full import, distribution, and sale of oral AMT would create a far more conducive environment for the support of these activities.