By Meredith Center, Plus Project Director, PSI and Malia Skjefte, Malaria Technical Advisor, PSI
Everyone loves a fun fact (and that’s a fact).
After decades of steady decline, malaria cases have seen a resurgence over the last few years, with an estimated 247 million cases in 2021 compared to 245 million cases in 2020. To counteract this recent rise in malaria incidence, PSI strives to strengthen the health systems that deliver malaria care and address the critical gaps that persist in testing and treatment practices. We begin with the needs of consumers and then work closely with governments, strategic partners, and other key stakeholders to address their unique perspectives.
As part of our official launch, we’re highlighting key facts about the Plus Project, a Unitaid-funded initiative led by PSI to co-design, implement, and evaluate country-adapted models of Perennial Malaria Chemoprevention (PMC). Recommended by the World Health Organization (WHO) as part of its malaria chemoprevention strategies, PMC is targeted at children in areas of year-round, moderate to high malaria transmission.
The Plus Project works in close collaboration with National Malaria Control Programs (NMCPs) to develop and implement PMC in four African countries, and to collect evidence on impact, effectiveness and cost-effectiveness. Implementation experience and research evidence from the project will be shared with national, regional and global stakeholders aiming to support the adoption and scale-up of PMC in the focus countries and other malaria-endemic countries of sub-Saharan Africa, including through revisions to national policies and guidelines.
Now, to the facts of how we are designing PMC to be cost-effective and sustainable:
FACT 1: WE ARE HELPING COUNTRIES TO ADAPT WHO GUIDELINES ON PMC
In 2022, the WHO updated its Guidelines for malaria to include PMC as a key chemoprevention intervention. This expands on and replaces the previous recommendation of Intermittent Preventive Treatment in infants (IPTi) using the combination medication, Sulfadoxine-Pyrimethamine (SP).
The updated guidance includes changes to the dosing schedule, age requirements, and considerations for drug resistance. While the previous guidelines recommended three doses of SP at predefined intervals of ten weeks, 14 weeks, and nine months old — to be timed with routine childhood vaccinations — the updated recommendation removes this strict specification on the number and timing of doses for PMC. Additionally, the recommended target age group extended to include children even older than one-year, furthering SP’s preventative impact.
As new evidence demonstrates the effectiveness of SP, even in areas with high parasitic resistance, the updated guidance removes previous restrictions on using SP based on resistance thresholds. This expands the possible geographies where PMC can be implemented, prompting countries to make decisions on use based on available evidence.
FACT 2: PMC LOOKS A BIT DIFFERENT IN EACH COUNTRY.
The project takes place across four focus countries: Cameroon, Benin, Côte d’Ivoire, and Mozambique. We will also collect limited data in three additional countries — Democratic Republic of Congo, Ghana, and Zambia — that are interested in the adoption and scale-up of PMC.
While the target group for our intervention are all children under two years, the total number of target doses of SP to be delivered varies by country ranging from four to eight doses. Dosages are delivered leveraging existing vaccine, vitamin A, and routine child visits to health facilities, as well as through community delivery in Cameroon. The different models of PMC with varying dosing schedules and channels will allow research studies to inform future decisions about when and how to implement PMC.
FACT 3: COMMUNITY ENGAGEMENT IS CENTRAL TO OUR WORK.
Community stakeholders range from the caregivers of the children receiving PMC to community health workers, providers, local government officials, community leaders, and staff of National Malaria Control Programs and Expanded Programs on Immunization. Underpinning these PMC activities are in-depth training sessions, routine monitoring, supervision, and community engagement activities, which are currently being integrated into existing country systems. We also helped establish country Advisory Groups, which advise, monitor, and support the PMC activities and research for maximum benefit and a view towards sustainability and full government ownership.
FACT 4: WE’VE GOT PARTNERS (AND LOTS OF THEM!)
The project’s approach to collaborative design reflects the shift to provide greater flexibility to NMCPs to adapt control strategies to suit their settings. The Plus Project partners with governments and other key stakeholders to design country-specific models of PMC for their context, including the number and timing of SP doses as well as the delivery channel. The PMC models in each focus country have been co-designed with key stakeholders of those countries and are a product of country-led ideation and decision-making. We use a customized evaluation approach with each focus country to generate data for policy work and decision-making.
The evaluations are led by the London School of Hygiene and Tropical Medicine (LSHTM) in collaboration with country research partners, including the Centre de Recherche Entomologique de Cotonou (CREC) in Benin, the Fobang Institutes for Innovations in Science and Technology (FINISTECH) in Cameroon, the Institut National de Santé Publique (INSP) in Côte d’Ivoire, and the Centro de Investigação em Saúde de Manhiça (CISM) in Mozambique, as well as the University of Copenhagen who is contributing to the genotyping work.
FACT 5: PMC IS ALREADY BEING DELIVERED.
Children have already begun to receive SP in Plus Project countries. The first dose of SP for PMC was delivered in Côte d’Ivoire in November 2022 and as of February 2023, the other three Plus Project countries have started their distribution. The project launch is successfully underway.
AND AS A FINAL FACT… WE WANT YOU TO STAY CONNECTED.
Over the next four years, we will release numerous communications materials featuring learnings, results, and insights from the project. For now, we invite you to stay up to date on our progress by visiting the Plus Project’s website where we provide resources, country updates, and perspectives from our partners: https://www.psi.org/project/plusproject/
…And don’t worry, there are more fun facts to come.
Feature Photo Credit: Malika Kounkourou, Princeton in Africa Fellow