{"id":63290,"date":"2024-11-08T16:09:32","date_gmt":"2024-11-08T21:09:32","guid":{"rendered":"https:\/\/www.psi.org\/?p=63290"},"modified":"2024-11-08T20:29:35","modified_gmt":"2024-11-09T01:29:35","slug":"leveraging-the-private-sector-to-counter-antimalarial-resistance","status":"publish","type":"post","link":"https:\/\/www.psi.org\/pt\/2024\/11\/leveraging-the-private-sector-to-counter-antimalarial-resistance\/","title":{"rendered":"Leveraging the Private Sector to Counter Antimalarial Resistance"},"content":{"rendered":"

By Paul Bouanchaud, Senior Research Advisor, PSI<\/em><\/p>\n\n\n\n

The emergence of antimicrobial resistance (AMR) is a growing threat in malaria-endemic regions, risking decades of progress in saving lives. Recognizing this urgency, Population Services International (PSI) and partners are pioneering solutions to strengthen resistance monitoring, diversify malaria treatments, and support better decision-making across health systems.<\/p>\n\n\n\n

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Current Treatments at Risk<\/h5>\n\n\n\n
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At the High-Level Meeting on AMR in September, the UN General Assembly highlighted this issue as \u201cone of the most urgent global health threats and development challenges\u201d to address, especially in the context of malaria control and elimination.<\/p>\n\n\n\n

The World Health Organization (WHO) currently recommends artemisinin combination therapy (ACT) as the primary treatment for uncomplicated malaria. ACT combines two different active ingredients \u2014 the fast-acting artemisinin and another antimalarial drug \u2014 to tackle resistance. In the two decades since its introduction, ACT has had a massive effect on reducing sickness and death from malaria.<\/p>\n\n\n\n

However, recent evidence of partial resistance to the artemisinin component of ACT has emerged in several areas of Southeast Asia<\/a> e sub-Saharan Africa<\/a> that are vulnerable to malaria.<\/p>\n\n\n\n

This resistance is believed to be driven by the use of ACTs for treating fevers without confirmatory testing for malaria, alongside the lack of diversity in the active ingredients commonly used (artemether and lumefantrine). When artemisinin starts to lose effectiveness, it puts more pressure on its partner drugs, also putting their effectiveness at risk.<\/p>\n\n\n\n

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Partnering to Combat Resistance \u2013 ACTwatch Lite Supporting Data for Decision-Making<\/h5>\n\n\n\n
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Enumerator conducts a quantitative interview with a provider in Lagos, Nigeria, to determine antimalarial and RDT availability, pricing, and sales at the pharmacy and performs an audit of the available products. <\/em><\/figcaption><\/figure>\n\n\n\n

To address these concerns, PSI stands with stakeholders such as the Bill & Melinda Gates Foundation, the U.S. President\u2019s Malaria Initiative (PMI), Unitaid, and the Global Fund to respond to country needs and support the diversification of ACTs<\/a>, along with other measures to detect and mitigate antimalarial resistance.<\/p>\n\n\n\n

In malaria-endemic countries, treatment is often accessed through private sector facilities and outlets, such as pharmacies, drugstores, and private clinics. However, there is a significant lack of quality, timely data on malaria treatment and low testing rates in the private sector for much of sub-Saharan Africa, which accounts for90% of the global malaria burden<\/a> with 249 million cases and 608,000 deaths, as estimated in 2022.<\/p>\n\n\n\n

O ACTwatch Lite project<\/a>, funded by the Gates Foundation and led by PSI, collects valuable data on antimalarial sales and malaria diagnostics in the private sector to support decision-making by governments, drug regulators, and other health system stakeholders. Pilot studies have been implemented in Benin, Cameroon, and Nigeria. Findings show that, similar to the public sector, artemether-lumefantrine (AL) is the most commonly distributed antimalarial. In Benim<\/a>, AL makes up 74% of all malaria medicines in the private sector, and in the two largest regions of Cameroon studied \u2013 Littoral and Centre \u2013 it makes up 62%.<\/p>\n\n\n\n

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Enumerator speaks with a provider in Kano State, Nigeria, about sales and pricing of products as she collects data for the ACTwatch Lite project. <\/em><\/figcaption><\/figure>\n\n\n\n

There is encouraging news, though. Private sector outlets are already stocking and distributing a wider range of alternative ACTs. For example, in Benin and two regions of Cameron, pharmacies are offering the drug combination dihydroartemisinin-piperaquine as an alternative, making up 12% and 26% of antimalarial sales in each country, respectively. This shows the private sector may be ready to meet the demand for more diverse treatments to combat drug resistance, if recommended.<\/p>\n\n\n\n

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These findings highlight how the ACTwatch Lite project is helping us understand drug resistance pressures in the private sector and putting valuable data in the hands of decision-makers.<\/p>\n\n\n\n

Learn more about what PSI and partners are doing to inform malaria decision making through the ACTwatch Lite project: https:\/\/www.psi.org\/actwatch-lite\/<\/a><\/p>\n\n\n\n

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