malaria act

Views:
 
Category: Education
     
 

Presentation Description

No description available.

Comments

Presentation Transcript

ACT IMPLEMENTATION IN THE AFRICAN REGION: An Update: 

ACT IMPLEMENTATION IN THE AFRICAN REGION: An Update Thomas SUKWA Malaria Drug Policy WHO/AFRO

Outline of Presentation: 

Outline of Presentation Definitions; Rationale for ACT Policies; Recommended ACTs for Africa; Evidence that ACT works; Current Status of Treatment Policies; Challenges; WHO Support for Deployment of ACTs; Conclusion.

Definitions: 

Definitions Antimalarial combination therapy (CT) is the simultaneous use of two or more blood schizonticidal drugs with different biochemical targets in the parasites and independent modes of action Fixed-combinations medicinal products Free-combinations (co-administered in separate tablets or capsules) Artemisinin-based combination therapy (ACT) is antimalarial combination therapy with an artemisinin derivative as one component of the combination

Definitions contd.: 

Definitions contd. Within this definition, the following therapies are not considered antimalarial combination therapy: use of an antimalarial drug with a non-antimalarial drug that enhances its action (e.g. chloroquine plus chlorpheniramine) use of a blood schizonticidal drug with a tissue schizonticidal or gametocytocidal drug (e.g. chloroquine plus primaquine) combinations in which neither of the individual components has significant schizonticidal effect (e.g. sulphadoxine-pyrimethamine, chlorproguanil–dapsone, atovaquone–proguanil)

Rationale for ACT: 

Rationale for ACT Widely established resistance to chloroquine and sulfadoxine-pyrimethamine; Theoretical basis of CT are: - protect individual drug against occurrence of resistance; - to decrease rate of decline in efficacy; - interrupt spread `of resistant strains’; - decrease transmission in a region; The degree of protection will depend on the frequency of genes resistant to the drugs in the combination already present in the parasite population and number of mutations to confer resistance.

Why Artemisinins?: 

Why Artemisinins? Short half-life hence good for combination; Rapid substantial reduction of the parasite biomass; Rapid resolution of clinical symptoms; Effective action against multi-drug resistant P. falciparum; Reduction of gametocyte carriage; No documented parasite resistance yet; Few reported adverse effects.

Adoption of Combination Therapy: 

Adoption of Combination Therapy Technical Consultation on Antimalarial Combination Therapy: Geneva, April 2001 Reviewed current evidence on antimalarial drug combination therapies in different epidemiological settings; Selected combinations for short-term use, particularly in Africa based on efficacy, safety, potential for wide-scale use, cost-effectiveness and potential to delay resistance.

Combinations Recommended: 

Combinations Recommended Artemether-Lumefantrine (Coartem); Artesunate (3 days) + Amodiaquine; Artesunate (3 days) + SP; 4. Artesunate (3 days) + Mefloquine 5. Amodiaquine + SP

Combinations NOT Recommended: 

Combinations NOT Recommended Chloroquine based combinations (e.g CQ + SP; CQ + Artesunate) Artesunate (single dose) + SP; 3. Chloproguanil-Dapsone (LapDap)

Slide10: 

EVIDENCE THAT ACT WORKS

Slide12: 

Cambodia Number of confirmed malaria cases reduced by 33% between 1999 and 2001 ( from 64,679 to 50,284) Number of recorded malaria deaths reduced by 54% between 1999 and 2001 (from 891 to 412)

Malaria Mortality Rate Thailand, 1949-1999: 

Malaria Mortality Rate Thailand, 1949-1999 MR per 100,000 Year

Malaria Notifications in KwaZulu Natal before (2000) and after (2001 – 2002) effective residual spraying w DDT and deployment of artemether-lumefantrine: 

Malaria Notifications in KwaZulu Natal before (2000) and after (2001 – 2002) effective residual spraying w DDT and deployment of artemether-lumefantrine

CURRENT STATUS OF TREATMENT POLICIES: 

CURRENT STATUS OF TREATMENT POLICIES

Trends in malaria treatment policy : 

Trends in malaria treatment policy CQ+SP SP/AQ AQ+SP ACT Malawi S.Africa Kenya Botswana Tanzania Ethiopia Zimbabwe Uganda S.Africa Rwanda DRC Burundi Zambia Eritrea Zanzibar Cameroon <1993 1998 1999 2000 2001 2002 2003 Burundi Mozambique 2004 Comores Gabon Côte d'Ivoire Senegal 1st-line: Ben Cam Ken Tan STP

Slide17: 

CURRENT TREATMENT POLICIES FOR UNCOMPLICATED MALARIA IN THE AFRICAN REGION (May 2004) ACT Policy = 13 CT Policy = 6 SP Policy = 3 CQ Policy = 20 EMRO Region

Challenges: 

Challenges

Global Challenges: 

Global Challenges Lack of Adequate Funding; Availability of ACTs; Long lead times involved in scaling-up production of ACTs; Lack of urgency and political will among international and national policy makers, donors,NGOs;

ACT forecast for Africa: 

ACT forecast for Africa 152,796,350 30,802,367 91,677,810 2005 18,481,420 2004 Upper Lower Forecasts for procurement only by the public sector Based on total morbidity estimates (for both public and private sectors)

Slide21: 

0 50 100 150 200 Number of Treatments (millions) 2004 2005 Year Minimum Maximum Current ACT production capacity Global forecasts of ACTs and production capacity

WHO support for deployment of ACTs: 

WHO support for deployment of ACTs

Slide23: 

Artemether-lumefantrine (Coartem®): Agreement between WHO and Novartis (May 2001) to make drug available to WHO at cost price for supplying governments of disease endemic developing countries, UN Agencies, governmental and non-governmental aid organizations working in association with such governments The MOU shall continue for 10 years Inability to place orders does not breach the MOU obligations 1. Procurement

2. Availability of the product: 

2. Availability of the product as long as Coartem® is commercially produced or distributed, Novartis will make it available to WHO at cost (ex-Basel) price: US$ 2.40 for a blister pack of 24 tablets (4 tabs/dose) US$ 1.90 for a blister pack of 18 tablets (3 tabs/dose) US$ 1.40 for a blister pack of 12 tablets (2 tabs/dose) US$ 0.90 for a blister pack of 6 tablets (1 tab/dose) yearly price reviews (around May every year) mutually acceptable independent auditor on pricing (on WHO request)

Course-of-therapy blister packs : 

Course-of-therapy blister packs 4 different packs: 10-14 kg (1-2 yrs) 15-24 kg (3-7 yrs) 25-34 kg (8-10 yrs) 35+ kg (11+ yrs)

Slide26: 

2.4 $ 1.9 $ 1.4 $ 0.9 $ 10.0 $ 40.0 $ COARTEM® PREFERENTIAL PRICING FOR PUBLIC SECTOR: EXPECTED PRICE CHANGES BY 2005 0.54 $ 1.06 $ 1.59 $ 2.11 $

3. Pre-qualification Scheme: 

3. Pre-qualification Scheme Expression of Interest (EOI) - Artemisinin-based antimalarials Products selected for Phase I: Artesunate (oral preparations) Dihydroartemisinin (tablets, capsules, granules, suppositories) Artemether (oral preparations) Artemether + lumefantrine (oral preparations) Artesunate (injection for IV and IM) Artemotil (injection forms) Dihydroartemisinin + piperaquine AS+MEF, AS+AQ, and AS+SP

Slide28: 

Greater role for laboratory diagnostics to improve the targeting of expensive treatments - microscopy facilities to be strengthened Rapid Diagnostic Tests (RDTs) can supplement microscopy in situations where the latter is not feasible Microscopy and RDTs have potential for cost saving expensive antimalarial treatment (>1 USD) in areas of low to moderate transmission A quality assurance facility has been established by WHO in WPRO to assist countries in the procurement of RDTs 4. Diagnosis

5. A Malaria Drug Facility: 

5. A Malaria Drug Facility Global market estimates and projections for antimalaria drugs based on the requirements of endemic countries Pre-qualify drug manufacturers to ensure quality of manufacturing and production; Negotiate price with manufacturers by pooling orders and forecasting market demands; Improve formulation and packaging needs of endemic countries by presenting country needs to the pharmaceutical industry, and supporting R & D in neglected areas; Procurement and distribution to endemic countries; Malaria Medicines Supply Services (MMSS).

GFATM funding of ACTs: 

GFATM - the largest financial supporter of ACTs in countries A total of about US$ 41 million has been committed over the full 5-year life of GFATM Board-approved proposals from African countries for the purchase of ACTs in three proposal rounds. In addition funds for chloroquine, SP or amodiaquine can be reprogrammed to ACTs if needed GFATM funding of ACTs Total annual number of ACT treatments (eq. adult doses) funded by GFATM

CONCLUSION: 

CONCLUSION

Slide32: 

The costs of estimated global ACT requirements far exceeds the current level of ACT financing by the GFATM. An enhancement of the financial resources for purchasing ACTs is, therefore, urgently required to both encourage endemic countries to adopt these effective treatment policies and to stimulate the market. Malaria is a highly treatable disease, and very effective treatment is available in the form of ACTs. WHO calls on all RBM partners to unite in a global coalition to enable countries accelerate access to ACTs and make these life-saving medicines affordable to the people in need. Momentum is high to ensure access to effective antimalarial treatment

authorStream Live Help