Progress and challenges of integrated drug efficacy surveillance for uncomplicated malaria in Thailand
Abstract Background Integrated drug efficacy surveillance (iDES) was formally introduced nationally across Thailand in fiscal year 2018 (FY2018), building on a history of drug efficacy monitoring and interventions. According to the National Malaria Elimination Strategy for Thailand 2017–2026, diagno...
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| Format: | Article |
| Language: | English |
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BMC
2021-06-01
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| Series: | Malaria Journal |
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| Online Access: | https://doi.org/10.1186/s12936-021-03791-2 |
| _version_ | 1829135193816956928 |
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| author | Prayuth Sudathip Aungkana Saejeng Nardlada Khantikul Thannikar Thongrad Suravadee Kitchakarn Rungniran Sugaram Cheewanan Lertpiriyasuwat Darin Areechokchai Deyer Gopinath David Sintasath Pascal Ringwald Sathapana Naowarat Niparueradee Pinyajeerapat Maria Dorina Bustos Jui A. Shah |
| author_facet | Prayuth Sudathip Aungkana Saejeng Nardlada Khantikul Thannikar Thongrad Suravadee Kitchakarn Rungniran Sugaram Cheewanan Lertpiriyasuwat Darin Areechokchai Deyer Gopinath David Sintasath Pascal Ringwald Sathapana Naowarat Niparueradee Pinyajeerapat Maria Dorina Bustos Jui A. Shah |
| author_sort | Prayuth Sudathip |
| collection | DOAJ |
| description | Abstract Background Integrated drug efficacy surveillance (iDES) was formally introduced nationally across Thailand in fiscal year 2018 (FY2018), building on a history of drug efficacy monitoring and interventions. According to the National Malaria Elimination Strategy for Thailand 2017–2026, diagnosis is microscopically confirmed, treatment is prescribed, and patients are followed up four times to ensure cure. Methods Routine patient data were extracted from the malaria information system for FY2018–FY2020. Treatment failure of first-line therapy was defined as confirmed parasite reappearance within 42 days for Plasmodium falciparum and 28 days for Plasmodium vivax. The primary outcome was the crude drug efficacy rate, estimated using Kaplan–Meier methods, at day 42 for P. falciparum treated with dihydroartemisinin–piperaquine plus primaquine, and day 28 for P. vivax treated with chloroquine plus primaquine; day 60 and day 90 efficacy were secondary outcomes for P. vivax. Results The proportion of patients with outcomes recorded at day 42 for P. falciparum malaria and at day 28 for P. vivax malaria has been increasing, with FY2020 follow-up rates of 61.5% and 57.2%, respectively. For P. falciparum malaria, day 42 efficacy in FY2018 was 92.4% (n = 249), in FY2019 93.3% (n = 379), and in FY2020 98.0% (n = 167). Plasmodium falciparum recurrences occurred disproportionally in Sisaket Province, with day 42 efficacy rates of 75.9% in FY2018 (n = 59) and 49.4% in FY2019 (n = 49), leading to an update in first-line therapy to pyronaridine–artesunate at the provincial level, rolled out in FY2020. For P. vivax malaria, day 28 efficacy (chloroquine efficacy) was 98.5% in FY2018 (n = 2048), 99.1% in FY2019 (n = 2206), and 99.9% in FY2020 (n = 2448), and day 90 efficacy (primaquine efficacy) was 94.8%, 96.3%, and 97.1%, respectively. Conclusions In Thailand, iDES provided operationally relevant data on drug efficacy, enabling the rapid amendment of treatment guidelines to improve patient outcomes and reduce the potential for the spread of drug-resistant parasites. A strong case-based surveillance system, integration with other health system processes, supporting biomarker collection and molecular analyses, and cross-border collaboration may maximize the potential of iDES in countries moving towards elimination. |
| first_indexed | 2024-12-14T18:18:35Z |
| format | Article |
| id | doaj.art-7da4b53b40c44a08a244d98169e4fd56 |
| institution | Directory Open Access Journal |
| issn | 1475-2875 |
| language | English |
| last_indexed | 2024-12-14T18:18:35Z |
| publishDate | 2021-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Malaria Journal |
| spelling | doaj.art-7da4b53b40c44a08a244d98169e4fd562022-12-21T22:52:07ZengBMCMalaria Journal1475-28752021-06-0120111610.1186/s12936-021-03791-2Progress and challenges of integrated drug efficacy surveillance for uncomplicated malaria in ThailandPrayuth Sudathip0Aungkana Saejeng1Nardlada Khantikul2Thannikar Thongrad3Suravadee Kitchakarn4Rungniran Sugaram5Cheewanan Lertpiriyasuwat6Darin Areechokchai7Deyer Gopinath8David Sintasath9Pascal Ringwald10Sathapana Naowarat11Niparueradee Pinyajeerapat12Maria Dorina Bustos13Jui A. Shah14Division of Vector Borne Diseases, Department of Disease Control, Ministry of Public HealthDivision of Vector Borne Diseases, Department of Disease Control, Ministry of Public HealthOffice of Disease Prevention and Control Region 1Division of Vector Borne Diseases, Department of Disease Control, Ministry of Public HealthDivision of Vector Borne Diseases, Department of Disease Control, Ministry of Public HealthDivision of Vector Borne Diseases, Department of Disease Control, Ministry of Public HealthDivision of Vector Borne Diseases, Department of Disease Control, Ministry of Public HealthDivision of Vector Borne Diseases, Department of Disease Control, Ministry of Public HealthWorld Health OrganizationU.S. President’s Malaria Initiative, Regional Development Mission for Asia, United States Agency for International DevelopmentWorld Health OrganizationInform Asia: USAID’s Health Research Program, RTI InternationalU.S. President’s Malaria Initiative, Regional Development Mission for Asia, United States Agency for International DevelopmentWorld Health OrganizationInform Asia: USAID’s Health Research Program, RTI InternationalAbstract Background Integrated drug efficacy surveillance (iDES) was formally introduced nationally across Thailand in fiscal year 2018 (FY2018), building on a history of drug efficacy monitoring and interventions. According to the National Malaria Elimination Strategy for Thailand 2017–2026, diagnosis is microscopically confirmed, treatment is prescribed, and patients are followed up four times to ensure cure. Methods Routine patient data were extracted from the malaria information system for FY2018–FY2020. Treatment failure of first-line therapy was defined as confirmed parasite reappearance within 42 days for Plasmodium falciparum and 28 days for Plasmodium vivax. The primary outcome was the crude drug efficacy rate, estimated using Kaplan–Meier methods, at day 42 for P. falciparum treated with dihydroartemisinin–piperaquine plus primaquine, and day 28 for P. vivax treated with chloroquine plus primaquine; day 60 and day 90 efficacy were secondary outcomes for P. vivax. Results The proportion of patients with outcomes recorded at day 42 for P. falciparum malaria and at day 28 for P. vivax malaria has been increasing, with FY2020 follow-up rates of 61.5% and 57.2%, respectively. For P. falciparum malaria, day 42 efficacy in FY2018 was 92.4% (n = 249), in FY2019 93.3% (n = 379), and in FY2020 98.0% (n = 167). Plasmodium falciparum recurrences occurred disproportionally in Sisaket Province, with day 42 efficacy rates of 75.9% in FY2018 (n = 59) and 49.4% in FY2019 (n = 49), leading to an update in first-line therapy to pyronaridine–artesunate at the provincial level, rolled out in FY2020. For P. vivax malaria, day 28 efficacy (chloroquine efficacy) was 98.5% in FY2018 (n = 2048), 99.1% in FY2019 (n = 2206), and 99.9% in FY2020 (n = 2448), and day 90 efficacy (primaquine efficacy) was 94.8%, 96.3%, and 97.1%, respectively. Conclusions In Thailand, iDES provided operationally relevant data on drug efficacy, enabling the rapid amendment of treatment guidelines to improve patient outcomes and reduce the potential for the spread of drug-resistant parasites. A strong case-based surveillance system, integration with other health system processes, supporting biomarker collection and molecular analyses, and cross-border collaboration may maximize the potential of iDES in countries moving towards elimination.https://doi.org/10.1186/s12936-021-03791-2Malaria eliminationSurveillanceDrug efficacyAntimalarialDrug resistance |
| spellingShingle | Prayuth Sudathip Aungkana Saejeng Nardlada Khantikul Thannikar Thongrad Suravadee Kitchakarn Rungniran Sugaram Cheewanan Lertpiriyasuwat Darin Areechokchai Deyer Gopinath David Sintasath Pascal Ringwald Sathapana Naowarat Niparueradee Pinyajeerapat Maria Dorina Bustos Jui A. Shah Progress and challenges of integrated drug efficacy surveillance for uncomplicated malaria in Thailand Malaria Journal Malaria elimination Surveillance Drug efficacy Antimalarial Drug resistance |
| title | Progress and challenges of integrated drug efficacy surveillance for uncomplicated malaria in Thailand |
| title_full | Progress and challenges of integrated drug efficacy surveillance for uncomplicated malaria in Thailand |
| title_fullStr | Progress and challenges of integrated drug efficacy surveillance for uncomplicated malaria in Thailand |
| title_full_unstemmed | Progress and challenges of integrated drug efficacy surveillance for uncomplicated malaria in Thailand |
| title_short | Progress and challenges of integrated drug efficacy surveillance for uncomplicated malaria in Thailand |
| title_sort | progress and challenges of integrated drug efficacy surveillance for uncomplicated malaria in thailand |
| topic | Malaria elimination Surveillance Drug efficacy Antimalarial Drug resistance |
| url | https://doi.org/10.1186/s12936-021-03791-2 |
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