USAID Malaria Program: Treatment and Drug Resistance
Two key elements of USAID's overall strategic approach to malaria programming relate directly to the success of malaria treatment, which when delivered together with preventive interventions will reduce the tremendous health burden of malaria. In these treatment related activities, USAID fully endorses the recommendation of WHO and the RBM partnership broadly that:
"treatment policies for falciparum malaria in all countries experiencing resistance to monotherapies should be combination therapies, preferably those containing an artemisinin derivative (ACT).”
- Promoting effective treatment of malaria illness. Recognition of malaria symptoms and prompt, effective treatment are critical to saving the lives of children infected with malaria. USAID programs aim to increase the proportion of children with fever who receive prompt treatment with an effective drug within 24 hours. This approach involves improving symptom recognition and treatment-seeking behaviors at the household level, improving case management at health facilities, improving the ability of caretakers and patients to understand and adequately follow treatment regimens, and developing national capacity to set appropriate policies for efficacious drug choice, effective strategies for treatment delivery to vulnerable children, and routine monitoring of antimalarial drug efficacy.
- Responding to the emergence and spread of drug-resistant malaria. Growing antimalarial drug resistance is challenging malaria control. To meet this challenge USAID as a committed RBM partner and with WHO guidance recommends artemisinin-based combination therapy (ACT) for treatment of falciparum malaria. Rapid deployment of ACT, particularly in Africa, presents financing, procurement, regulatory and communication challenges at all levels. USAID and the rest of the RBM partnership are committed to addressing these challenges.
Since the 1980s, USAID-supported programs have called attention to the impact of antimalarial drug resistance in Africa. In the early to mid-1990s USAID supported WHO and CDC to develop and implement standard protocols for assessment of therapeutic efficacy, a framework for treatment policy development and revision, strengthen capacity within WHO to provide expert advice on treatment policy, and establishment of information databases of the results of efficacy testing.
Following a 1998 global consultative meeting on drug resistance and combination therapy, USAID began a systematic program of support to efforts to accelerate effective response to growing drug resistance, including development of appropriate combination therapies. In the period FY98-03 this program has included:
- Funding to the WHO/World Bank/UNDP Special Programme for Research and Training in Tropical Diseases (TDR) to carry out safety and efficacy studies on ACT in Africa, to bring rectal artesunate to registration, and to support large field implementation studies for ACT. Approximately $4 million.
- Funding to CDC for research on ACT impact and implementation in Tanzania. Approximately $4 million.
- Funding in Asia through a partnership of WHO Regional Offices (WHO/WPRO and SEARO); the Centers for Disease Control and Prevention, Atlanta (CDC); the Rational Pharmaceutical Management Project (RPM+/MSH) and United States Pharmacopeia. This partnership provides technical assistance to inter-country work in the Mekong sub-region to collect, analyze, and share evidence and information on therapeutic efficacy, policies, treatment strategies, drug quality, and manufacturing standards to strengthen response to drug resistance and deployment of ACT. Approximately $5 million.
- Funding in Latin America for technical assistance through PAHO, CDC, RPM+/MSH and USP for similar inter-country work in the Amazon Basin, the focus of multi-drug resistant malaria in the Americas. This work has resulted in adoption of ACT in Peru, Bolivia, Suriname, Colombia and Ecuador. Approximately $6 million.
- Bilateral support to malaria programs in Cambodia, Indonesia, Nepal, and the Philippines largely focusing on technical assistance for efficacy monitoring , policy revision and strengthened treatment delivery. Approximately $7 million.
- Bilateral support to malaria programs in Bolivia and Peru, largely focusing on technical assistance for improved response to antimalarial resistance. Approximately $5 million.
- Technical assistance in Africa through the Malaria Action Coalition to regional, inter-country and country programs to monitor therapeutic efficacy, revise and strengthen policy and improve drug procurement, delivery and use. Approximately $5 million.
- In this period USAID bilateral programs in Africa programmed approximately $89 million of malaria funding. These programs include significant support for technical assistance directly related to treatment policy revision and strengthened treatment delivery in Angola, Benin, Burundi, DRCongo, Eritrea, Ghana, Liberia, Madagascar, Malawi, Mali, Nigeria, Rwanda, Senegal, and Zambia.
- Financial support to an Institute of Medicine expert committee on Economics of Antimalarial Drugs, which will provide recommendations to RBM partners to address the financing of ACT.
- During this period the Bureau for Global Health has programmed approximately $5 million in activities supporting the development of strategies that will prepare the way for more widespread use of ACT, such as innovative approaches for antimalarial drug financing; improved treatment of children; field testing of more sensitive, specific, and user-friendly malaria diagnostics; and evaluation of different approaches to home-based treatment of malaria.
In FY04 USAID expects to increase support for programs and activities which take on the joint challenges of antimalarial drug resistance and insufficient access to effective treatment. This new effort will include two significant new activities: direct investment in the development of new antimalarial drugs and technical assistance to RBM as it establishes a malaria facility to forecast demand for ACTs, ensure quality, coordinate procurement, and stimulate the global supply market.
Regional Initiatives
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