Artemisinin-based combination therapies (ACTs) are the current WHO-recommended standard of care for uncomplicated malaria. They are highly efficacious (with cure rates between 94–99%), and work quickly.1 Thanks to donor investment in recent years, procurement of ACTs has steadily increased. Furthermore, the introduction of different ACT combinations since 2008 has provided countries with a greater choice of treatments to include in national malaria treatment guidelines.
Dr Keziah Malm, from Ghana’s National Malaria Control Progamme provides insight into the real-world advantages of multiple first-line ACTs, which were first instituted in Ghana in 2007.
1. In your experience, what are the advantages of having multiple first-line antimalarials?
It gives patients a choice, which means that those who experience adverse reactions with one drug can select another. In the case of treatment failure with one drug, it’s also advantageous to have an alternative, rather than switching straight away to intravenous quinine or artesunate, which is much more complicated to administer. It also reduces the pressure on one manufacturer and, in case of stock-outs at the point-of-care, one product can be substituted for another.
2. How did you ensure a smooth transition from single to multiple first-line therapies in Ghana?
One of the most important ingredients was appropriate behaviour change communications and the involvement of key stakeholders in the entire process. Also, because the market and supply chain becomes more complex with multiple therapies, monitoring becomes more important. The National Health Service in Ghana has been collaborating with the Society for Private Medical Practitioners and pharmaceutical organizations to improve monitoring. Even so, there is still more work to be done to scale-up the current levels of distribution/use and adherence to guidelines.
1. Rueangweerayut R et al. “Pyronaridineartesunate versus mefloquine plus artesunate for malaria.” N Engl J Med. 366(14):1298- 309 (2012).