Prof. Dr. Christian BurriHead of Department

Department of Medicines Research

London, 6th May 2014

Malaria - on the road to malaria elimination?

All-Party Parliamentary Group on Malaria & Neglected Tropical Diseases

Swiss Tropical & Public Health Institute

The Swiss TPH …… the Swiss Tropical Institute (STI) was

founded in 1943 as a public organisation based on a local government act

… is an associated institute of the University of Basel

… has the mandate to contribute to the improvement of the health of populations internationally and nationally through excellence in research, services, and teaching & training at the levels ofinnovation, validation & application

… has over 650 staff from over 60 nations, thereof ~80 PhD students

The Swiss TPH …… the Swiss Tropical Institute (STI) was

founded in 1943 as a public organisation based on a local government act

… is an associated institute of the University of Basel

… has the mandate to contribute to the improvement of the health of populations internationally and nationally through excellence in research, services, and teaching & training at the levels ofinnovation, validation & application

… has over 650 staff from over 60 nations, thereof ~80 PhD students

IntroductionMalaria cases and deaths in DRC

Source: WHO World Malaria Report 2013

0 50,000,000 100,000,000 150,000,000 200,000,0000

2,000,000

4,000,000

6,000,000

8,000,000

10,000,000

12,000,000

Burkina Faso

DRC

NigeriaUnited Republic of Tanzania

Uganda

Confirmed Malaria Cases & Deaths

Burkina FasoBurundiCôte d'IvoireDRCEthiopiaGhanaKenyaMalawiMaliMozambiqueNigerNigeriaUnited Republic of TanzaniaUgandaZambia

Population

Pres

umed

& C

onfir

med

Mal

aria

Cas

es

• “(Severe) Malaria Treatment with Injectable Artesunate”

• Despite change of WHO guidelines quinine still treatment of choice for treatment of severe malaria in DRC

To inform the NMCP of the DRC about the operational requirements and challenges of nationwide rolled out of injectable artesunate through a limited scope implementation study

MATIAS studyGoal

MATIASStudy design

Descriptive implementation study with a before-after evaluation in confirmed severe malaria cases Investigate operational issues

• Basic clinical assessment• Time & motion study• Feasibility & acceptability

Nov 12 Jan 13 Apr 13 June 13

Quinine Injectable artesunate

N=399 N=350

Study sites

Dem Rep Congo

HZ of Maluku2 study sites - CSHZ of Masina

1 study site - Hospital

HZ of Kimpese3 study sites - Hospital + 2 CS

HZ of Kisantu2 study sites - Hospital + 1 CS

MATIAS studyStakeholders involved in process

Programme national de la Lutte contre le Paludisme (PNLP)

 World Health Organisation

Direction de la Pharmacie, des Médicaments et des Plantes Médicinales (3ème Direction)

 UNICEF

Direction de la Lutte contre la Maladie (4ème Direction)

 Global Fund

Centre de Pharmacovigilance, UniKin   USAID, Presidential Malaria Initiative

Comité Scientifique du Paludisme   SANRU

École de Santé Public Kinshasa   Population Services International

Département de Parasitologie, UniKin   Caritas

    DfID

  Centers for Disease Control and Prevention

    Médecins sans Frontières

Guilin Pharmaceutical Co. Ltd.

ResultsKey outcomes

Quinine Artesunate

Overall mortality rate 15 (3.8%) 6 (1.7%)

Time to discharge - (days) 3 (1,9) 2 (1,9)

Overall personnel time - (min) 36 (13- 92) 33 (10-60)

If you had to make the choice between quinine and artesunate -which one would you choose ? (Patients)

3.3% 96.7%

Because of rapid action 35.3%

Because of no adverse effects 24.4%

Do you find more or less difficult to prepare artesunate compared to quinine?– less difficult (Staff)

75%

What is your level of satisfaction towards injectable artesunate – satisfied / very satisfied (Staff)?

100%

MATIASDissemination

• Inclusion into strategic plan 2013 – 2015 of NMCP

• Progressive implementation within 3 years (30, 50, 100%)

• Projected need for DRC

2013 2014 2015 2016

# vials (50mg/5ml)

0 247’116 216’450 438’062

# boxes of 10 0 2’471 2’165 4’381

Unit cost $ 66.2 66.2 66.2

Total cost $ 0 163’591 143’290 289’997

SANRU Program

SANRU Program

Malaria eliminationAccess & sustainable success

CHB

CHB

http://www.swisstph.ch

MATIASHaemoglobin trend at follow up visits (Artesunate)

Serious adverse events during follow up7 SAEs reported in relation to anemia (2.0%)

2 patients referred to hospital3 patients required blood transfusion1 persistent form

No fatality