The meeting of the BBINS Malaria Drug Resistance Monitoring Network was convened in New Delhi, India on 15-16 Oct 2019. The objectives were:
1. To provide an update on the recommendations of the 2018 meeting;
2. To review and discuss implementation and results of the recent therapeutic efficacy studies (TES) of each country;
3. To present updates on the integrated drug efficacy surveillance (iDES) in near elimination areas, and updates on the role and results of the molecular marker for tracking artemisinin resistance K13 and of other molecular markers for malaria drug resistance; and
4. To develop work plans and budgets for each country and the network for TES and iDES monitoring in 2020-2021, considering a possible harmonization of future malaria treatment regimens across countries.
The participants included: representatives from the countries of the BBINS network (Bangladesh, Bhutan, India, Nepal and Sri Lanka) and Maldives; WHO country office focal points, representatives from WHO SEARO and HQ, select experts and partners.
The meeting started with welcome by Dr T. Aditama Ag. CDS, WHO SEARO. He read the Regional Director’s message that emphasized the criticality of the meeting. Though most ACTs remain effective, Artemisinin resistance have been reported for P. falciparum in the Greater Mekong Sub-region. All countries therefore, should remain vigilant and ensure strengthening of drug resistance monitoring.
Salient discussion points were as under:
• Most countries in the region have shown decline in malaria cases.
• The first-line ACTs in all countries are currently effective for both P. falciparum and P. vivax malaria.
• P. falciparum kelch 13 mutations (marker for artemisinin partial resistance) have been identified in a few cases Bangladesh and India. Delayed clearance or ACT failure were not observed in the patients carrying these mutations. Work is ongoing to conduct a TES in the areas from which the kelch 13 mutations were reported.
• Considering the challenges for TES especially due to decline in number of cases for enrolment, the enrolment criteria and study area should be adjusted as per the need without compromising technical/ethical issues.
• Countries need to prepare TES protocols as per prescribed templates with realistic budget for smooth approvals at all levels. Countries and the WHO need to explore possible sources of funding, e.g. the Global Fund, where applicable.
• For iDES that is integrated within the programme as part of the surveillance system, Ethics Committee approval is not mandatory.
• The approval process of TES protocols needs to be minimized at every level (country, WHO) to ensure timely initiation.
• Countries need to take action on recommendations.
Salient recommendations were as under:
For the countries:
• Results/reports of TES should be shared with respective country programme as soon as these are completed, and countries are encouraged to publish the same in national/international journals.
• Countries should conduct further investigation on reports of kelch 13 mutations.
• Countries should update treatment guidelines regularly based on TES data and the WHO treatment guidelines.
• Countries should strengthen capacities for microscopy. QA for microscopy should be ensured for TES. The ECAAMS should include laboratory technicians engaged in TES studies.
• Countries should share data/information of imported cases directly with relevant country(ies).
For the WHO:
• WHO should support QA for PCR and molecular markers in the network/region.
• WHO should consider inclusion of countries of the region that are not part of BBINS network but share border e.g. Myanmar in TES meetings and inclusion of India/Bangladesh in Mekong/Pacific network meetings periodically.
1. To provide an update on the recommendations of the 2018 meeting;
2. To review and discuss implementation and results of the recent therapeutic efficacy studies (TES) of each country;
3. To present updates on the integrated drug efficacy surveillance (iDES) in near elimination areas, and updates on the role and results of the molecular marker for tracking artemisinin resistance K13 and of other molecular markers for malaria drug resistance; and
4. To develop work plans and budgets for each country and the network for TES and iDES monitoring in 2020-2021, considering a possible harmonization of future malaria treatment regimens across countries.
The participants included: representatives from the countries of the BBINS network (Bangladesh, Bhutan, India, Nepal and Sri Lanka) and Maldives; WHO country office focal points, representatives from WHO SEARO and HQ, select experts and partners.
The meeting started with welcome by Dr T. Aditama Ag. CDS, WHO SEARO. He read the Regional Director’s message that emphasized the criticality of the meeting. Though most ACTs remain effective, Artemisinin resistance have been reported for P. falciparum in the Greater Mekong Sub-region. All countries therefore, should remain vigilant and ensure strengthening of drug resistance monitoring.
Salient discussion points were as under:
• Most countries in the region have shown decline in malaria cases.
• The first-line ACTs in all countries are currently effective for both P. falciparum and P. vivax malaria.
• P. falciparum kelch 13 mutations (marker for artemisinin partial resistance) have been identified in a few cases Bangladesh and India. Delayed clearance or ACT failure were not observed in the patients carrying these mutations. Work is ongoing to conduct a TES in the areas from which the kelch 13 mutations were reported.
• Considering the challenges for TES especially due to decline in number of cases for enrolment, the enrolment criteria and study area should be adjusted as per the need without compromising technical/ethical issues.
• Countries need to prepare TES protocols as per prescribed templates with realistic budget for smooth approvals at all levels. Countries and the WHO need to explore possible sources of funding, e.g. the Global Fund, where applicable.
• For iDES that is integrated within the programme as part of the surveillance system, Ethics Committee approval is not mandatory.
• The approval process of TES protocols needs to be minimized at every level (country, WHO) to ensure timely initiation.
• Countries need to take action on recommendations.
Salient recommendations were as under:
For the countries:
• Results/reports of TES should be shared with respective country programme as soon as these are completed, and countries are encouraged to publish the same in national/international journals.
• Countries should conduct further investigation on reports of kelch 13 mutations.
• Countries should update treatment guidelines regularly based on TES data and the WHO treatment guidelines.
• Countries should strengthen capacities for microscopy. QA for microscopy should be ensured for TES. The ECAAMS should include laboratory technicians engaged in TES studies.
• Countries should share data/information of imported cases directly with relevant country(ies).
For the WHO:
• WHO should support QA for PCR and molecular markers in the network/region.
• WHO should consider inclusion of countries of the region that are not part of BBINS network but share border e.g. Myanmar in TES meetings and inclusion of India/Bangladesh in Mekong/Pacific network meetings periodically.