ANTIMALARIAL DRUG RESISTANCE, ARTEMISININ-BASED COMBINATION THERAPY, AND THE CONTRIBUTION OF MODELING TO ELUCIDATING POLICY CHOICES

SHUNMAY YEUNG Wellcome Trust-Mahidol University-Oxford Tropical Medicine Research Program, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Health Policy Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom; Liverpool School of Tropical Medicine, Liverpool, United Kingdom

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WIRICHADA PONGTAVORNPINYO Wellcome Trust-Mahidol University-Oxford Tropical Medicine Research Program, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Health Policy Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom; Liverpool School of Tropical Medicine, Liverpool, United Kingdom

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IAN M. HASTINGS Wellcome Trust-Mahidol University-Oxford Tropical Medicine Research Program, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Health Policy Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom; Liverpool School of Tropical Medicine, Liverpool, United Kingdom

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ANNE J. MILLS Wellcome Trust-Mahidol University-Oxford Tropical Medicine Research Program, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Health Policy Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom; Liverpool School of Tropical Medicine, Liverpool, United Kingdom

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NICHOLAS J. WHITE Wellcome Trust-Mahidol University-Oxford Tropical Medicine Research Program, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Health Policy Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom; Liverpool School of Tropical Medicine, Liverpool, United Kingdom

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Increasing resistance of Plasmodium falciparum malaria to antimalarial drugs is posing a major threat to the global effort to “Roll Back Malaria”. Chloroquine and sulfadoxine-pyrimethamine (SP) are being rendered increasingly ineffective, resulting in increasing morbidity, mortality, and economic and social costs. One strategy advocated for delaying the development of resistance to the remaining armory of effective drugs is the wide-scale deployment of artemisinin-based combination therapy. However, the cost of these combinations are higher than most of the currently used monotherapies and alternative non-artemisinin-based combinations. In addition, uncertainty about the actual impact in real-life settings has made them a controversial choice for first-line treatment. The difficulties in measuring the burden of drug resistance and predicting the impact of strategies aimed at its reduction are outlined, and a mathematical model is introduced that is being designed to address these issues and to clarify policy options.

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