The Containment project was an innovative three-year project aimed at addressing resistance to anti-malaria drugs along the Thai-Cambodia border. In 2008, the project received $22.5 million in funding from the Bill & Melinda Gates Foundation. Malaria Consortium was a key partner on this project, providing technical support to the national malaria programmes of Cambodia and Thailand, local and international partners.
This project and its findings are crucial as the anti-malaria drugs in question, artemisinin-based combination therapy (ACT), are currently the most effective combination of drugs for treating malaria. Suspected resistance to ACTs could have a seriously detrimental effect on sustaining the gains made so far in the fight against malaria in Asia. The spread of artemisinin resistance to Africa could also mean a huge setback in malaria control efforts.
The project aimed to detect and effectively treat all malaria cases in the target areas, to reduce drug pressure for the selection of resistant parasites and to contain transmission of malaria, especially among mobile and migrant populations who are at the highest risk of spreading the resistant parasites. Preventive methods such as the distribution and use of long lasting insecticidal nets (LLINs), including long lasting insecticidal hammock nets (LLIHNs) for mobile and migrant populations were increased in an attempt to reach every individual in the target areas. The use of treatment to prevent transmission includes finding and treating confirmed cases early with effective drugs before development of the later, sexual stages of the parasite (gametocytes), which are responsible for transmission, as well as using drugs against the gametocytes.
There was a strong emphasis on improving surveillance systems and active case finding, particularly among mobile and migrant populations who are likely to be key agents in the spread of artemisinin-resistant malaria. The ban on the sale of monotherapies removed counterfeit drugs and prevented further inappropriate treatment in the private sector together in order to curb the emergence and spread of artemisinin resistance. Other strategies such as comprehensive behaviour change communication, community mobilisation and advocacy were also supporting the containment/elimination of artemisinin-resistant parasites.
The project performed basic and operational research to fill knowledge gaps and ensure that strategies applied were evidence-based. Malaria Consortium had the principal role of monitoring and evaluation and providing technical support for surveillance, behaviour change communications and coordination to ensure rapid and high quality implementation of the strategy.
Malaria Consortium was an advisory member of the International Task Force for Artemisinin Resistance Containment, reviewing the project’s overall technical achievements and providing recommendations. The organisation also led on the development, harmonisation and implementation of the project’s behaviour change communication strategies. These were of high importance, ensuring preventive methods such as long lasting insecticide treated nets (LLINs) and hammock nets for mobile and migrant populations reached universal coverage in target areas on both sides of the border.
A significant achievement of the project was the design of a Day 3 SMS reporting system for malaria cases. Malaria Consortium, working with local software developers, inSTEDD, developed a unique SMS system as part of a larger effort to try and track ‘day 3’ positive cases in the community. Day 3 cases are those where the malaria parasite has not cleared the patient’s blood three days after being given artemisinin combination therapy and is viewed as a possible indication of resistance). Village Malaria Workers (VMWs) take slides of blood samples at day 0 and day 3; health facility staff read these and send a simple coded SMS to the open source software. The software links with the Malaria Information System (MIS), a database where incoming information is processed, as well as to Google Maps. The day 3 positive cases are mapped to identify potential hotspots of resistance.
Malaria Consortium assessed the Day 3 community and health facility based surveillance systems for feasibility and cost and provided recommendations for moving forward. The system has now been expanded for all Plasmodium falciparum cases in Cambodia as the country moves towards elimination.
Malaria Consortium was in charge of overall monitoring and evaluation of the project, supporting both Cambodia and Thailand in their data collection and analysis. The organisation provided technical support in developing and Cambodia, reaching mobile populations in both countries through this innovative method.
Efforts to contain artemisinin resistance continue through the successful Global Fund to Fight AIDS, Tuberculosis and Malaria grants to Cambodia (Round 9) and Thailand (Round 10) – both of which Malaria Consortium helped to develop. More recently, Malaria Consortium is also engaged in supporting the surveys for the Myanmar Artemisinin Resistance Containment (MARC) strategy.
For more information, please read the report and the Project Brief or contact firstname.lastname@example.org