Malaria Medicines & Diagnostics: trends and supply requirements Dr. Andrea Bosman Diagnosis, Treatment and Vaccines WHO Global Malaria Programme 4 November 2010, Geneva
Proportion of patients seeking treatment for malaria symptoms Use of diagnostic tests in formal health sector 53% Clinical Diagnosis (355 million/yr) 28% No action 44% Formal Health Sector 8% RDT 28% Informal Private Sector 39% Microscopy Source: CHAI Analysis, global estimates for patients living at risk of malaria, based on 2008 World Malaria Report & UNICEF Intervention Coverage Reports
ACT procurement for public sector distribution 6-24 months from adoption to implementation Forecast GFappeal on ACTs Cumulative number of countries Millions of ACT treatment courses WHO policy on ACTs
Reduction of >50% in cases: 29 countries outside of Africa and … (Source: World Malaria Report 2009)
Reduction of >50% in cases: …. in 9 African countries Rwanda Eritrea Zambia Sao Tome and Principe Also: Botswana, Cape Verde, Namibia, South Africa, Swaziland
Malaria decrease in Africa due to effective control Systematic review: 24 studies conducted between 1989 and 2005 in 15 different African countries including 15’331 patients Proportion of malaria among fevers highly variable: 2% to 81%: Median parasite rate = 26% Median PfPR 1985-19992-10 = 37% Median PfPR 2000-20072-10 = 17% D'Acrémont et. al. (2009). PLoS Med, 6 (1): e252
Diagnosis of malaria: % reported cases in public sector with parasitological diagnosis Based on cases reported to WHO: African % biased upwards since countries reporting tend to undertake more case confirmation.
Deployment of RDTs in Livingstone (Zambia): impact on malaria cases and ACT consumption ACT RDTs From over 25'000 ACTs in 2007 to less than 5'000 in 2008 Source: NMCC, Zambia MoH
Reduction of ACT consumption with RDT scale-up in Senegal public health services Courtesy of Dr S. Thiam, PNLP Senegal ~ 0.5 million less ACT consumed in 2008-2009
Rwanda: preliminary analysis (WMR 2010) Malaria cases & ACT annual orders % malaria positive % % malaria outpatients % malaria inpatients LLIN distribution
Countries with projects on (integrated) Community Case Management PSI/TDR Malaria Consortium Save the Children IRC Catalytic Initiative PMI/MCH Courtesy of Dr F. Pagnoni, TDR
Affordable Medicine Facility for malaria: Phase 1 Niger Nigeria Cambodia Uganda Ghana Kenya Tanzania Madagascar As of Sept 2010, 92 first-line buyers are making 24 co-payment requests (equivalent to US$ 8.02 million). AMFm co-paid ACTs are on sale in Ghana and Kenya.
Conclusions • Malaria reducing in near 40 countries due to high coverage of RDTs, ACTs and LLINs - often in combination • Reduction of ACT consumption in areas with high level of use of malaria diagnostics (e.g. testing >80% of suspected cases) • At global level impact on ACT needs is limited because: • low use of malaria diagnostics in countries with high burden • ongoing expansion of ACT access interventions, i.e. community case management and AMFm (Phase I) • variable coverage of vector control (malaria resilience)