MIVS-ACT project tracking partner drug resistance in GMS showcases surveillance in near real-time

The Molecular and in vitro surveillance of ACT partner drug efficacy in the GMS (MIVS-ACT), funded by the French 5% Initiative on AIDS, Tuberculosis and Malaria, aims to support regional malaria control and elimination efforts by focusing on resistance to the partner drugs used in combination with artemisinins. More than 5,000 specimens have been tested and their results mapped with a targeted turn-around time of 3 months for prospectively collected specimens to be able to track the spread or emergence of resistance to antimalarials in near-real time.

MIVS-ACT aims to gather up to 10,000 specimens in order to make critical information on the prevalence and distribution of markers of ACT partner drug resistance, including P. falciparum multidrug resistance gene (pfmdr1) and P. falciparum plasmepsin2 gene (pfpm2), available to policy makers and public health officials in near real-time through regularly updated maps. These data will be complemented by in vitro phenotyping of more than 200 isolates selected from across the region to assess parasite susceptibility to ACTs and to monitor for resistance emerging due to known or as yet uncharacterised or candidate genetic markers.

Policy makers can use these results to aid the selection of drug combinations for deployment, including as part of novel strategies – such as drug rotation, sequential administration or triple ACT combinations – to prolong the efficacy of current antimalarials and urgently support containment and elimination goals in the region.

A research consortium led by the Faculty of Tropical Medicine at Mahidol University in Bangkok is completing the project in partnership with the Mahidol Oxford Research Unit (MORU), the WorldWide Antimalarial Resistance Network (WWARN) and the Institut Pasteur du Cambodge. MIVS-ACT was made possible thanks to timely funding support from the 5% Initiative on AIDS, Tuberculosis and Malaria, implemented by Expertise France and funded by the French Ministry of Foreign Affairs and International Development in support of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

“The results so far demonstrate that sharing molecular marker data on partner drug resistance in near-real time is feasible. Along with next-generation technologies, such approaches can provide information that can be used to optimise treatments for patients with malaria and in doing so help maintain the efficacy of ACTs,” said Associate Prof Mallika Imwong, Head of the Department of Molecular Tropical Medicine & Genetics at Mahidol University.

“In addition to providing urgent information that can assist public health officials, we aim to strengthen capacity in the region so that surveillance can be integrated into regular activities”, said Dr Mehul Dhorda, Head of WWARN’s Asia Regional Centre. “To this end, we are making available specimens with parasites carrying resistance-conferring mutations for use in validation of genotyping assays or as part of a proficiency testing scheme.”

Researchers expect to complete work in 2019.