New programme launches molecular and in vitro surveillance of ACT partner drug efficacy in the Greater Mekong Subregion (MIVS-ACT)

In the context of increasing artemisinin resistance (ART-R) in the Greater Mekong Subregion of Asia, the effectiveness of the antimalarial partner drugs becomes the most important determinant of artemisinin-based combination treatment (ACT) efficacy. Therefore, resistance to ACT partner drugs such as mefloquine, piperaquine, lumefantrine, amodiaquine must be assessed rapidly throughout the region to ensure that optimal antimalarial treatment strategies are implemented.

The MIVS-ACT Project will gather up to 10,000 specimens over the next 3 years with the goal of providing critical information on the prevalence and distribution of markers of ACT partner drug resistance, including pfmdr1 and pf-plasmepsin-II, 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 up to 200 or more selected isolates collected 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 will be able to use these results to select the most effective drug combinations which may include 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.

Assoc. Prof. Mallika Imwong, Head of the Department of Molecular Tropical Medicine & Genetics at the Faculty of Tropical Medicine, Mahidol University, Thailand comments, ‘This programme gives us an urgent insight into the suspected declining efficacy of not just artemisinin medicines, but also valuable partner drugs. We will work quickly over the next 3 years with our partners at the Institut Pasteur du Cambodge, The Wellcome Trust Oxford Overseas Units and the WorldWide Antimalarial Resistance Network (WWARN) to map the prevalence and distribution of markers of partner drug resistance.’

Monitoring and surveillance activities will extend beyond the 3-year duration of the MIVS-ACT project. Teams will provide training on in vitro assays within partner laboratories and disseminate resources to support quality assurance of genotyping tests.

The MIVS-ACT project is 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.

‘We’re delighted with the scope of this drug resistance focused programme, and see it as an important piece of the eradication agenda driven by the global health community. We’re keen to build the research evidence-base on resistance, and ensure that, together together with the Regional Artemisinin Initiative, supported by The Global Fund, we’re working with communities that are most at risk of treatment for malaria failing.’ says Eric Fleutelot, Regional Counsellor in Global Health for SE Asia, Embassy of France, Thailand.

The project will be carried out by a consortium constituted of the Faculty of Tropical Medicine, Mahidol University (lead organisation), the Mahidol-Oxford Tropical Medicine Research Unit Tropical Health Network, WWARN and the Institut Pasteur du Cambodge. 

The MIVS-ACT project is funded thanks to 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. 

Discover more about WWARN's Asia Regional Centre. View the Molecular Surveyor Maps - Molecular Surveyor pfmdr1 & pfcrt and K13 Surveyor

For further information, please contact the Head of our Asia Regional Centre Dr Mehul Dhorda on email: mehul.dhorda@wwarn.org