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Deploying triple artemisinin-based combination therapy (TACT) for malaria treatment in Africa: ethical and practical
Paulina Tindana1, Freek de Haan2, Chanaki Amaratunga3,4
1School of Public Health, College of Health Sciences, University of Ghana, P.O. Box LG13, Legon, Ghana.
Insights
Triple artemisinin-based combination therapy (TACT) offers a potential solution to combatting artemisinin resistance in malaria treatment. This approach addresses critical ethical and practical challenges for effective malaria control in Africa.
Area of Science:
- Tropical Medicine
- Pharmacology
- Public Health
Background:
- Malaria significantly impacts African children under five, necessitating effective treatments for control and elimination.
- Artemisinin-based combination therapies (ACTs) are first-line malaria treatments, but emerging drug resistance in Southeast Asia poses a threat to their efficacy.
- Resistance to ACTs could spread to Africa, jeopardizing malaria control gains.
Discussion:
- Triple artemisinin-based combination therapy (TACT) is proposed to mitigate artemisinin and partner drug resistance.
- This paper examines ethical tensions and practical implementation issues associated with TACT deployment in Africa.
- Lessons from ACT introduction and clinical studies inform the discussion on TACT's potential.
Key Insights:
- TACT development is crucial for addressing artemisinin resistance in Africa.
- Ethical considerations and practicalities are vital for successful TACT implementation.
- Proactive strategies are needed to safeguard malaria treatment efficacy.
Outlook:
- TACT offers a promising strategy to overcome drug resistance and sustain malaria elimination efforts.
- Addressing ethical and practical challenges is key to realizing TACT's potential.
- Continued research and careful implementation are essential for malaria control in Africa.
Abstract:
Malaria remains a major cause of morbidity and mortality in Africa, particularly in children under five years of age. Availability of effective anti-malarial drug treatment is a cornerstone for malaria control and eventual malaria elimination. Artemisinin-based combination therapy (ACT) is worldwide the first-line treatment for uncomplicated falciparum malaria, but the ACT drugs are starting to fail in Southeast Asia because of drug resistance. Resistance to artemisinins and their partner drugs could spread from Southeast Asia to Africa or emerge locally, jeopardizing the progress made in malaria control with the increasing deployment of ACT in Africa. The development of triple artemisinin-based combination therapy (TACT) could contribute to mitigating the risks of artemisinin and partner drug resistance on the African continent. However, there are pertinent ethical and practical issues that ought to be taken into consideration. In this paper, the most important ethical tensions, some implementation practicalities and preliminary thoughts on addressing them are discussed. The discussion draws upon data from randomized clinical studies using TACT combined with ethical principles, published literature and lessons learned from the introduction of artemisinin-based combinations in African markets.
