Hot Topics in Malaria - PowerPoint PPT Presentation

1 / 42
About This Presentation
Title:

Hot Topics in Malaria

Description:

Should people living with HIV/AIDS be targeted for ITNs? ... The impact of HIV/AIDS on malaria infections in children is less clear. ... – PowerPoint PPT presentation

Number of Views:167
Avg rating:3.0/5.0
Slides: 43
Provided by: dca98
Category:
Tags: aids | hot | malaria | topics

less

Transcript and Presenter's Notes

Title: Hot Topics in Malaria


1
HOT TOPICS in MALARIA

Hot Topics in Malaria
2
USAID The Blind Hydra
USAID Fails to Buy DDT
.
.
Senate Bill Proposes to Move Malaria Program to
State
.
RBM Attacked as Failed Program
.
.
3
Welcome to the
Malaria Wars
4
(No Transcript)
5
(No Transcript)
6
Prevention
  • The most effective way to prevent malaria is
    through the selective and safe use of
    insecticides that kill the malaria transmitting
    mosquito.
  • There are two options for getting these
    insecticides into the homes of those most at
    risk indoor residual spraying (IRS) and
    insecticide-treated nets (ITNs).
  • USAID supports the use of both IRS and ITNs.

7
When is IRS the Best Option?
  • IRS is best suited for areas of unstable malaria,
    epidemic prone malaria, in urban settings when
    local transmission of malaria is well documented,
    and in refugee camps.
  • In each of these settings IRS has important
    advantages it has rapid and reliable short-term
    impact and can be targeted to communities at
    highest risk.
  • IRS is, however, relatively demanding in terms of
    the logistics, infrastructure, skills, planning
    systems and coverage levels.

8
When are ITNs the Best Option?
  • The consensus is that in endemic Africa (south of
    the Sahel and north of the Zambezi River) ITNs
    are the most practical and effective means for
    protecting the population
  • ITNs have been shown to be highly deployable in
    rural Africa using the existing NGOs, commercial
    sector, community groups and public sector
    infrastructure.

9
When are ITNs the Best Option?
  • ITNs provide significant protection to those
    sleeping under them, and can reduce all cause
    mortality in children by one-fifth and episodes
    of malaria by half.
  • Maintaining supply chains and behavioral
    promotion activities to keep ITNs widely
    available, insecticidally-active and effectively
    used is a challenge, but well-designed programs
    are having good success in many countries.

10
Are there Prohibitions Against Procuring
Insecticides?
  • USAID resources can be used to procure
    insecticides for its health programs, including
    DDT.
  • Purchase or use of insecticides require an
    environmental risk assessment.
  • The required environmental assessment procedures
    are described in Title 22 of the Code of Federal
    Regulations, Part 216 (22 CFR 216).

11
Should people living with HIV/AIDS be targeted
for ITNs?
  • Among adult men and non-pregnant women, HIV/AIDS
    may augment the risk of malaria illness,
    especially in those with advanced
    immuno-suppression.
  • In areas of unstable malaria transmission,
    HIV-infected adults with low CD4 cell counts may
    also be more susceptible to treatment failures of
    antimalarial drugs. In addition, acute malaria
    episodes temporarily increase viral replication
    and HIV viral load.
  • As an important cause of anemia, malaria
    frequently leads to blood transfusion, which is a
    potential risk factor for HIV infection

12
Should people living with HIV/AIDS be targeted
for ITNs?
  • The following are the recommended strategies for
    addressing the risk of malaria and HIV
    co-infection
  • In areas of malaria transmission protection by
    ITNs is a high priority for people living with
    HIV/AIDS.
  • HIV-positive pregnant women as risk of malaria
    should always be protected by ITNs, and in
    addition receive either intermittent preventive
    treatment with SP (at least 3 doses) or daily
    cotrimoxazole prophylaxis.

13
Are there any other new technologies on the
horizon?
  • An exciting new product that is expected to be on
    the market in early 2005 is a long-lasting
    retreatment KO Tab 1,2,3.
  • Employing a new technology that mixes traditional
    insecticide with chemical binders the
    traditional dipping of nets will be sufficient
    to transform them into long-lasting nets.
  • The advent of permanent retreatments creates an
    opportunity for transforming all of the
    traditional ITNs already in the field into
    long-lasting nets dramatically increasing the
    number of households benefiting from ITNs.

14
Are there any other new technologies on the
horizon?
  • In addition, USAID has been working with textile
    groups to develop a new LLIN using the KO Tab
    1,2,3 chemistry.
  • This LLIN will be marketed as Dawa plus and be on
    the market this summer - at significantly lower
    cost than current LLINs.

15
(No Transcript)
16
(No Transcript)
17
(No Transcript)
18
Treatment
  • Prompt treatment with a safe and effective
    antimalarial drug is a fundamental component of
    the World Health Organizations, Roll Back
    Malarias and USAIDs strategy to control
    malaria.
  • Correct use of antimalarial treatment will not
    only shorten the duration of malarial illness,
    but also reduce the frequency of complications
    and the risk of death.

19
What is the current status of antimalarial drug
resistance in the world?
  • The spread and intensification of antimalarial
    drug resistance represents one of the most
    serious challenges to malaria control worldwide.
  • In Southeast Asia, strains of P. falciparum have
    developed resistance to multiple antimalarial
    agents and very few drugs remain effective.
  • In South America, high levels of resistance to
    both chloroquine and SP are already present
    throughout the Amazon Basin.
  • In Africa south of the Sahara, chloroquine
    resistance is now widespread and increasing
    resistance to SP has been documented in East and
    southern Africa.

20
What drugs are currently recommended for
treatment of malaria?
  • WHO now recommends that all countries
    experiencing resistance to their current
    first-line single-drug antimalarial therapy
    change to combination therapy, preferably with an
    artemisinin drug.
  • Four ACT regimens are recommended
  • artemether-lumefantrine (Coartem),
  • amodiaquine-artesunate,
  • SP-artesunate, and
  • mefloquine-artesunate.
  • A fifth, non-ACT, combination, SP plus
    amodiaquine, is another alternative in settings
    where both drugs remain efficacious.

21
What is the status of ACTsupplies worldwide?
  • By 2006 worldwide demand for artemisinin is
    expected to increase to 150 million treatments
    (up from 50 million treatments in 2004).
  • This forecasted increase has to-date outstripped
    the worldwide production capacity for ACTs
    leading to shortfalls in supplies.
  • In response, USAID is supporting efforts to
    increase the cultivation in east Africa of
    Artemisia annua, the plant from which artemisinin
    is extracted, to increase availability of the raw
    product. This is expected to lead to an
    additional 50 million pediatric treatments by the
    end of 2005.

22
What is the status of ACTsupplies worldwide?
  • USAID, in addition, is actively working with
    pharmaceutical companies to upgrade their ACT
    production capacity.
  • By 2007 it is expected that worldwide supplies of
    ACTs will be more in line with demand. In the
    interim, strategic targeting of ACTs will be
    required to ensure that those countries with high
    levels of drug resistance have adequate drug
    supplies.

23
GFATM budget for all ACTs by PSM Plan stages and
by countries
24
Are there prohibitions against USAID purchasing
antimalarial drugs?
  • There are no prohibitions to the purchase of
    antimalarial drugs with USAID funds.
  • In the case of antimalarials, such as ACTs, which
    have not been approved by the Food and Drug
    Administration, they can still be purchased by
    USAID if their safety and efficacy have been
    demonstrated by a recognized authority, such as
    WHO.

25
Are there prohibitions against USAID purchasing
antimalarial drugs?
  • Generally, USAID has limited its purchase of
    antimalarials to emergency or transitional
    situations, finding it more effective to work
    with other financing institutions, such as the
    World Bank and the Global Fund to Fight AIDS,
    Tuberculosis and Malaria, to ensure adequate
    supplies of effective antimalarials.
  • USAID has focused its efforts on the provision of
    technical assistance to countries to update their
    malaria treatment policies, implement those new
    policies smoothly and effectively and monitor the
    results of the changes in policy.

26
Are people living with HIV/AIDS at greater risk
of malaria?
  • HIV infection diminishes the ability of pregnant
    women and immunocompromised adults to control P.
    falciparum infections.
  • The prevalence and intensity of malaria infection
    during in HIV patients is higher.
  • Similarly, patients with HIV infections are more
    likely to have symptomatic malaria infections and
    pregnant women have an increased risk for
    malaria-associated adverse birth outcomes.

27
Are people living with HIV/AIDS at greater risk
of malaria?
  • .
  • Co-infections with HIV/AIDS and malaria increase
    both the severity of illness and the risk of
    anemia.
  • For these reasons, accurate diagnosis and prompt
    therapy with a highly effective antimalarial drug
    regimen, preferably an ACT, is recommended.
  • The impact of HIV/AIDS on malaria infections in
    children is less clear.

28
Are there any new technologies or treatments on
the horizon?
  • Final approval of a new rectal artesunate
    treatment for severe malaria in children is
    expected in 2006.
  • A pediatric formulation of artemether-lumefantrin
    e (Coartem) should marketed by early 2008.
  • Several other new artemisinin combination
    therapies that are likely to be significantly
    less expensive than those currently available and
    co-formulated for easier compliance.should become
    available over the next 3-4 years. These include
    artesunate-chlorproguanil-dapsone (Lapdap) a
    combination of dihydroartemisinin and piperaquine
    (Artekin) and a combination of artesunate and
    pyronaridine.

29
(No Transcript)
30
(No Transcript)
31
(No Transcript)
32
Malaria in Pregnancy
  • .
  • The major impact of P. falciparum infection
    during pregnancy is related to anemia in the
    mother and the presence of parasites in the
    placenta.
  • The resulting impairment of fetal nutrition
    contributes to low birth weight and is a leading
    cause of poor infant survival and development in
    Africa.
  • There are between 100,000 and 200,000 deaths
    annually in Africa of infants from complications
    associated with malaria-related low birth weight.

33
Malaria in Pregnancy
  • . .
  • For areas with moderate to high levels of malaria
    transmission, such as most of sub-Saharan
    Africa,WHO recommends a three-pronged use of
    intermittent preventive treatment (IPT)
    insecticide-treated nets (ITN) and case
    management of malarial illnesses.

34
What is intermittent preventive treatment (IPT)?
  • IPT involves the administration of two or three
    full, curative antimalarial treatments with an
    effective drug, beginning in the second trimester
    after quickening.
  • At present SP is the only drug recommended by
    the WHO for IPT.
  • The spread of resistance of P. falciparum to SP
    in eastern and southern Africa has raised
    concerns about the efficacy of SP for IPT. The
    current guidance is that SP remains an effective
    strategy for IPT providing adequate protection
    from malaria infection in pregnant women.

35
What is intermittent preventive treatment (IPT)?
  • There are efforts, however, to identify
    alternative IPT options which would be
    introduced as evidence mounts that SP is no
    longer an effective option for IPT.
  • Since more than 70 of pregnant women in Africa
    attend antenatal clinics at least once during
    their pregnancy, the provision of IPT during ANC
    visits is both feasible and attractive.

36
Is IPT recommended for women living in areas of
low malaria transmission?
  • There is no evidence that pregnant women living
    in areas with low levels of malaria transmission,
    as found in Asia or Latin America, benefit from
    IPT and as such, is not recommended

37
What is the impact of HIV/AIDS on malaria during
pregnancy?
  • Co-infected pregnant women are at very high risk
    of anemia and malarial infection of the placenta.
    As a result, a considerable proportion of
    children born to women with HIV and malaria
    infection have low birth weight and are more
    likely to die during infancy.
  • It is unclear whether malaria during pregnancy
    increases the risk of mother-to-child
    transmission of HIV, as studies examining this
    relationship have shown conflicting results

38
What is the impact of HIV/AIDS on malaria during
pregnancy?
  • While the risk of malaria in HIV women is
    greatest during the first and second pregnancies,
    in the presence of HIV infection, the risk
    associated with placental malaria seems to be
    independent of the number of pregnancies, and
    multigravidae with HIV infection are similar to
    primagravidae without HIV infection in terms of
    their susceptibility to and the negative
    consequences of malaria infection.

39
What is the Recommended Treatment for HIV
Infected Pregnant Women?
  • A minimum of three doses of SP is required to
    obtain maximum protection. for HIV pregnant
    women living in areas with high levels of
    transmission

40
(No Transcript)
41
(No Transcript)
42
(No Transcript)
Write a Comment
User Comments (0)
About PowerShow.com