Prof. Dr. Christian Burri Head of Department Department of Medicines Research London, 6 th May 2014...
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Transcript of Prof. Dr. Christian Burri Head of Department Department of Medicines Research London, 6 th May 2014...
Prof. Dr. Christian BurriHead of Department
Department of Medicines Research
London, 6th May 2014
Malaria - on the road to malaria elimination?
All-Party Parliamentary Group on Malaria & Neglected Tropical Diseases
Swiss Tropical & Public Health Institute
The Swiss TPH …… the Swiss Tropical Institute (STI) was
founded in 1943 as a public organisation based on a local government act
… is an associated institute of the University of Basel
… has the mandate to contribute to the improvement of the health of populations internationally and nationally through excellence in research, services, and teaching & training at the levels ofinnovation, validation & application
… has over 650 staff from over 60 nations, thereof ~80 PhD students
The Swiss TPH …… the Swiss Tropical Institute (STI) was
founded in 1943 as a public organisation based on a local government act
… is an associated institute of the University of Basel
… has the mandate to contribute to the improvement of the health of populations internationally and nationally through excellence in research, services, and teaching & training at the levels ofinnovation, validation & application
… has over 650 staff from over 60 nations, thereof ~80 PhD students
IntroductionMalaria cases and deaths in DRC
Source: WHO World Malaria Report 2013
0 50,000,000 100,000,000 150,000,000 200,000,0000
2,000,000
4,000,000
6,000,000
8,000,000
10,000,000
12,000,000
Burkina Faso
DRC
NigeriaUnited Republic of Tanzania
Uganda
Confirmed Malaria Cases & Deaths
Burkina FasoBurundiCôte d'IvoireDRCEthiopiaGhanaKenyaMalawiMaliMozambiqueNigerNigeriaUnited Republic of TanzaniaUgandaZambia
Population
Pres
umed
& C
onfir
med
Mal
aria
Cas
es
• “(Severe) Malaria Treatment with Injectable Artesunate”
• Despite change of WHO guidelines quinine still treatment of choice for treatment of severe malaria in DRC
To inform the NMCP of the DRC about the operational requirements and challenges of nationwide rolled out of injectable artesunate through a limited scope implementation study
MATIAS studyGoal
MATIASStudy design
Descriptive implementation study with a before-after evaluation in confirmed severe malaria cases Investigate operational issues
• Basic clinical assessment• Time & motion study• Feasibility & acceptability
Nov 12 Jan 13 Apr 13 June 13
Quinine Injectable artesunate
N=399 N=350
Study sites
Dem Rep Congo
HZ of Maluku2 study sites - CSHZ of Masina
1 study site - Hospital
HZ of Kimpese3 study sites - Hospital + 2 CS
HZ of Kisantu2 study sites - Hospital + 1 CS
MATIAS studyStakeholders involved in process
Programme national de la Lutte contre le Paludisme (PNLP)
World Health Organisation
Direction de la Pharmacie, des Médicaments et des Plantes Médicinales (3ème Direction)
UNICEF
Direction de la Lutte contre la Maladie (4ème Direction)
Global Fund
Centre de Pharmacovigilance, UniKin USAID, Presidential Malaria Initiative
Comité Scientifique du Paludisme SANRU
École de Santé Public Kinshasa Population Services International
Département de Parasitologie, UniKin Caritas
DfID
Centers for Disease Control and Prevention
Médecins sans Frontières
Guilin Pharmaceutical Co. Ltd.
ResultsKey outcomes
Quinine Artesunate
Overall mortality rate 15 (3.8%) 6 (1.7%)
Time to discharge - (days) 3 (1,9) 2 (1,9)
Overall personnel time - (min) 36 (13- 92) 33 (10-60)
If you had to make the choice between quinine and artesunate -which one would you choose ? (Patients)
3.3% 96.7%
Because of rapid action 35.3%
Because of no adverse effects 24.4%
Do you find more or less difficult to prepare artesunate compared to quinine?– less difficult (Staff)
75%
What is your level of satisfaction towards injectable artesunate – satisfied / very satisfied (Staff)?
100%
MATIASDissemination
• Inclusion into strategic plan 2013 – 2015 of NMCP
• Progressive implementation within 3 years (30, 50, 100%)
• Projected need for DRC
2013 2014 2015 2016
# vials (50mg/5ml)
0 247’116 216’450 438’062
# boxes of 10 0 2’471 2’165 4’381
Unit cost $ 66.2 66.2 66.2
Total cost $ 0 163’591 143’290 289’997