ORAL ARTEMISININ MONOTHERAPY MARKET STILL MAINTAINS A FOOTHOLD IN MYANMAR, 2015 Christina Riley 1 , Si Thu Thein 2 , Hnin Su Su Khin 2 ; ACTwatch Group* 1 1 PSI; 2 PSI /Myanmar * ACTwatch is a Population Services International (PSI) research project implemented in partnership with the London School of Tropical Medicine and Hygiene and Ministries of Health in project countries. ACTwatch is funded by the Bill and Melinda Gates Foundation, DFID and UNITAID. Poster contents do not necessarily reflect the views of the funders. For more information please visit www.actwatch.info or contact Megan Littrell at [email protected] . ASTMH, 65 th Annual Meeting, Atlanta, Nov 2016 CONCLUSION Availability and distribution of oral AMT is a serious problem throughout Myanmar, with particularly urgent need to address this problem in India border areas. It’s distribution, especially at sub-optimal dosing is likely to further exacerbate the spread of artemisinin resistance in Myanmar. Access to QA ACT treatment is low across domains with the exception of higher availability in AMTR program areas. There is urgent need for rapid national scale-up and strengthening of strategies, including those used by the private sector AMTR program, to rid oral AMT from the market, and increase access to QA ACT. Policy changes that ban the full import, distribution, and sale of oral AMT would create a far more conducive environment for the support of these activities. Figure 1: Selected study area Figure 2: Availability of QA ACT, CQ, & Oral AMT among private sector antimalarial-stocking outlets (Among all outlets with at least one antimalarial in stock on the day of the survey) Figure 3: Antimalarial market share within private sector outlets, by domain (Relative market volume (sale/distribution) of antimalarials) Figure 4: Oral AMT distribution over the past week among oral AMT-stocking outlets (Among all outlets with at least oral AMT in stock on the day of the survey) 0 10 20 30 40 50 60 70 80 90 100 AMTR Intervention N=785 AMTR Comparison N=350 Western/India Border N=823 Bangladesh Border/Rakhine N=638 National N=2,596 PERCENTAGE OF OUTLETS QA ACT Chloroquine Oral AMT 0 10 20 30 40 50 60 70 80 90 100 AMTR Intervention AMTR Comparison Western/India Border Bangladesh border/Rakhine National MARKET SHARE Any ACT Non-QA ACT Chloroquine Other Non-artemisinin Oral AMT Non-Oral AMT None distributed Distributed < 1 full course Distributed >= 1full course Figure 5: Median no. of 50mg oral AMT tablets typically dispensed to consumers, relative to the full course 2 tablets of oral AMT were typically dispensed to treat an adult, and sold for $0.36 Figure 6: Oral AMT time-to-expiry, among all oral AMT products audited, 2015 Among all oral AMT products in stock on the day of the survey Expired Less than 1 year 1-2 years Greater than 2 years BACKGROUND The containment of artemisinin resistance in Myanmar, historically an antimalarial resistance gateway to the India sub-continent and beyond, is crucial to global malaria control and elimination. Resistance containment relies on removal of oral artemisinin monotherapy (oral AMT), rapid infection detection and use of quality-assured artemisinin combination therapy (QA ACT) indicated for P. falciparum and chloroquine plus primaquine indicated for P. vivax. METHODS A 2015 outlet survey was conducted in the private sector within 4 domains: intervention and comparison areas in eastern/central Myanmar for the Artemisinin Monotherapy Replacement Project (AMTR) in operation since 2012; western border areas with India; and the Bangladesh border / Rakhine region. A sample of 28,664 private outlets was screened for availability of malaria testing and treatment, and an audit was completed for all available antimalarials and malaria rapid diagnostic tests (RDTs) across 4,064 outlets (Figure 1). RESULTS What types of antimalarials are available in the private sector in Myanmar? Among antimalarial-stocking private outlets, oral AMT availability was highest in the India Border (54%) and AMTR Comparison areas (31%) and lower in the Bangladesh border/Rakhine (15%) and AMTR intervention areas (25%). QA ACT was widely available in AMTR intervention areas (63%) but less so elsewhere (comparison, 30%; India border, 12%; Bangladesh border/Rakhine 17%). Chloroquine availability was particularly high in the west at 69% in the Bangladesh border/Rakhine area and 48% in the India Border area (Figure 2). What types of antimalarials are distributed in the private sector in Myanmar? The majority of antimalarials distributed by the private sector were the first-line treatments, QA ACTs (16-54%) and chloroquine (8-41%). QA ACT market share was highest in the AMTR Intervention area at 54%. Chloroquine was the antimalarial most often distributed in the other three domains. However, oral AMT distribution was also very common, with private sector market share ranging from 13% in the Bangladesh border/Rakhine region to 35% in the India Border region (Figure 3). How much oral AMT is typically distributed to consumers? One in four oral AMT-stocking outlets reportedly distributed the drug in the past week (Figure 4) and distribution of less than a full-course was very common. The median number of 50mg tablets dispensed to treat an adult was 2. This sub-optimal dosing is well below the recommended adult equivalent treatment dose of approximately 20 tablets (Figure 5). The median price per tablet was $0.16, indicating that 2 tablets of oral AMT ($0.32) is 10% cheaper than the median price of ACT ($0.36). What are the characteristics of oral AMT found in Myanmar? All oral AMT products found in Myanmar were manufactured in either Vietnam, China, or locally in Myanmar. Three-quarters of the available products were Artesunate®, manufactured by Mediplantex in Vietnam. Over 70% of Artesunate® by Mediplantex still had a shelf life of greater than two years at the time of the survey (Figure 6), suggesting that it had been manufactured quite recently and was imported no earlier than late 2013. LB-5410
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
ORAL ARTEMISININ MONOTHERAPY MARKET STILL MAINTAINS A FOOTHOLD IN MYANMAR, 2015
Christina Riley1, Si Thu Thein2, Hnin Su Su Khin2; ACTwatch Group* 1
1 PSI; 2 PSI /Myanmar
* ACTwatch is a Population Services International (PSI) research project implemented in partnership with the London School of Tropical Medicine and Hygiene and Ministries of
Health in project countries. ACTwatch is funded by the Bill and Melinda Gates Foundation, DFID and UNITAID. Poster contents do not necessarily reflect the views of the funders.
For more information please visit www.actwatch.info or contact Megan Littrell at [email protected].
ASTMH, 65th Annual Meeting, Atlanta, Nov 2016
CONCLUSIONAvailability and distribution of oral AMT is a serious problem throughout Myanmar, with particularly urgent need to address this problem in India border areas. It’s distribution, especially at sub-optimal dosing is likely to further exacerbate the spread of artemisinin resistance in Myanmar. Access to QA ACT treatment is low across domains with the exception of higher availability in AMTR program areas. There is urgent need for rapid national scale-up and strengthening of strategies, including those used by the private sector AMTR program, to rid oral AMT from the market, and increase access to QA ACT. Policy changes that ban the full import, distribution, and sale of oral AMT would create a far more conducive environment for the support of these activities.
Figure 1: Selected study area Figure 2: Availability of QA ACT, CQ, & Oral AMT among private sector
antimalarial-stocking outlets (Among all outlets with at least one antimalarial in
stock on the day of the survey)
Figure 3: Antimalarial market share within private sector outlets, by domain
(Relative market volume (sale/distribution) of antimalarials)
Figure 4: Oral AMT distribution over the past week among oral AMT-stocking outlets
(Among all outlets with at least oral AMT in stock on the day of the survey)
0
10
20
30
40
50
60
70
80
90
100
AMTRIntervention
N=785
AMTRComparison
N=350
Western/IndiaBorderN=823
BangladeshBorder/Rakhine
N=638
NationalN=2,596
PER
CEN
TAG
E O
F O
UTL
ETS
QA ACT Chloroquine Oral AMT
0
10
20
30
40
50
60
70
80
90
100
AMTR Intervention AMTR Comparison Western/India Border Bangladeshborder/Rakhine
National
MA
RK
ET
SH
AR
E
Any ACT Non-QA ACT Chloroquine Other Non-artemisinin Oral AMT Non-Oral AMT
None distributed
Distributed < 1 full course
Distributed >= 1full course
Figure 5: Median no. of 50mg oral AMT tablets typically dispensed to consumers, relative to the full course
2 tablets of oral AMT were
typically dispensed to treat an
adult, and sold for $0.36
Figure 6: Oral AMT time-to-expiry, among all oral AMT products audited, 2015
Among all oral AMT products in stock on the day of the survey
Expired
Less than 1 year
1-2 years
Greater than 2 years
BACKGROUND
The containment of artemisinin resistance in Myanmar, historically an antimalarial resistance
gateway to the India sub-continent and beyond, is crucial to global malaria control and
elimination. Resistance containment relies on removal of oral artemisinin monotherapy (oral
AMT), rapid infection detection and use of quality-assured artemisinin combination therapy (QA
ACT) indicated for P. falciparum and chloroquine plus primaquine indicated for P. vivax.
METHODS
A 2015 outlet survey was conducted in the private sector within 4 domains: intervention and
comparison areas in eastern/central Myanmar for the Artemisinin Monotherapy Replacement
Project (AMTR) in operation since 2012; western border areas with India; and the Bangladesh
border / Rakhine region. A sample of 28,664 private outlets was screened for availability of
malaria testing and treatment, and an audit was completed for all available antimalarials and
malaria rapid diagnostic tests (RDTs) across 4,064 outlets (Figure 1).
RESULTSWhat types of antimalarials are available in the private sector in Myanmar?
Among antimalarial-stocking private outlets, oral AMT availability was highest in the India Border
(54%) and AMTR Comparison areas (31%) and lower in the Bangladesh border/Rakhine (15%)
and AMTR intervention areas (25%). QA ACT was widely available in AMTR intervention areas
(63%) but less so elsewhere (comparison, 30%; India border, 12%; Bangladesh border/Rakhine
17%). Chloroquine availability was particularly high in the west at 69% in the Bangladesh
border/Rakhine area and 48% in the India Border area (Figure 2).
What types of antimalarials are distributed in the private sector in Myanmar?
The majority of antimalarials distributed by the private sector were the first-line treatments, QA
ACTs (16-54%) and chloroquine (8-41%). QA ACT market share was highest in the AMTR
Intervention area at 54%. Chloroquine was the antimalarial most often distributed in the other
three domains. However, oral AMT distribution was also very common, with private sector market
share ranging from 13% in the Bangladesh border/Rakhine region to 35% in the India Border
region (Figure 3).
How much oral AMT is typically distributed to consumers?
One in four oral AMT-stocking outlets reportedly distributed the drug in the past week (Figure 4)
and distribution of less than a full-course was very common. The median number of 50mg tablets
dispensed to treat an adult was 2. This sub-optimal dosing is well below the recommended adult
equivalent treatment dose of approximately 20 tablets (Figure 5). The median price per tablet was
$0.16, indicating that 2 tablets of oral AMT ($0.32) is 10% cheaper than the median price of ACT
($0.36).
What are the characteristics of oral AMT found in Myanmar?
All oral AMT products found in Myanmar were manufactured in
either Vietnam, China, or locally in Myanmar. Three-quarters of
the available products were Artesunate®, manufactured by
Mediplantex in Vietnam. Over 70% of Artesunate® by
Mediplantex still had a shelf life of greater than two years at the
time of the survey (Figure 6), suggesting that it had been
manufactured quite recently and was imported no earlier than late
2013.
LB-5410
Related Documents
