Multiple first-line therapies as part of the response to antimalarial drug resistance

Partial resistance to artemisinin, linked to Pfkelch13 mutations, has recently emerged in several African countries, leading to slower parasite clearance times. Artemisinin partial resistance does not lead to ACT failure where the partner medicines are still effective. However, additional resistance to partner drugs would jeopardize ACT effectiveness. To address this threat, WHO launched a strategy to respond to drug resistance in Africa in 2022. This strategy aims to improve detection, enable timely responses, and reduce resistance impact through evidence-based measures.

The strategy includes multiple measures, including one on multiple first-line therapies (MFT) which aims to extend the therapeutic lifespan of ACTs. This implementation guide provides guidance for malaria programmes by defining MFT, reviewing their impact on resistance, assessing implications for policy and implementation, and identifying evidence gaps for future research.