“Last man standing” – tracking the evolution of Plasmodium falciparum resistance against artemisinin-based combination therapy in East-Africa

Objectives

This study aims to continue and deepen the temporal and spatial surveillance of selection of molecular markers associated with antimalarial drug resistance as an early warning system of evolution and spread of P. falciparum tolerance/resistance against ACT in Bagamoyo district, Tanzania, and Zanzibar.

In addition, the project will study if the efficacy, i.e. parasite clearance times (both by a novel real-time PCR based quantitative method and by microscopy) and PCR corrected cure rates, of artesunate-amodiaquine in Zanzibar and artemether-lumefantrine in Bagamoyo district, Tanzania, for treatment of uncomplicated P. falciparum malaria has been impaired by the selection of ACT tolerance/resistance markers that occurred in the respective parasite populations during a decade of wide-scale ACT use.

The data will provide improved understanding of the evolution of ACT resistance, and thus an opportunity for optimized surveillance strategies for ACT resistance.