Malaria treatment policies and drug efficacy in Haiti from 1955-2012

Abstract

ObjectivesChloroquine (CQ), after 67 years of use in Haiti, is still part of the official treatment policy for malaria. Several countries around the world have used CQ in the past due to its low incidence of adverse events, therapeutic efficacy, and affordability, but were forced to switch treatment policy due to the development of widespread CQ resistance. The purpose of this paper was to compile literature on malaria treatment policies and antimalarial drug efficacy in Haiti over 67-year period.MethodsA systematic review of PubMed, Web of Science, and the Armed Forces Pest Management Board, was conducted to find pertinent documents on national malaria treatment policies and antimalarial drug efficacy studies in Haiti between 1955 and 2012. A total of 329 citations and abstracts were reviewed independently by two researchers, of which thirty three met the final inclusion criteria of studies occurring in Haiti between 1955 and 2012 which specifically discuss malaria treatment policies and drug efficacy.ResultsResults suggest that CQ has been the predominant antimalarial drug in use from 1955 to 2012. In 2010 single dose primaquine (PQ) was added to the national treatment policy, however it is not clear whether this new policy has been put into practice.ConclusionsAlthough no widespread CQ resistance has been reported, some studies have detected low levels of CQ resistance. Increased surveillance and monitoring for CQ resistance should be implemented in Haiti.

Nationwide Monitoring for Plasmodium falciparum Drug-Resistance Alleles to Chloroquine, Sulfadoxine, and Pyrimethamine, Haiti, 2016–2017

“…Investigations of P. falciparum resistance to chloroquine in Haiti have been numerous and ongoing since 1981. Even the first reports in the early 1980s found in vivo and in vitro evidence for possible resistance to chloroquine (27,28), which had been in use in Haiti at least since the 1950s (29). With the advent of mutations in the Pfcrt gene serving as molecular markers for chloroquine resistance (18,19), the Pfcrt K76T haplotype has been reported sporadically in Haiti since 2009, but always at very low rates (2,30).…”

Establishing a National Molecular Surveillance Program for the Detection of Plasmodium falciparum Markers of Resistance to Antimalarial Drugs in Haiti

“…1 Chloroquine (CQ) has been used to treat malaria in Haiti as either a monotherapy or combination drug since 1955. [2][3][4] Despite widespread resistance to CQ worldwide, in the Caribbean and Central America, P. falciparum remains sensitive to CQ. A 3-day course of CQ plus a single dose of primaquine (PQ) (to target the gametocytes and prevent ongoing transmission) is the first-line treatment for uncomplicated malaria in Haiti.…”

No Plasmodium falciparum Chloroquine Resistance Transporter and Artemisinin Resistance Mutations, Haiti

“…Haiti is a unique country in the Americas because malaria is caused there mainly by Plasmodium falciparum . Despite chloroquine being used for treatment of malaria since 1955, P. falciparum is generally still susceptible to this drug ( 1 ). Thus, chloroquine, plus a single dose of the gametocytocidal drug primaquine, is still the first-line treatment for uncomplicated malaria in Haiti, as indicated by the ministry of health.…”