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

Abstract

Chloroquine remains the first-line treatment for uncomplicated malaria in Haiti, and until recently, sulfadoxine-pyrimethamine was the second-line treatment. A few studies have reported the presence of molecular markers for resistance in Plasmodium falciparum parasites, and in vivo therapeutic efficacy studies (TESs) have been limited. Recognizing the history of antimalarial resistance around the globe and the challenges of implementing TESs in low-endemic areas, the Ministry of Health established a surveillance program to detect molecular markers of antimalarial resistance in Haiti. Sentinel sites were purposefully selected in each of Haiti's 10 administrative departments; an 11th site was selected in Grand'Anse, the department with the highest number of reported cases. Factors considered for site selection included the number of malaria cases identified, observed skills of laboratory technicians conducting rapid diagnostic tests (RDTs), stock and storage conditions of RDTs, accuracy of data reporting to the national surveillance system, and motivation to participate. Epidemiologic data from 2,437 patients who tested positive for malaria from March 2016 to December 2018 and consented to provide samples for molecular sequencing are presented here. Of these, 936 (38.4%) patients reported self-treatment with any medication since the onset of their illness before diagnosis; overall, 69 (2.8%) patients reported taking an antimalarial. Ten patients (0.4%) reported travel away from their home for at least one night in the month before diagnosis. Establishing a molecular surveillance program for antimalarial drug resistance proved practical and feasible in a resource-limited setting and will provide the evidence needed to make informed treatment policy decisions at the national level.

Making data map-worthy—enhancing routine malaria data to support surveillance and mapping of Plasmodium falciparum anti-malarial resistance in a pre-elimination sub-Saharan African setting: a molecular and spatiotemporal epidemiology study

“…Low and moderate transmission settings have started implementing centralized genomic surveillance. For instance, Haiti [ 90 ], Honduras [ 91 ] and South Africa [ 28 ] provide examples of national molecular surveillance, while the GenRe-Mekong study provides a model for regional surveillance [ 92 ]. However, a feasibility study and cost-effectiveness analysis may be needed to inform the relevance of such a system in high malaria transmission settings.…”

Assessment of Plasmodium falciparum anti-malarial drug resistance markers in pfcrt and pfmdr1 genes in isolates from Honduras and Nicaragua, 2018–2021

“…Therefore, there are six countries in the Americas that still use chloroquine and primaquine as first-line of treatment against uncomplicated P. falciparum malaria: Guatemala, Honduras, Nicaragua, Costa Rica, Haiti, and the Dominican Republic [ 1 ]. Given the imminent threat of the spontaneous appearance of mutant parasite strains due to drug exerted pressure, as well as increasing human migration to North America through the Central American isthmus [ 24 , 25 ], it is important to periodically monitor parasite populations for evidence of CQR [ 26 ]. This study is an effort to contribute to the routine surveillance of CQR in P. falciparum that has been carried out in Central America since 2010.…”

Assessment of Plasmodium Falciparum Antimalarial Drug Resistance Markers in pfcrt and pfmdr1 Genes in Isolates from Honduras and Nicaragua, 2018-2021

“…: Guatemala, Honduras, Nicaragua, Costa Rica, Haiti, and the Dominican Republic [1]. Given the imminent threat of the spontaneous appearance of mutant parasite strains due to drug exerted pressure, as well as increasing human migration to North America through the Central American isthmus, it is important to periodically monitor parasite populations for evidence of CQR [20,21]. This study is an effort to contribute to the routine surveillance of CQR in P. falciparum that has been carried out in Central America since 2010.…”