To what extent are the antimalarial markets in African countries ready for a transition to triple artemisinin-based combination therapies?

Abstract

Introduction Triple artemisinin-based combination therapies (TACTs) are being developed as a response to artemisinin and partner drug resistance in the treatment of falciparum malaria in Southeast Asia. In African countries, where current artemisinin-based combination therapies (ACTs) are still effective, TACTs have the potential to benefit the larger community and future patients by mitigating the risk of drug resistance. This study explores the extent to which the antimalarial drug markets in African countries are ready for a transition to TACTs. Methods A qualitative study was conducted in Nigeria and Burkina Faso and comprised in-depth interviews (n = 68) and focus group discussions (n = 11) with key actor groups in the innovation system of antimalarial therapies. Results Evidence of ACT failure in African countries and explicit support for TACTs by the World Health Organization (WHO) and international funders were perceived important determinants for the market prospects of TACTs in Nigeria and Burkina Faso. At the country level, slow regulatory and implementation procedures were identified as potential barriers towards rapid TACTs deployment. Integrating TACTs in public sector distribution channels was considered relatively straightforward. More challenges were expected for integrating TACTs in private sector distribution channels, which are characterized by patient demand and profit motives. Finally, several affordability and acceptability issues were raised for which ACTs were suggested as a benchmark. Conclusion The market prospects of TACTs in Nigeria and Burkina Faso will depend on the demonstration of the added value of TACTs over ACTs, their advocacy by the WHO, the inclusion of TACTs in financial and regulatory arrangements, and their alignment with current distribution and deployment practices. Further clinical, health-economic and feasibility studies are required to inform decision makers about the broader implications of a transition to TACTs in African counties. The recent reporting of artemisinin resistance and ACT failure in Africa might change important determinants of the market readiness for TACTs.

Ethical considerations in deploying triple artemisinin-based combination therapies for malaria: An analysis of stakeholders’ perspectives in Burkina Faso and Nigeria

“…Our study exemplified a mixture of ethical issues and factors relevant to policy and implementation. Our findings complement a recently reported study on regulatory and market positioning considerations of potentially deploying TACTs in Africa [28].…”

“…As outlined by public health ethics frameworks, the burdens of TACTs such as additional cost to end-users should be minimized [26]. National malaria control programmes would need to advocate for TACTs to be covered under national health insurance schemes, provided for free under donor programmes, or negotiate with drug developers to make these drugs more affordable to patients [28].…”

“…In this paper, we report findings of a qualitative study on the key ethical issues that should be anticipated to inform the effective potential deployment of TACTs in Africa. The analyses of the readiness of antimalarial markets in African countries for a transition to TACTs based on this qualitative study has been reported elsewhere [28]. Drawing on existing public health ethics frameworks and empirical qualitative data from in-depth interviews and focus group discussions in Nigeria and Burkina Faso, we discuss the ethical considerations for deploying TACTs in Africa and highlight the recommendations suggested by the stakeholders.…”

Expert perspectives on the introduction of Triple Artemisinin-based Combination Therapies (TACTs) in Southeast Asia: a Delphi study

“…Malaria experts expressed concerns about the potential of adverse effects and other safety risks for TACTs. Indeed, an increase in adverse events such as vomiting, headache and fatigue was also mentioned as a major risk for TACTs’ acceptance in Africa [ 42 ]. It is encouraging that clinical studies thus far suggest good tolerability of TACTs, except for a small increased risk of vomiting [ 14 ].…”

A framework for stakeholder engagement in the adoption of new antimalarial treatments in Africa: a case study of Nigeria

“…Suggestions include exploring the potential of rotating ACTs before high treatment failure rates are detected, deploying multiple rst-line therapies at the same time, and extending the duration of treatment regimens [12]. Additionally, triple artemisinin-based combination therapies (TACTs), where artemisinin is combined with two carefully selected, widely-used partner drugs is also proposed and being investigated as a possible strategy to prevent or delay artemisinin resistance from emerging [24][25][26][27][28][29]. All these strategies will require policy change, the context of which may be more complex depending on the type of treatment, required delivery methods, and health system variabilities among others.…”