Prof. Dr. Christian Burri Head of Department Department of Medicines Research London, 6 th May 2014 Malaria - o n the road to malaria elimination? All-Party Parliamentary Group on Malaria & Neglected Tropical Diseases

Swiss Tropical & Public Health Institute The Swiss TPH … …the Swiss Tropical Institute (STI) was founded in 1943 as a public organisation based on a local government act …is an associated institute of the University of Basel … has the mandate to contribute to the improvement of the health of populations internationally and nationally through excellence in research, services, and teaching & training at the levels of innovation, validation & application …has over 650 staff from over 60 nations, thereof ~80 PhD students The Swiss TPH … …the Swiss Tropical Institute (STI) was founded in 1943 as a public organisation based on a local government act …is an associated institute of the University of Basel … has the mandate to contribute to the improvement of the health of populations internationally and nationally through excellence in research, services, and teaching & training at the levels of innovation, validation & application …has over 650 staff from over 60 nations, thereof ~80 PhD students

Introduction Malaria cases and deaths in DRC Source: WHO World Malaria Report 2013

“(Severe) Malaria Treatment with Injectable Artesunate” Despite change of WHO guidelines quinine still treatment of choice for treatment of severe malaria in DRC  To inform the NMCP of the DRC about the operational requirements and challenges of nationwide rolled out of injectable artesunate through a limited scope implementation study MATIAS study Goal

MATIAS Study design  Descriptive implementation study with a before-after evaluation in confirmed severe malaria cases  Investigate operational issues Basic clinical assessment Time & motion study Feasibility & acceptability Nov 12 Jan 13 Apr 13 June 13 QuinineInjectable artesunate N=399N=350

Study sites Dem Rep Congo  HZ of Maluku 2 study sites - CS HZ of Masina 1 study site - Hospital HZ of Kimpese 3 study sites - Hospital + 2 CS HZ of Kisantu 2 study sites - Hospital + 1 CS

MATIAS study Stakeholders involved in process Programme national de la Lutte contre le Paludisme (PNLP) World Health Organisation Direction de la Pharmacie, des Médicaments et des Plantes Médicinales (3 ème Direction) UNICEF Direction de la Lutte contre la Maladie (4 ème Direction) Global Fund Centre de Pharmacovigilance, UniKin USAID, Presidential Malaria Initiative Comité Scientifique du Paludisme SANRU École de Santé Public Kinshasa Population Services International Département de Parasitologie, UniKin Caritas DfID Centers for Disease Control and Prevention Médecins sans Frontières Guilin Pharmaceutical Co. Ltd.

Results Key outcomes QuinineArtesunate Overall mortality rate15 (3.8%)6 (1.7%) Time to discharge - (days)3 (1,9)2 (1,9) Overall personnel time - (min) 36 (13- 92)33 (10-60) If you had to make the choice between quinine and artesunate - which one would you choose ? (Patients) 3.3%96.7% Because of rapid action 35.3% Because of no adverse effects 24.4% Do you find more or less difficult to prepare artesunate compared to quinine?– less difficult (Staff) 75% What is your level of satisfaction towards injectable artesunate – satisfied / very satisfied (Staff)? 100%

MATIAS Dissemination Inclusion into strategic plan 2013 – 2015 of NMCP Progressive implementation within 3 years (30, 50, 100%) Projected need for DRC # vials ( 50mg/5ml) 0247’116216’450438’062 # boxes of 10 02’4712’1654’381 Unit cost $ 66.2 Total cost $ 0163’591143’290289’997

SANRU Program Malaria elimination Access & sustainable success CHB

MATIAS Haemoglobin trend at follow up visits (Artesunate) Serious adverse events during follow up 7 SAEs reported in relation to anemia (2.0%) 2 patients referred to hospital 3 patients required blood transfusion 1 persistent form  No fatality