scholarly journals Challenges Associated with Scaling up Artemisinin Combination Therapy in Sub-Saharan Africa A Review Article

2008 ◽  
Vol 3 (1) ◽  
pp. 42-48
Author(s):  
J. Njuguna ◽  
S.S. Qader
Keyword(s):  
Combination Therapy ◽  
Artemisinin Combination Therapy ◽  
Scaling Up ◽  
Review Article ◽  
Sub Saharan Africa ◽  
Sub Saharan

scholarly journals Persistence of mRNA indicative of Plasmodium falciparum ring-stage parasites 42 days after artemisinin and non-artemisinin combination therapy in naturally infected Malians

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Almahamoudou Mahamar ◽  
Kjerstin Lanke ◽  
Wouter Graumans ◽  
Halimatou Diawara ◽  
Koualy Sanogo ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Artemisinin Combination Therapy ◽  
Parasite Prevalence ◽  
Sub Saharan Africa ◽  
Ring Stage ◽  
Qrt Pcr ◽  
Sub Saharan ◽  
Stage Parasite ◽  
Ring Stage Parasite

Abstract Background Malaria control in sub-Saharan Africa relies upon prompt case management with artemisinin-based combination therapy (ACT). Ring-stage parasite mRNA, measured by sbp1 quantitative reverse-transcriptase PCR (qRT-PCR), was previously reported to persist after ACT treatment and hypothesized to reflect temporary arrest of the growth of ring-stage parasites (dormancy) following exposure to artemisinins. Here, the persistence of ring-stage parasitaemia following ACT and non-ACT treatment was examined. Methods Samples were used from naturally infected Malian gametocyte carriers who received dihydroartemisinin–piperaquine (DP) or sulfadoxine–pyrimethamine (SP–AQ) with or without gametocytocidal drugs. Gametocytes and ring-stage parasites were quantified by qRT-PCR during 42 days of follow-up. Results At baseline, 89% (64/73) of participants had measurable ring-stage parasite mRNA. Following treatment, the proportion of ring-stage parasite-positive individuals and estimated densities declined for all four treatment groups. Ring-stage parasite prevalence and density was generally lower in arms that received DP compared to SP–AQ. This finding was most apparent days 1, 2, and 42 of follow-up (p < 0.01). Gametocytocidal drugs did not influence ring-stage parasite persistence. Ring-stage parasite density estimates on days 14 and 28 after initiation of treatment were higher among individuals who subsequently experienced recurrent parasitaemia compared to those who remained free of parasites until day 42 after initiation of treatment (pday 14 = 0.011 and pday 28 = 0.068). No association of ring-stage persistence with gametocyte carriage was observed. Conclusions The current findings of lower ring-stage persistence after ACT without an effect of gametocytocidal partner drugs affirms the use of sbp1 as ring-stage marker. Lower persistence of ring-stage mRNA after ACT treatment suggests the marker may not reflect dormant parasites whilst it was predictive of re-appearance of parasitaemia.

scholarly journals Persistence of P. Falciparum Ring-Stage Parasites 42 Days After Artemisinin and Non-Artemisinin Combination Therapy in Naturally Infected Malians

2020 ◽  
Author(s):  
Almahamoudou Mahamar ◽  
Kjerstin Lanke ◽  
Wouter Graumans ◽  
Halimatou Diawara ◽  
Koualy Sanogo ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Artemisinin Combination Therapy ◽  
Sub Saharan Africa ◽  
Ring Stage ◽  
Treatment Groups ◽  
Qrt Pcr ◽  
Sub Saharan ◽  
Stage Parasite ◽  
Ring Stage Parasite

Abstract Background: Malaria control in sub-Saharan Africa relies upon prompt case management with artemisinin-based combination therapy (ACT). Ring-stage parasites, measured by sbp1 quantitative reverse-transcriptase PCR (qRT-PCR), were previously reported to persist after ACT treatment and hypothesized to reflect temporary arrest of the growth of ring-stage parasites (dormancy) following exposure to artemisinins. Here, we examined the persistence of ring-stage parasitemia following ACT and non-ACT treatment. Methods: We used samples from naturally infected Malian gametocyte carriers who received dihydroartemisinin-piperaquine (DP) or sulfadoxine-pyrimethamine (SP-AQ) with or without gametocytocidal drugs. Gametocytes and ring-stage parasites were quantified by qRT-PCR during 42 days of follow-up. Results: At baseline, 89% (64/73) of participants had measurable ring-stage parasites. Following treatment, the proportion of ring-stage parasite-positive individuals and ring-stage parasite densities declined for all four treatment groups. Participants who received DP had 81% lower post-treatment ring-stage parasite density compared to participants who received SP-AQ (p<0.001). Gametocytocidal drugs did not influence ring-stage parasite persistence. Ring-stage parasite densities on days 14 and 28 after initiation of treatment were higher among individuals who subsequently experienced recurrent parasitemia compared to those who remained free of parasites until day 42 after initiation of treatment (pday 14=0.011 and pday 28=0.068). We observed no association of ring-stage persistence with gametocyte carriage. Conclusions: Our findings of lower ring-stage persistence after ACT treatment without an effect of gametocytocidal partner drugs affirms the use of sbp1 as ring-stage marker and argues against preferential persistence of low densities of rings following ACT treatment. The implications of our findings for monitoring drug sensitivity require further study.

scholarly journals Persistence of P. Falciparum Ring-stage Parasites 42 Days After Artemisinin and Non-artemisinin Combination Therapy in Naturally Infected Malians

2020 ◽  
Author(s):  
Almahamoudou Mahamar ◽  
Kjerstin Lanke ◽  
Wouter Graumans ◽  
Halimatou Diawara ◽  
Koualy Sanogo ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Artemisinin Combination Therapy ◽  
Sub Saharan Africa ◽  
Ring Stage ◽  
Treatment Groups ◽  
Qrt Pcr ◽  
Sub Saharan ◽  
Stage Parasite ◽  
Ring Stage Parasite

Abstract BackgroundMalaria control in sub-Saharan Africa relies upon prompt case management with artemisinin-based combination therapy (ACT). Ring-stage parasites, measured by sbp1 quantitative reverse-transcriptase PCR (qRT-PCR), were previously reported to persist after ACT treatment and hypothesized to reflect temporary arrest of the growth of ring-stage parasites (dormancy) following exposure to artemisinins. Here, the persistence of ring-stage parasitemia following ACT and non-ACT treatment was examined. MethodsSamples were used from naturally infected Malian gametocyte carriers who received dihydroartemisinin-piperaquine (DP) or sulfadoxine-pyrimethamine (SP-AQ) with or without gametocytocidal drugs. Gametocytes and ring-stage parasites were quantified by qRT-PCR during 42 days of follow-up. ResultsAt baseline, 89% (64/73) of participants had measurable ring-stage parasites. Following treatment, the proportion of ring-stage parasite-positive individuals and ring-stage parasite densities declined for all four treatment groups. Participants who received DP had 81% lower post-treatment ring-stage parasite density compared to participants who received SP-AQ (p<0.001). Gametocytocidal drugs did not influence ring-stage parasite persistence. Ring-stage parasite densities on days 14 and 28 after initiation of treatment were higher among individuals who subsequently experienced recurrent parasitemia compared to those who remained free of parasites until day 42 after initiation of treatment (pday 14=0.011 and pday 28=0.068). No association of ring-stage persistence with gametocyte carriage was observed. Conclusions Our findings of lower ring-stage persistence after ACT treatment without an effect of gametocytocidal partner drugs affirms the use of sbp1 as ring-stage marker. Lower persistence of ring-stage parasites after ACT treatment suggests the marker may not reflect dormant parasites whilst it was predictive of re-appearance of parasitemia.

scholarly journals Promoting Scale-Up Across a Global Project Platform: Lessons from the Evidence to Action Project

2021 ◽  
Author(s):  
Laura Ghiron ◽  
Eric Ramirez-Ferrero ◽  
Rita Badiani ◽  
Regina Benevides ◽  
Alexis Ntabona ◽  
...  
Keyword(s):  
Family Planning ◽  
Scale Up ◽  
Scaling Up ◽  
Sub Saharan Africa ◽  
Health System Strengthening ◽  
Country Level ◽  
Look Ahead ◽  
Republic Of The Congo ◽  
Sub Saharan ◽  
Multi Stakeholder

AbstractThe USAID-funded flagship family planning service delivery project named Evidence to Action (E2A) worked from 2011 to 2021 to improve family planning and reproductive health for women and girls across seventeen nations in sub-Saharan Africa using a “scaling-up mindset.” The paper discusses three key lessons emerging from the project’s experience with applying ExpandNet’s systematic approach to scale up. The methodology uses ExpandNet/WHO’s scaling-up framework and guidance tools to design and implement pilot or demonstration projects in ways that look ahead to their future scale-up; develop a scaling-up strategy with local stakeholders; and then strategically manage the scaling-up process. The paper describes how a scaling-up mindset was engendered, first within the project’s technical team in Washington and then how they subsequently sought to build capacity at the country level to support scale-up work throughout E2A’s portfolio of activities. The project worked with local multi-stakeholder resource teams, often led by government officials, to equip them to lead the scale-up of family planning and health system strengthening interventions. Examples from project experience in the Democratic Republic of the Congo, Kenya, Nigeria, and Uganda illustrating key concepts are discussed. E2A also established a community of practice on systematic approaches to scale up as a platform for sharing learning across a variety of technical agencies engaged in scale-up work and to create learning opportunities for interacting with thought leaders around critical scale-up issues.

Scaling Up HIV/AIDS Care Among Women in Sub-Saharan Africa: Cross-Cultural Barriers

2013 ◽  
pp. 249-265 ◽  
Author(s):  
Damalie Nakanjako ◽  
Florence Maureen Mirembe ◽  
Jolly Beyeza-Kashesya ◽  
Alex Coutinho
Keyword(s):  
Scaling Up ◽  
Cross Cultural ◽  
Sub Saharan Africa ◽  
Cultural Barriers ◽  
Sub Saharan ◽  
Hiv Aids

scholarly journals Scaling up Family Medicine in Uganda

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Innocent K. Besigye ◽  
Jane F. Namatovu
Keyword(s):  
Family Medicine ◽  
Health Systems ◽  
Family Physicians ◽  
Scaling Up ◽  
Sub Saharan Africa ◽  
Potential Contribution ◽  
Training Institutions ◽  
Sub Saharan ◽  
Health Managers

It is evident that politicians, health managers and academics are realising the potential contribution of Family Medicine to health systems in sub-Saharan Africa. The challenge is in training institutions to recruit and train enough Family Physicians in order to meet expectations. The 3rd Family Medicine Conference in Uganda, held in October 2013, explored innovative ways of scaling up Family Medicine training and practice in Uganda.

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