Trends in antimalarial medicine and malaria diagnostic availability in Cambodia between 2009 and 2013

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  • Treatment failure using the artemisinin combination therapies (ACT) artemether lumefantrine (AL), artesunate mefloquine (ASMQ) and dihydroartemisinin piperaquine (DHA PPQ ) has been detected in more than 10% of cases in Cambodia. 1 Factors believed to have contributed to emerging drug resistance in Cambodia include the unregulated sale of artemisinin monotherapies for over 40 years; limited access to ACTs; co-blistered ACTs that are not coformulated (facilitating continued use of artemisinin monotherapy); and ubiquitous counterfeit and sub-standard drugs. Current regulatory efforts and malaria policy are aimed at protecting artemisinin-based combination therapy (ACT) treatment efficacy.
  • To protect the efficacy of artemisinin, the sale of oral artemisinin monotherapy (oAMT) was banned in Cambodia in 2009 and strategies were deployed to enforce this ban through stronger regulation of private sector outlets.
  • To ensure parasite clearance in the context of evolving drug resistance, the first-line treatment for P. falciparum (Pf) in Cambodia changed from ASMQ to ASMQ or DHA-PPQ in 2012 following targeted use of DHA-PPQ since 2009 in artemisinin resistance containment areas.
  • The 2012 national malaria treatment guidelines state that all suspected malaria cases should receive confirmatory testing prior to treatment.
  • Multiple strategies have been implemented to ensure the scale up of malaria blood testing and first-line treatment. These include a Village Malaria Worker (VMW) program supported within the public sector, and a social marketing approach in the private sector. Recent ACT and RDT subsidies available to the public and private sectors have been funded through the Global Fund including delivery of co-paid DHA-PPQ to first-line buyers in 2012 and 2013.