Modeling policy interventions for slowing the spread of artemisinin-resistant pfkelch R561H mutations in Rwanda.
Modeling policy interventions for slowing the spread of artemisinin-resistant pfkelch R561H mutations in Rwanda.
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DOI：
10.1038/s41591-023-02551-w
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发表时间：
2023-11
期刊：
影响因子：
82.9
通讯作者：
Boni, Maciej F.
中科院分区：
文献类型：
--
作者：
Zupko, Robert J.;Nguyen, Tran Dang;Ngabonziza, J. Claude S.;Kabera, Michee;Li, Haojun;Tran, Thu Nguyen-Anh;Tran, Kien Trung;Uwimana, Aline;Boni, Maciej F.
青蒿素联合疗法（ACTs）在治疗简单的恶性疟原虫疟疾方面非常有效，但在卢旺达出现的新的pfkelch 13 R561 H突变与寄生虫清除延迟有关，这表明需要采取干预措施来减缓其传播。使用卢旺达特定的空间校准的个人为基础的疟疾模型，我们评估26个战略，旨在尽量减少治疗失败和延迟R561 H的传播后3，5和10年。与目前的蒿甲醚-苯芴醇3天疗程相比，延长ACT疗程和部署多种一线治疗（MFT）减少了5年后的治疗失败。这些选择中最好的（MFT政策）导致中位治疗失败计数降低49%，中位R561 H等位基因频率比基线低0.15。耐药管理的新方法，如三联ACT或两种不同ACT的序贯疗程，预计比更长的ACT疗程或MFT具有更大的影响;这些方法与5年内的中位治疗失败计数相关，比当前方法低81-92%。迫切需要对目前在非洲流行的青蒿素耐药基因型采取政策应对措施，以防止整个人口的治疗失败率上升。一个模型调查了26种可能的疟疾治疗政策干预方案，结果表明，采用多种一线抗疟疗法是在5年内减缓卢旺达青蒿素耐药pfkelch R561 H突变传播的最有效的单一政策变化。
Artemisinin combination therapies (ACTs) are highly effective at treating uncomplicated Plasmodium falciparum malaria, but the emergence of the new pfkelch13 R561H mutation in Rwanda, associated with delayed parasite clearance, suggests that interventions are needed to slow its spread. Using a Rwanda-specific spatial calibration of an individual-based malaria model, we evaluate 26 strategies aimed at minimizing treatment failures and delaying the spread of R561H after 3, 5 and 10 years. Lengthening ACT courses and deploying multiple first-line therapies (MFTs) reduced treatment failures after 5 years when compared to the current approach of a 3-d course of artemether–lumefantrine. The best among these options (an MFT policy) resulted in median treatment failure counts that were 49% lower and a median R561H allele frequency that was 0.15 lower than under baseline. New approaches to resistance management, such as triple ACTs or sequential courses of two different ACTs, were projected to have a larger impact than longer ACT courses or MFT; these were associated with median treatment failure counts in 5 years that were 81–92% lower than the current approach. A policy response to currently circulating artemisinin-resistant genotypes in Africa is urgently needed to prevent a population-wide rise in treatment failures. A model investigating 26 possible malaria treatment policy intervention scenarios showed that introducing multiple first-line antimalarial therapies is the most effective single policy change in slowing the spread of artemisinin-resistant pfkelch R561H mutations in Rwanda over 5 years.
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影响因子：
11.8
作者：
Bergmann C;van Loon W;Habarugira F;Tacoli C;Jäger JC;Savelsberg D;Nshimiyimana F;Rwamugema E;Mbarushimana D;Ndoli J;Sendegeya A;Bayingana C;Mockenhaupt FP
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10.1016/s1473-3099(18)30068-9
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通讯作者：
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影响因子：
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作者：
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DOI：
10.3389/fepid.2022.1041896
发表时间：
2022-01-01
期刊：
Frontiers in epidemiology
影响因子：
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作者：
Boni, Maciej F
通讯作者：
Boni, Maciej F