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The long-term goal in malaria control is elimination or even eradication. In Mozambique, the EDCTP-funded ADAM project is supporting the implementation of an evidence-based strategy for malaria elimination. With control activities starting in 2022, this demonstration project will generate practical insights that can be applied in a wider roll-out in other areas of the country. The project is co-funded by the South African Medical Research Council.
The elimination strategy is based on intensified vector control and six-monthly mass antimalarial drug administration for two consecutive years, followed by reactive targeted mass drug administration in areas where malaria persists. Previous studies have shown that mass drug administration reduced transmission sufficiently to enable initiation of more targeted (focal) mass drug administration, as recommended by WHO.
The Mozambique National Malaria Control Programme now has a goal of elimination of malaria in areas of low transmission intensity. The ADAM project has worked with the National Malaria Control Programme and other stakeholders to develop a delivery strategy and monitoring plan, based on integration of population-wide and follow-up targeted mass drug administration into routine activities. The first mass drug administration campaign was launched in Chidenguele, Mozambique, in December 2022.
Ganaplacide, formerly known as KAF156, is a new antimalarial compound, with a novel mechanism of action, being developed through a partnership between Novartis and the Medicines for Malaria Venture (MMV). It has been paired with an existing drug, lumefantrine, in a combination therapy, and a solid dispersion formulation has been developed to facilitate once-daily dosing.
As well as clearing malaria infections, including artemisinin-resistant strains, the ganaplacide–lumefantrine combination has the potential to block transmission of the malaria parasite. In a phase II trial, ganaplacide–lumefantrine was as efficacious as Coartem, the ‘gold-standard’ artemisinin combination therapy (ACT). EDCTP is now providing €10 million funding for a pivotal phase III trial of ganaplacide– lumefantrine in a range of sites, including Burkina Faso, Gabon, Mali and Niger. The German Federal Ministry for Education and Research (BMBF) is providing an additional €1 million funding.
The phase III study will be carried out by the West African Network for Clinical Trials of Antimalarial Drugs 2 (WANECAM 2). Previously with EDCTP funding, the WANECAM consortium carried out influential studies confirming the efficacy of pyronaridine–artesunate (Pyramax) and dihydroartemisinin–piperaquine ACTs.
Highlights from malaria-based projects in 2022 include the announcement of a phase III trial for an innovative drug treatment, plus the launch of a mass drug administration campaign as a demonstration project in Mozambique.
Progress in malaria projects