To what extent are the antimalarial markets in African countries ready for a transition to triple artemisinin-based combination therapies?
Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
PLOS ONE
Abstract
Introduction
Triple artemisinin-based combination therapies (TACTs) are being developed as a response
to artemisinin and partner drug resistance in the treatment of falciparum malaria in Southeast
Asia. In African countries, where current artemisinin-based combination therapies
(ACTs) are still effective, TACTs have the potential to benefit the larger community and
future patients by mitigating the risk of drug resistance. This study explores the extent to
which the antimalarial drug markets in African countries are ready for a transition to TACTs.
Methods
A qualitative study was conducted in Nigeria and Burkina Faso and comprised in-depth
interviews (n = 68) and focus group discussions (n = 11) with key actor groups in the innovation
system of antimalarial therapies.
Results
Evidence of ACT failure in African countries and explicit support for TACTs by the World
Health Organization (WHO) and international funders were perceived important determinants
for the market prospects of TACTs in Nigeria and Burkina Faso. At the country level,
slow regulatory and implementation procedures were identified as potential barriers towards
rapid TACTs deployment. Integrating TACTs in public sector distribution channels was considered
relatively straightforward. More challenges were expected for integrating TACTs in
private sector distribution channels, which are characterized by patient demand and profit
motives. Finally, several affordability and acceptability issues were raised for which ACTs
were suggested as a benchmark.
Conclusion
The market prospects of TACTs in Nigeria and Burkina Faso will depend on the demonstration
of the added value of TACTs over ACTs, their advocacy by the WHO, the inclusion of
TACTs in financial and regulatory arrangements, and their alignment with current distribution
and deployment practices. Further clinical, health-economic and feasibility studies are
required to inform decision makers about the broader implications of a transition to TACTs
in African counties. The recent reporting of artemisinin resistance and ACT failure in Africa
might change important determinants of the market readiness for TACTs.
Description
RESEARCH ARTICLE
Keywords
antimalarial markets, African countries, triple artemisinin, triple artemisinin-based combination therapies