Antimalarial and antimicrobial drug resistance
A series of observational and treatment trials have been completed characterising increasing antimalarial drug resistance in the region and defining the relative contributions of artemisinin and ACT partner drug resistance to treatment failure.
The studies confirm the evolution over time of artemisinin resistance, with a single PfKelch mutation, C580Y, becoming dominant. A C580Y mutated, relatively fit P. falciparum lineage has now spread from western Cambodia over a large geographical area including north-eastern Thailand, southern Laos, and southern Vietnam, and during this course has acquired piperaquine resistance. Laboratory transcriptomic studies have confirmed that oxidative stress and protein damage responses mediate artemisinin resistance in malaria parasites.
The Africa Asia Programme is actively involved in SEDRIC and in the IHME-led project to assess the burden of and map antimicrobial drug resistance (AMR) globally. We are working on novel ways to collect high-quality AMR data with associated clinical outcomes and will soon start the ACORN project to assess this in Cambodia and Vietnam. Antibiotic usage was assessed in chicken farms in Thailand, and the concept of the ‘antibiotic footprint’ for food products promoted.