In collaboration with TDR, the Global Fund, and the Pan American Health Organization (PAHO), scientists are conducting research to support implementation of a promising malaria self-diagnosis and self-treatment kit for hard-to-reach populations in Suriname, Brazil and French Guiana.
While Suriname is now very close to achieving elimination of malaria, foci of transmission of the disease persist among illegal migrant workers crossing the borders with Brazil and French Guiana. These populations are often traveling to and from gold mines in the Amazon rainforest and have very little or no access to health services.
To address this challenge, an innovative self-diagnosis and self-treatment kit called Malakit was developed through a collaboration between three scientific centres: the Centre d'Investigation Clinique Antilles-Guyane (Cayenne Hospital in French Guiana), the Oswaldo Cruz Foundation in Brazil and the Foundation for the Advancement of Scientific Research in Suriname. Operational research on Malakit was carried out between 2018 and 2020 in the Suriname-French Guiana border and the Brazil-French Guiana border regions with the support of several institutions, including the Global Fund to Fight AIDS, Tuberculosis and Malaria and PAHO.
Published results of this tri-national pilot trial showed that Malakit was used correctly by 72% of the 223 persons who reported using it. The intervention appears to have accelerated the decline in malaria incidence in the study sites by 43%.
This encouraging result has prompted the research team and Suriname’s Ministry of Health to include the kits in their routine tools against malaria and to evaluate the potential for further deployment through improving the diagnostic of the G6PD deficiency. Following discussions between the Global Fund, TDR and the respective ministries of health and research teams, a research project has been developed to improve the impact of this Malakit intervention.
The project involves the following three activities:
- Tailoring messages on drug resistance: An earlier study revealed that some people do not understand the risks of not taking the full treatment course. A qualitative study will be conducted to better understand how the concept of drug resistance is explained to the gold miner population. An adaptation of the educational tools (such as drawings and videos) will be made in consultation with the population, taking into consideration factors such as language and education level.
- Adapting Malakit to target Plasmodium vivax (P. vivax): Until now, Malakit has been mostly targeting the Plasmodium falciparum parasite, which has declined significantly in the region. As P. vivax is now the primary parasite to target, Malakit must now be adapted for this use and allow for the detection of G6PD deficiency, in order to deliver the adapted treatment.
- Support regional discussions on malaria management in hard-to-reach populations: A regional workshop, with participation of countries and organizations that have been tackling similar malaria transmission contexts, will provide a forum for sharing experiences. Evaluation of the first two activities will be presented at the workshop, which is scheduled to take place in mid-2022.