Over the past three years, TDR has been one of several partners supporting the Malakit Project, which has made significant progress in controlling malaria among hard-to-reach populations in Brazil, French Guiana and Suriname. The possibility of transferring this innovative intervention, which focuses on self-testing and self-care, to other countries such as Senegal and India is now being explored.
Gold miners in the Amazon are particularly vulnerable to malaria, given difficulties accessing healthcare in this remote region. In addition, their reliance on informal drug markets raises the risk of antimalarial resistance.
The Malakit intervention
Malakit intervention includes self-testing and self-care kits distributed to the mining community, aiming to ensure early diagnosis and proper treatment adherence. The diagnostic kit includes three single-use rapid diagnostic tests and illustrated step-by-step instructions. If a test result is positive, the treatment kit offers an artemisinin combination therapy (ACT), a single dose of primaquine and paracetamol.
The Malakit intervention appears to have accelerated the decline in malaria incidence in the region by 43% between April 2018 and March 2020, the researchers reported in a paper published in Lancet Regional Health in 2021.
Since then, TDR has been supporting research on implementing and scaling up the Malakit approach to:
-generate additional data on enhancing the kit's effectiveness and make it available to a larger population;
-improve the understanding of malaria drug resistance;
-address current challenges in distributing Malakit; and
-foster discussion on managing residual malaria in target populations in the region.
Scaling up and transferring the approach to other regions
After a two-year experimental period (2018–2020), the strategy was integrated into the Surinamese National Malaria Elimination Programme (NMEP). In 2024, it was integrated into French Guiana’s Regional Malaria Elimination Plan 2024-2028, with mobile intervention teams set up to reach more miners. Brazil is also considering scaling up the intervention.
While scale-up efforts have faced challenges, lessons learned from implementation of Malakit in the Amazon region have prompted discussions on transferring the approach to other contexts, such as Senegal and India, which are currently conducting feasibility studies. TDR is providing financial and scientific support to the Senegalese Ministry of Health on a feasibility study, which includes adaptation of information, education, and communication tools.
In India, the Regional Medical Research Centre in Assam, under the Indian Council of Medical Research, is conducting a pilot study to evaluate the feasibility and effectiveness of introducing Malakit in the Tripura region, where a hard-to-reach population of Jhum cultivators and their children experience difficult access to malaria tests and treatment.
The Malakit Project holds promise for significantly reducing malaria transmission and may even allow countries to reach malaria elimination, as well as improving health outcomes in vulnerable communities in multiple malaria endemic regions around the world.
For more information, please contact Dr Florence Fouque.