The meeting of the Bangladesh, Bhutan, India, Nepal, Sri Lanka (‎BBINS)‎ Malaria drug resistance monitoring network

Overview

A meeting of the BBINS Malaria Drug Resistance Monitoring Network was convened in New Delhi, India on 15–16 October 2019. Country representatives from BBINS countries (Bangladesh, Bhutan, India, Nepal and Sri Lanka) and Maldives, country office focal points, experts and partners attended the meeting.

An update of the recommendations of the 2018 meeting, and results of recent therapeutic efficacy studies (TES) or integrated drug efficacy surveillance (iDES) in these countries were presented. Updates on molecular marker Kelch 13 (K13) for tracking resistance to artemisinin and other malaria drugs, were also shared.

The countries then developed workplans and budgets for TES monitoring in 2020– 2021. Panel discussions were also held on updating malaria treatment regimens across countries, based on evidence generated from TES studies, and data on molecular markers for drug resistance.

The salient conclusions which emerged are:

1. Most countries in the Region have shown a decline in malaria cases;
2. First-line artemisinin-based combination therapies (ACTs) for both P. falciparum and P. vivax malaria, are currently effective in all countries;
3. K 13 mutations have been identified in the countries which have tested it, i.e., Bangladesh and India. However, these mutations are not resistanceconfirmed mutations, and are not linked to clinical treatment failure. Countries have been advised to conduct further investigation on reports of K 13 mutations.
4. Considering the challenges for TES, especially due to decline in the number of cases for enrollment, the enrollment criteria and study area need to be suitably modified without compromising technical/ethical issues.
5. Countries should strengthen capacities for microscopy and ensure quality assurance (QA) for TES. The external competency assessment (ECA) for microscopists, should include technicians engaged in TES studies.
6. Results/reports of TES studies should be shared with the country programme soon after completion, and countries encouraged to publish the same in national/ international journals.
7. WHO should support QA for polymerase chain reaction (PCR) and molecular markers.
8. Countries of the region, which are not part of the BBIINS Network but share borders with it, should also be invited for TES meetings.