BBINS Meeting, 19-21 August 2020

19 – 21 August 2020

The virtual meeting of the expanded Bangladesh, Bhutan, India, Nepal and Sri  Lanka (BBINS) Malaria Drug Resistance Monitoring Network including (Indonesia, Maldives and Timor-Leste) was convened from 19 to 21 August 2020 with following objectives :

General Objective:

To review antimalarial drug resistance through Therapeutic Efficacy Studies (TES) conducted in Bangladesh, Bhutan, India, Indonesia, Maldives, Nepal, Sri Lanka and Timor Leste

Specific Objectives: 

  1. Presentation and discussion of latest malaria drug efficacy monitoring data 

  2. Updates on molecular markers and available tools

  3. Updating of national plans for drug efficacy monitoring and the support through the networks

The participants included representatives from national malaria programmes and principal investigators from SEAR countries Bangladesh, Bhutan, India, Indonesia, Maldives Nepal, Sri Lanka and Timor-Leste; technical experts and partners; WHO country office focal points, representatives from WHO SEARO and HQ. The meeting started with welcome by Dr T. Aditama Ag. CDS, WHO SEARO followed by RD’s address which was read by Dr Pem Namgyal, Director, Programme Management.

Salient discussion points were as under:

The meeting started with Global and Regional updates including salient points of TES protocols and quality assurance and  an update on the recommendations of the 2019 meeting. Countries shared results of the recent therapeutic efficacy studies (TES) or integrated drug efficacy surveillance (iDES). Recent advances and status of molecular marker K13 for tracking artemisinin resistance and other molecular markers for malaria drug resistance were also shared. The countries then developed work plans and budgets for TES monitoring in 2021-2022. Panel discussion was  also held on challenges and mitigation measures for  conducting TES studies in context of Covid 19 ensuring safety of patients as well as health staff.

Salient recommendations were as under:

For the countries :

  • National treatment policies should be updated, if relevant, based on results of TES and WHO treatment guidelines. Countries are encouraged to include another ACT as a 2nd line (and ensure stock availability).

  • Protocols should be based on WHO standardized protocol (template) with relevant modification as per national regulations/ guidelines

  • If failure to achieve required sample size is a regular feature in high burden countries, the selection of the study sites needs to be re-visited during planning. Inform national and WHO EC of any site amendment. 

  • Countries near elimination should strengthen case based surveillance, including monitoring of response to antimalarials. Funding for this should be secured in a sustainable manner. Including them in their GF proposals is encouraged.

  • TES studies are totally relying on quality microscopy. Capacity building should continue even during present COVID-19 crisis using innovative methods

  • In the context of COVID-19, suspected cases should be tested as per national guidelines ensuring safety of the patients and the staff

  • Confirmed cases of malaria, if found to be positive for COVID-19, should not be included in TES, but should be treated as per national guidelines

  • If confirmed cases of malaria were found to be positive for COVID-19 during follow up, such cases should be withdrawn from the study and referred to health facility as per respective national guidelines

For WHO :

  • WHO should continue to support quality assurance for microscopy, PCR and molecular markers in the network / region, including  financial support, where relevant

  • WHO should provide technical support and  guidance to countries for quality implementation of TES in the light of dynamic situation of pandemic

  • WHO should support capacity building of Country Programmes for surveillance, which includes iDES.