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Unitaid and the race to end malaria Unitaid News – October 2019

Unitaid and partners are jump-starting innovations for the prevention, diagnosis and treatment of malaria. This month’s newsletter gives updates from three of our innovative prevention projects.

Contents

1. At the starting line: the New Nets Project

2. At the halfway mark: TIPTOP for a safe pregnancy

3. At the finish line: new-generation insecticides

The New Nets Project hits the ground running

The first shipment of new-generation mosquito nets—1.2 million of them—has just arrived in Rwanda. A second batch, of two million nets, will be distributed in Burkina Faso in early November.

The deliveries mark the beginning of an intense phase for the New Nets Project, which intends to establish bed nets treated with new insecticide combinations as an important tool against malaria-carrying mosquitoes, particularly those that can no longer be killed by pyrethroid, the insecticide used on previous generations of nets. The project will build the evidence needed to allow the World Health Organization to consider making new policy for the use of these nets and will also assess their cost-effectiveness under pilot conditions.

“I’m pleased to say that the national mass-distribution campaign is about to begin,” said Dr. Aimable Mbituyumuremyi of Rwanda Ministry of Health’s Biomedical Centre. “We expect these new types of nets to work against resistant mosquitoes and contribute to a decrease in malaria incidence.”

The US$ 66 million cost of the project is being shared equally by Unitaid and the Global Fund. IVCC will head the project, working with London School of Hygiene and Tropical Medicine (LSHTM), Population Services International (PSI) and PATH.

One of the best ways to avoid malaria is to sleep under a long-lasting mosquito net treated with insecticide. But mosquitoes are incredibly good at adapting to survive. Over the past 15 years, they have developed resistance to the insecticides used on nets.

Mali, Mozambique, Nigeria and Côte d’Ivoire are the next countries set to receive the nets, in 2020.

TIPTOP is bending the curve to prevent malaria in pregnancy

Our TIPTOP project with Jhpiego set out to discover if we could increase malaria prevention for pregnant women by sending health workers straight to their front doors with the right medicine. The idea is to combine malaria prevention with prenatal care, and in doing so, increase both.

Now at its halfway point, the five-year project is yielding very encouraging results. Malaria prevention for pregnant women is way up, and prenatal care is increasing or holding steady in the four participating countries: Democratic Republic of the Congo, Madagascar, Mozambique and Nigeria.

“During the first phase of the project we worked hard to promote TIPTOP, through community leaders, project launches, and so forth,” said Kristen Vibbert, senior program officer at Jhpiego, an international nonprofit organization affiliated with Johns Hopkins University. “So the pregnant women in the TIPTOP countries are not surprised at all when the community health workers knock on their doors.”

TIPTOP has increased antimalaria coverage in pregnancy 74 percent on average across the four countries and is on track to reach 100,000 pregnant women. But the project aspires to make a much broader impact. It is gathering evidence that could lead the World Health Organization to update its policy on malaria prevention for pregnant women. TIPTOP promotes a new model that involves community outreach. They call it a “no missed opportunities” approach.

“A policy change would have a monumental impact on maternal and newborn health,” said Elaine Roman, TIPTOP project director. “It would be a game-changer in sub-Saharan Africa, as women will have more opportunities to get the right medicines, at the right time, and right in their own communities.”

TIPTOP countries are positioning themselves to move into the project’s second phase, which is set to start in November. Plans are to expand TIPTOP to include two new districts in each country. To mark the milestone, Jhpiego today released a short film about progress thus far:

To hear an in-depth conversation about TIPTOP and malaria in pregnancy, listen to Voice of America’s Health Chat host Linord Moudou interview Jhpiego’s Elaine Roman:

To learn about Unitaid’s role in TIPTOP, click here.

New-generation insecticides take their rightful place in the malaria toolbox

Unitaid’s four-year project on new-generation insecticides wraps up December, having clearly proved the worth of innovative sprays in helping protect African communities from malaria-carrying mosquitoes.

Launched in 2016, the NgenIRS project was Unitaid’s first foray into vector control. Liverpool-based IVCC and partners are implementing the project, whose aim is to bring new, long-lasting indoor insecticides that can kill the robust and wily mosquito populations that have become impervious to older insecticides. Sixteen countries have participated.

Before the project began, only one long-lasting indoor spray was available that could still kill these extra-tough mosquitoes, and it was too expensive for many countries to afford. As a result, indoor spraying had declined or disappeared altogether, although it had once been effective and well-accepted.

It seemed that an important malaria tool was on the verge of extinction.

“When the project started, it was actually uncertain if there was going to be a future for IRS (indoor residual spraying). Was there even going to be a marketplace?” said Christen Fornadel, technical coordinator at IVCC. “But then in comes the NGenIRS project and—long story short—today we’ve got prices reduced from over $23 down to around $15, a more stable market, more countries adding IRS, and IRS having expanded to three products for countries to choose from. I think by any of those indicators we’ve been successful.”

The next step, Fornadel said, will be to decide how long-lasting indoor spraying can best work with other established methods, and with coming innovations, in an integrated vector-management system.

Unitaid is now funding pilots of several new vector-control tools: spatial repellent sheets suitable for outdoor settings such as refugee camps, mass-distribution of antiparasitic drugs to disrupt mosquito populations, and new-generation bed nets.

Watch our animated video to learn more about the project.

Or read our project page on the NgenIRS project.

Coming up in November’s issue: Unitaid unveils new projects to fight tuberculosis at the 50th Union World Conference on Lung Health in Hyderabad, India. https://hyderabad.worldlunghealth.org