RAVREDA-AMI:
PAHO's Amazonian Network for the Surveillance of Antimalarial Drug Resistance (RAVREDA)
in Cooperation with
USAID's Amazon Malaria Initiative (AMI)
Background |
Development |
Expected Results |
Meetings |
Yearly Reports |
Project Proposals and Workplans: 2003–2004, 2002 | Practical Guide
In 1998, the Pan American Health Organization (PAHO), Regional Office of the World Health Organization (WHO), convened a group of experts in Brazil to review a protocol for monitoring the efficacy of anti-malarial drugs. The group developed a standardized method for evaluating the therapeutic efficacy of malarial drugs used in the management of P. falciparum cases in the Americas. Draft guidelines for assessment of the therapeutic efficacy of Chloroquine for P. vivax malaria were developed at the same meeting, revised by a PAHO-convened group in 2000 and subsequently reviewed in December 2001 at a WHO meeting on monitoring resistance to antimalarial drugs. With these developments, it is expected that guidelines for monitoring P. vivax will soon be available.
Within the framework of the Roll Back Malaria initiative in the Americas, PAHO has been supporting the Amazon countries in establishing a surveillance network using the protocol adapted by PAHO/WHO for monitoring anti-malarial drugs resistance in the Amazon (Red Amazónica para la Vigilancia de la Resistencia a las Drogas Antimaláricas /, RAVREDA), resulting from a request by countries at a meeting in Bahia, Brazil, in March 2001.
In October 2001, as part of the investment made by the US Agency for International Development (USAID) in the global Roll Back Malaria initiative, its Latin America and Caribbean Bureau for Infectious Diseases decided to give PAHO a grant for US$ ten million. PAHO initiated a program of activities with the support the USAID-funded Amazon Malaria Initiative (AMI). The project also contributes to the worldwide goal of Roll Back Malaria to significantly reduce the global burden of that disease through interventions adapted to local needs. It is expected that USAID funding for approximately US$ ten million will take place over the next five years.
PAHO’s Regional office will provide technical cooperation and coordinate project activities in the Amazon countries (Bolivia, Colombia, Ecuador, Guyana, French Guiana, Peru, Suriname, and Venezuela), where 95% of the 277,773 reported cases in the region for 2001 of Plasmodium falciparum occurred. Focal points at PAHO’s country offices will oversee implementation of the activities in six of the eight target countries of the Amazon Basin (Brazil, Colombia, Ecuador, Guyana, Suriname and Venezuela.). Support to Peru and Bolivia will be provided through the USAID field mission programs in those countries, in coordination with PAHO. The US Centers for Disease Control and Prevention (CDC) will provide technical assistance to support the implementation of regional and country-level activities. In addition, technical support to carry out studies will be provided by CDC personnel assigned to the Navy Medical Research Detachment in Lima (NAMRID) in Lima, and from the Peruvian National Institute of Health.
Funds provided by USAID to date have greatly contributed to the further development and strengthening of a regional network for the surveillance of antimalarial drug resistance. National surveillance networks were established in each target country to assess the efficacy of antimalarial drugs. In addition, studies of the efficacy of antimalarial drugs for P. falciparum were initiated, and studies of P. vivax drug resistance were contemplated in a few countries.
Regional Activities
During 2001-2002, major activities at regional level were the development of a priority agenda, the design of monitoring and evaluation of instruments for regional and national workplans. A technical meeting with participation of representatives of all participating countries, USAID, CDC and PAHO was held and partnership roles and responsibilities agreed upon. Sentinel sites have been selected in each country, drugs for testing identified and duration for studies defined; priority areas for additional operational research were completed, development of a call for proposals to access small grants is in progress. Information on the developments within the network will be disseminated through the PAHO web site. With the exception of Guyana, most countries either have technical competence or have recently undertaken in vivo studies. As a result, regional technical support was provided to Guyana to assist in initiating project activities.
National Activities
At the country level, activities focused on the establishment and support of a National Coordinating Technical Committee to operate and maintain a surveillance network of malaria in each country. Selection and rendering sentinel sites operational to initiate the collection of the data for the evaluation in vivo of the efficacy of the malarial drugs was also completed for those planned for the first year. During 2001/2002 sentinel sites were provided with equipment and supplies (Brazil, Colombia, Ecuador, Suriname, Venezuela) and training of human resources for the execution of the standardized protocols (Brazil, Ecuador, Suriname, Venezuela) and malaria microscopy and parasite density determination (Ecuador, Suriname). Activities focused on the evaluation of rapid tests for malaria diagnosis at sites in Suriname and Brazil, and studies were initiated. Implementation of rapid tests may be appropriate especially where health facilities do not exist and/or establishment of laboratory facilities is not considered feasible.
To facilitate dialogue and joint efforts among the target countries and their institutions, the first Technical Coordination Meeting was held in March 2002 to present the first-year work plans for all project partners. Additionally, sentinel sites or possible areas for undertaking both national and border studies for the prevention and control of antimalarial resistance were discussed. Preliminary commitments were established among expert institutions identified in South America and the national representatives of project target countries in relation to the requirements and needs for training and technical assistance of participating countries. A second steering committee meeting is proposed for September 2002 and work plans for the second and third year of the project are being developed for submission to USAID.
In another development, the PAHO Regional and PWR-Brazil offices have been collaborating with TDR and the Brazilian Ministry of Health in developing a multi-centric study of the combination antimalarial, Artemether and Lumefantrine (Coartem) in Amazonas and Pará states.
These activities are planned to generate a national capability to design and implement national and sub national anti malarial drug policy in the countries of the Region. As a rational method to contain the spread of anti-malarial resistant parasites.
- Second Technical Meeting, Belém, Pará, Brazil, March 2003 (forthcoming)
- First Technical Meeting, Santa Cruz, Bolivia, March 2002
- Background Meeting, Bahia, Brazil, March 2001
- Up to 2002: Status Report on Malaria Programs in the Americas (based on 2001 data)
- Up to 2001:Report on the Status of Malaria Programs in the Americas (based on 2000 data)
- 2000 data tables (in Spanish only)
Project Proposals and Workplans: 2003–2004 | 2002