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| With the help of ACT Malaria training courses, microscopists in Vietnam and other Asia countries improve their skills at diagnosing malaria. |
Regional Infectious Diseases Program
BACKGROUND
The Greater Mekong Sub-region is burdened with over 343,000 confirmed cases of malaria and 4,130 malaria deaths annually, although the latter is likely much higher because of poor detection and reporting in underserved areas where the disease is most likely to occur. The sites that first provided the world with Chloroquine, sulfadoxine-pyrimethamine, and mefloquine resistance are now showing increasing failure rates to artemisinin combination therapy. TB is still a serious problem in the Mekong countries with over 830,000 new infectious cases and about 17,000 deaths each year; unless addressed, co-infection with HIV/AIDS and the emergence of multiple-drug resistant (MDR) strains of TB will continue to generate additional cases of TB. While coverage of quality TB and malaria services has gradually expanded over the past few years, marginalized groups, such as migrants, the poor, and prisoners, are still generally underserved. Poor quality drugs and inappropriate use of drugs result in ineffective treatment and the creation of drug resistance.
ACTIVITY DESCRIPTION
Activities in the Greater Mekong Sub-region continue to focus on TB, malaria, dengue fever, disease surveillance, and infectious disease prevention and control in underserved populations, including migrants and host communities on the Thai-Burmese border. Continued strengthening and expansion of TB treatment using directly observed treatment strategy (DOTS), monitoring of MDR-TB, enhancing collaboration between HIV and TB vertical programs, and developing better linkages between the public and private sector are major areas of focus for TB-funded projects. Malaria-related activities are closely linked via the Mekong Roll Back Malaria Initiative and include continued monitoring of drug efficacy and drug quality, examining adherence to therapy and inappropriate drug use, continued sub-regional capacity-building through training, and enhanced regional coordination efforts. Dengue fever support is focusing on improving surveillance, strengthening case management at the peripheral levels, and to explore innovative approaches to control and prevention.
Mekong Malaria Initiative
During the past year, 5 Mekong countries (Cambodia, China, Laos, Thailand, Vietnam) conducted routine anti-malarial drug efficacy and quality testing and two countries (Thailand, Cambodia) conducted studies to determine to what extent the recommended malaria treatment is being used by patients. Support was provided to Cambodia, China, Laos, and Vietnam for developing and/or implementing malaria activities funded by the GFATM.
ACTMalaria
USAID in support of ACTMalaria (Asian Collaborative Training Network for Malaria) brings together National Malaria Control Programs from Bangladesh, Burma, Cambodia, China, Indonesia, Lao PDR, Malaysia, Philippines, Singapore, Thailand, and Vietnam for collaborative training of staff. ACTMalaria also serves to enhance communication among member countries on malaria problems affecting common borders through the ACTMalaria Information Resource Center.
Regional TB
Implementation of TB/HIV surveillance in a demonstration project in Cambodia and completion of a regional study on TB and poverty. Support was also provided for laboratory quality assurance for TB (Cambodia and Viet Nam) and development and implementation/monitoring of GFATM-funded TB programs in Cambodia, China, Laos, Vietnam.
Asian Network of Excellence in Quality Assurance of Medicines (ANEQAM)
USAID/RDMA has initiated a new regional framework to address the issue of drug quality in the Asia region. ANEQAM pulls together drug quality testing expertise from Centers of Excellence based in Thailand and the Philippines, combined with assistance from WHO and the United States Pharmacopeia, and provides regional technical assistance on various aspects of drug quality assurance including drug control management systems, laboratory testing methods, confirmation testing, good manufacturing practices, bioavailability studies, among others. Already RDMA/OPH-funded partners in the network have described serious problems in multiple countries in the Mekong Sub-region with infectious disease drugs in the region and engaged partners at various levels to seek solutions.
Asia-Pacific Dengue Partnership
RDMA/OPH is supporting the creation of the Asia-Pacific Dengue Partnership which aims to coordinate countries in the Asia-Pacific region to follow WHO recommendations of implementation of (1) Prevention of dengue through integrated vector management; (2) Standard case management; (3) Epidemic prevention and control; and (4) Partnerships. The partnership also enhances the collection of dengue/dengue hemorrhagic surveillance data at country level using geographic information systems and DengueNet
ACHIEVEMENTS
Selected ID achievements are presented below:
- Currently, Cambodia, Thailand, and Vietnam have 100% DOTS coverage for TB control and Burma, Thailand, and Vietnam have reached or maintained case detection rates above the 70% target level. At the same time, Cambodia, China, and Vietnam have maintained treatment success levels well above the 85% target level.
- Counterfeit antimalarial drugs have been found in all six countries of the Greater Mekong Sub-region. Efforts by USAID funded partners have applied pressure at both the drug retail levels and through efforts by WHO and Interpol at the manufacturer levels. Recent surveillance of drug quality revealed no further counterfeit drugs where there once were multitudes.
- USAID funds supporting dengue fever control efforts were mobilized in Lao PDR during recent epidemics which contributed significantly to reductions in morbidity associated with dengue.
- The ACTMalaria Resource Center, an online library catering to the needs of information-seekers relating to malaria was successfully launched. The database is designed to compile a bibliographic listing of all materials related to malaria and other mosquito-born diseases. It will provide users information on what is available and how to access it.
CONTACTS
Cathy Bowes, SUVP Health Development Offiver
Dr. John MacArthur, Intectious Diseases Advisor
Office of Public Health
U.S. Avency for International Development, RDMA
GPF Witthayu Tower A
93/1 Wireless Road
Bangkok 10330 Thailand
Office: (66-2) 263-7404
Fax: (66-2) 263-7499
E-mail: cbowes@usaid.gov, jmacarthur@usaid.gov FURTHER READING
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