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首页> 外文期刊>The American Journal of Tropical Medicine and Hygiene >Comparing the Impact of Artemisinin-Based Combination Therapies on Malaria Transmission in Sub-Saharan Africa
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Comparing the Impact of Artemisinin-Based Combination Therapies on Malaria Transmission in Sub-Saharan Africa

机译：比较基于青蒿素的联合疗法对撒哈拉以南非洲疟疾传播的影响

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摘要

Artemisinin-based combination therapies (ACTs) are currently considered the first-line treatments for uncomplicated Plasmodium falciparum malaria. Among these, artemether-lumefantrine (AL) has been the most widely prescribed ACT in sub-Saharan Africa. Recent clinical trials conducted in sub-Saharan Africa have shown that dihydroartemisinin-piperaquine (DP), a most recent ACT, may have a longer post-treatment prophylactic period and post-treatment infection period (duration of gametocyte carriage) than AL. Using epidemiological and clinical data on the efficacy of AL and DP, we developed and parameterized a mathematical transmission model that we used to compare the population-level impact of AL and DP for reducing P. falciparum malaria transmission in sub-Saharan Africa. Our results showed that DP is likely to more effectively reduce malaria incidence of clinical episodes than AL. However in low P. falciparum transmission areas, DP and AL are likely to be equally effective in reducing malaria prevalence. The predictions of our model were shown to be robust to the empirical uncertainty summarizing the epidemiological parameters. DP should be considered as a replacement for AL as first-line treatment of uncomplicated malaria in highly endemic P. falciparum communities. To optimize the effectiveness of ACTs, it is necessary to tailor treatment policies to the transmission intensity in different settings.
机译：基于青蒿素的联合疗法（ACTs）目前被认为是单纯性恶性疟原虫疟疾的一线治疗。在这些药物中，蒿甲醚-荧光黄素（AL）是撒哈拉以南非洲地区使用最广泛的ACT。最近在撒哈拉以南非洲进行的临床试验表明，最新的ACT二氢青蒿素-哌喹（DP）可能比AL具有更长的治疗后预防期和治疗后感染期（配子运输时间）。利用有关AL和DP功效的流行病学和临床数据，我们开发并参数化了一种数学传播模型，该模型用于比较AL和DP对减少撒哈拉以南非洲恶性疟原虫疟疾传播的人群水平影响。我们的结果表明，DP可能比AL更有效地减少临床发作的疟疾发病率。但是，在恶性疟原虫低传播地区，DP和AL可能在减少疟疾流行方面同样有效。结果表明，我们的模型预测对总结流行病学参数的经验不确定性具有鲁棒性。在高度流行的恶性疟原虫群落中，DP应该被认为是AL的替代品，以作为对复杂性疟疾的一线治疗。为了优化ACT的有效性，有必要针对不同环境中的传播强度调整治疗策略。

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