Article type
Abstract
Background:
Artemisinin and partner drugs, primary malaria treatments, face resistance, first in the Greater Mekong Sub region and now in Sub-Saharan Africa, posing a major threat, especially to African children. The MARC SE-Africa project aims to identify and disseminate evidence of this resistance, exploring alternative drug therapies. The MAGIC Evidence Ecosystem Foundation, a project partner, contributes to evidence synthesis and guideline development.
Challenges in evidence synthesis:
Challenges arise in presenting evidence for diseases like malaria, where surrogate outcomes are common. Policymakers focus on patient-related outcomes such as treatment failure, indicated by recrudescence or mortality, as key issues in making informed decisions regarding anti-malarial therapy. However, relying on these outcomes may be impractical as they often manifest when it's too late to intervene effectively. Therefore, molecular markers (Kelch 13 mutations) should be regarded as early indicators, prompting timely action. The certainty of these markers influencing drug failure and outcomes remains a critical question for policymakers.
Objective:
To develop a methodological approach linking molecular markers to patient-reported outcomes for assessing evidence on artemisinin and partner drug resistance.
Methodology:
We developed a causal pathway illustrating the progression of anti malarial drug resistance from resistance indicators (Kelch 13 mutations) to patient outcomes (treatment failure and recrudescence). Utilizing the GRADE approach, we will present evidence at each stage evaluating the magnitude of indirectness. (Figure attached)
Predicted outcome:
Certainty decisions range from high (no indirectness) to very low (very great indirectness), with gradients in between. High certainty prompts swift and decisive action based on molecular markers. However, lower certainty, especially if it's low or very low, diminishes the urgency for immediate and aggressive measures. Our goal is to craft a clear and easily interpretable evidence-based presentation for policymakers.
Relevance and Importance to patients:
By prioritizing Kelch 13 mutations as early indicators through a causal pathway and utilizing an evidence-based approach with GRADE, we provide timely insights into drug resistance progression. This empowers policymakers for prompt treatment strategy adjustments. This approach is crucial in mitigating patient mortality from uncomplicated falciparum malaria, emphasizing the impact of our evidence-based initiative on shaping more effective and responsive healthcare policies.
Artemisinin and partner drugs, primary malaria treatments, face resistance, first in the Greater Mekong Sub region and now in Sub-Saharan Africa, posing a major threat, especially to African children. The MARC SE-Africa project aims to identify and disseminate evidence of this resistance, exploring alternative drug therapies. The MAGIC Evidence Ecosystem Foundation, a project partner, contributes to evidence synthesis and guideline development.
Challenges in evidence synthesis:
Challenges arise in presenting evidence for diseases like malaria, where surrogate outcomes are common. Policymakers focus on patient-related outcomes such as treatment failure, indicated by recrudescence or mortality, as key issues in making informed decisions regarding anti-malarial therapy. However, relying on these outcomes may be impractical as they often manifest when it's too late to intervene effectively. Therefore, molecular markers (Kelch 13 mutations) should be regarded as early indicators, prompting timely action. The certainty of these markers influencing drug failure and outcomes remains a critical question for policymakers.
Objective:
To develop a methodological approach linking molecular markers to patient-reported outcomes for assessing evidence on artemisinin and partner drug resistance.
Methodology:
We developed a causal pathway illustrating the progression of anti malarial drug resistance from resistance indicators (Kelch 13 mutations) to patient outcomes (treatment failure and recrudescence). Utilizing the GRADE approach, we will present evidence at each stage evaluating the magnitude of indirectness. (Figure attached)
Predicted outcome:
Certainty decisions range from high (no indirectness) to very low (very great indirectness), with gradients in between. High certainty prompts swift and decisive action based on molecular markers. However, lower certainty, especially if it's low or very low, diminishes the urgency for immediate and aggressive measures. Our goal is to craft a clear and easily interpretable evidence-based presentation for policymakers.
Relevance and Importance to patients:
By prioritizing Kelch 13 mutations as early indicators through a causal pathway and utilizing an evidence-based approach with GRADE, we provide timely insights into drug resistance progression. This empowers policymakers for prompt treatment strategy adjustments. This approach is crucial in mitigating patient mortality from uncomplicated falciparum malaria, emphasizing the impact of our evidence-based initiative on shaping more effective and responsive healthcare policies.