From chloroquine to artemisinin-based combination therapy: the Sudanese experience.
BACKGROUND
In Sudan, chloroquine (CQ) remains the most frequently used drug for falciparum malaria for more than 40 years. The change to artemisinin-based combination therapy (ACT) was initiated in 2004 using the co-blister of artesunate + sulfadoxine/pyrimethamine (AS+SP) and artemether + lumefantrine (ART+LUM), as first- and second-line, respectively. This article describes the evidence-base, the process for policy change and it reflects the experience of one year implementation. Relevant published and unpublished documents were reviewed. Data and information obtained were compiled into a structured format.


METHODS
Sudan has used evidence to update its malaria treatment to ACTs. The country moved without interim period and proceeded with country-wide implementation instead of a phased introduction of the new policy. The involvement of care providers and key stakeholders in a form of a technical advisory committee is considered the key issue in the process. Development and distribution of guidelines, training of care providers, communication to the public and provision of drugs were given great consideration. To ensure presence of high quality drugs, a system for post-marketing drugs surveillance was established. Currently, ACTs are chargeable and chiefly available in urban areas. With the input from the Global Fund to fight AIDs, Tuberculosis and Malaria, AS+SP is now available free of charge in 10 states.


CONCLUSIONS
Implementation of the new policy is affected by the limited availability of the drugs, their high cost and limited pre-qualified manufacturers. Substantial funding needs to be mobilized by all partners to increase patients' access for this life-saving intervention.
Malik
E M
EM
National Malaria Control Programme, Khartoum, Sudan. fatihmmalik@hotmail.com
Mohamed
T A
TA
Elmardi
K A
KA
Mowien
R M
RM
Elhassan
A H
AH
Elamin
S B
SB
Mannan
A A
AA
Ahmed
E S
ES
D000962:Antimalarials / Q000008:administration & dosage* / Q000627:therapeutic use*; D000077549:Artemether; D037621:Artemisinins / Q000008:administration & dosage* / Q000627:therapeutic use*; D000077332:Artesunate; D002738:Chloroquine / Q000008:administration & dosage / Q000627:therapeutic use*; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D004983:Ethanolamines / Q000008:administration & dosage / Q000627:therapeutic use; D005449:Fluorenes / Q000008:administration & dosage / Q000627:therapeutic use; D006291:Health Policy; D006801:Humans; D000078102:Lumefantrine; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000453:epidemiology; D011358:Product Surveillance, Postmarketing; D011739:Pyrimethamine / Q000008:administration & dosage / Q000627:therapeutic use; D012717:Sesquiterpenes / Q000008:administration & dosage* / Q000627:therapeutic use*; D013397:Sudan / Q000453:epidemiology; D013413:Sulfadoxine / Q000008:administration & dosage / Q000627:therapeutic use; D013997:Time Factors
D000962:Antimalarials; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes; D012717:Sesquiterpenes; C001205:fanasil, pyrimethamine drug combination; D000077332:Artesunate; D013413:Sulfadoxine; D002738:Chloroquine; C031327:artemisinin; D000077549:Artemether; D000078102:Lumefantrine; D011739:Pyrimethamine