Mitchel Guzman

Global efforts in the fight against malaria in the last 20 years have decreased morbidity and mortality by 30 and 50% respectively, but progress towards elimination has slowed in recent years and remains a major public health problem, especially in places with fewer resources contributing to the perpetuation of poverty.

In Peru, a similar behavior is observed, such that the government initiative for the elimination of malaria Plan Malaria Zero (PMC) has decreased during Phase I of control from 55227 to 15640 between 2017 and 2020 respectively, but there is a sustained increase concentrated in areas with less access to health services,  exacerbated by both by geographic isolation and higher levels of poverty in the country, mainly among the indigenous population.

Phase II towards elimination faces this and other challenges that escape the current surveillance system such as the high prevalence of asymptomatic and submicroscopic cases, human mobilization, detection of recurrences, relapses by Plasmodium vivax, molecular changes of the parasite, the emergence of resistance to ACT and the need for more sensitive diagnostic tests; the role of the asymptomatic and submicroscopic human reservoir as well as human mobilization in maintaining transmission have been widely highlighted in previous studies, but there is insufficient information regarding the rest.

In the Peruvian Amazon has been reported that after receiving supervised treatment with chloroquine plus primaquine according to the standards of the Ministry of Health (MINSA), 76% of patients had a recurrence (Delgado-Ratto et al., 2014). On the other hand, chloroquine and sulfadoxine resistance mutations have recently been reported, although there is no evidence of artemisinin resistance in Plasmodium falciparum (Villena et al., 2022).

The last treatment efficacy study for P. falciparum was in 2011 (De Oliveira et al., 2011), while for P. vivax it was in 2012 (Graf et al., 2012) and WHO recommends monitoring efficacy every 2 years for early detection of treatment failure. We aim to assess whether the current antimalarial treatment regimens provided by MINSA are still effective in the real-life conditions of remote Amazonian areas, we will work in a pragmatic study to evaluate the therapeutic efficacy of current antimalarial treatments against uncomplicated malaria for both species, P. vivax and P. falciparum:

• Assessing the clinical and parasitological response of the current treatment of uncomplicated malaria by P. vivax in Peru
  
• Assessing the clinical and parasitological response of the current treatment of uncomplicated malaria by P. falciparum in Peru
• Determining the presence of polymorphisms in the marker genes of resistance to antimalarial drugs of the current treatment of uncomplicated malaria
•  Estimating the contribution of relapses to recurrent P. vivax infections
• Assessing the knowledge, practices, and attitudes of health care providers prescribing antimalaria treatment in Peru
  
• Evaluating the factors influencing adherence to P. vivax malaria treatment in Peru
  

The effectiveness of treatments, as well as molecular surveillance has implications for policy makers in changing the therapeutic regimen, the impact of recurrences on the maintenance of transmission is crucial for elimination, it is also important to know if treatment policies are implemented as established by guidelines. All this information will help to improve the strategies of the malaria elimination plan in Peru.