MRCG at LSHTM & MoH Hold a 4-day Training for the Monitoring of Antimalarial Drug Efficacy in The Gambia

23 September 2022
The Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine (MRCG), in collaboration with the National Malaria Control Programme (NMCP) convened a four -day training workshop for health workers involved in the upcoming Therapeutic Efficacy Study 2022 (TES22).

The training, held from the 12th to 15th September 2022 at the Unit’s campus in Fajara, involved 25 nurses (Community health Nurses, State Enrolled Nurses & Registered Nurses), Fields Assistants from both the Government and MRCG at LSHTM, as well nine Laboratory Technicians from the National Public Health Laboratory (NPHL). The four -day intensive training was punctuated by lectures and practical sessions on all study procedures. The team of trainers and facilitators included malaria experts from the NMCP, the NPHL and the MRCG at LSHTM.

The Therapeutic Efficacy Study 2022 (TES22) is particularly significant for The Gambia within the global context of increasing artemisinin resistance, including reports of partial resistance from Rwanda and Uganda. It is against this backdrop that the WHO strongly recommends that NMCPs and their partner research institutions undertake Therapeutic Efficacy Studies every two years to assess the efficacy of their national treatment policy. In The Gambia, the study will assess the efficacy and safety of the first- (Artemether-lumefantrine (AL or Coartem™) and second line (Dihydroartemisinin-piperaquine (DP or D-ARTEPP™) antimalarial treatments..

Thanks to advanced molecular and genetic analysis performed locally at the MRCG at LSHTM, the Ministry of Health (MoH) will obtain rapid and quality-controlled results on the efficacy in vivo and in vitro of AL and DP as well as on the prevalence of molecular markers of resistance to dihydroartemisinin, and partners drugs (lumefantrine and piperaquine).

Dr Annette Erhart, an Associate Professor in Clinical Epidemiology at the LSHTM doubles as the Co-principal Investigator of the TES22 study. On the importance of the workshop, she said, “ This training,  conducted with our colleagues from the MoH, was highly relevant and useful for the health staff on the ground. Not only will it ensure the smooth implementation of the TES22 study, but more importantly it sensitised the health staff on the growing threat of antimalarial drug resistance in Africa and on the importance of strictly applying the WHO guidelines on case management and surveillance of drug efficacy.

“The malaria researchers at MRCG at LSHTM are fully committed to supporting the national efforts to monitor and tackle antimalaria drug resistance.”

Dr.  Edgard Dabira, the Study Coordinator said the four-day training on the monitoring of antimalarial drug efficacy in The Gambia  has enabled them  to review the study protocol and procedures  as well as  Good Clinical Practice (GCP).

“We also did a dry run at Brikama District Hospital, one of the three recruiting sites.  The interactive training went smoothly, and the participants showed a great interest in all the modules. I am confident that they will be able to successfully implement the study in their respective sites.”

Since its inception in 1947, the Unit has maintained a strong partnership with the Ministry of Health to deliver an effective public health system and improve health services. Speaking on the collaboration between the MRCG at LSHTM and NMCP, the Principal Investigator of the study Mr Balla Gibba said, “The previous therapeutic efficacy studies were led by the NMCP as the Principal Investigator and technical guidance was provided by MRCG at LSHTM. However, the Ministry of Health through the NMCP consulted MRC at LSHTM to support conducting the TES22 on its behalf.

“The studies on antimalarial medicines will provide up-to-date data and information on the efficacy and safety of the medicines used for the treatment of uncomplicated malaria in the Gambia.  NMCP will use the evidence generated from these studies to inform decisions on the national treatment policy for uncomplicated plasmodium falciparum malaria.”

Foday Ceesay, a nurse at the Outpatients Department (OPD) of Brikama District Hospital highlighted the significance of the training, saying “It is timely as we are in the malaria season. I have learnt a lot about the use of antimalaria drugs and this will help me in my routine work at the OPD.”

He added that the training has further awakened him to the need for compliance with GCP to ensure the safety and wellbeing of people taking part in studies are protected and that research data is reliable.

Isatou F.  Jammeh, a nurse at the Outpatient Department of Kuntaur Major Health Centre in the Central River Region, believed her participation in the training will lead to better OPD service delivery.   “This training has boosted my knowledge and it will help me to improve more in terms of OPD service delivery. I have learnt the proper way of doing the Rapid Diagnostics Test and the importance of consenting patients.”

The TES22 will be conducted in three health facilities, namely Brikama District Hospital (West Coast Region 2), Gambira (Upper River Region), and Kuntaur (Central River Region) Health Centres from September 2022 until January 2023 with a targeted sample size of 264 malaria patients.