- A safe, effective, and affordable intervention for preventing malaria in infants (IPTi), has been recommended by the WHO since 2010, yet access remains limited.
- The initiative seeks to maximize the benefits of the antimalarial intervention by increasing the number of doses administered and extending coverage beyond the currently recommended 9 months to protect children in their first two years of life.
- Through a country-led, co-design process, the project will develop scalable IPTi delivery models and generate compelling evidence to catalyze wide-spread roll-out of this life-saving intervention in high-burden countries across Africa. Four countries, Benin, Cameroon, Côte d’Ivoire, and Mozambique will initially be targeted by this initiative.
Geneva / Washington, DC, 15 September 2021 – To kick-start progress against malaria and improve child health in Africa, a new initiative, funded by Unitaid and led by Population Services International (PSI), will support widespread adoption of an effective but underutilized prevention method that could avert 6.7 million cases of malaria and anemia in children under two by 2030.
Intermittent Preventive Treatment of malaria in infants (IPTi) with sulfadoxine-pyrimethamine (SP) is a safe, affordable, and effective intervention shown to reduce rates of malaria and anemia in children under one year of age by 30 percent and 21 percent respectively. The World Health Organization (WHO) recommended IPTi for use in 2010, yet the intervention has not been widely adopted in Africa.
With a US $35 million investment from Unitaid, the Intermittent Preventive Treatment in infants – Plus (IPTI+) project will develop scalable models of IPTi+, an innovation on the WHO-recommended IPTi, that expands the number of preventive doses of SP administered to children and extends coverage of IPTi through a child’s second year of life. Over the life of the project, the IPTi+ project will administer an estimated 2.5 million doses of SP for IPTi+ protecting over half a million children under two years of age from malaria and anemia.
Brought to scale, IPTi+ will help reignite progress against malaria in the Africa region, where 94 percent of all malaria cases and deaths occur each year. Progress in reducing malaria rates has plateaued in recent years and the COVID-19 pandemic has caused additional setbacks and interruptions to malaria efforts across the continent.
IPTi+ targets a crucial population: children under the age of five accounted for nearly 70% of the estimated 409,000 malaria deaths globally in 2019. Children under two years of age are among the most vulnerable to malaria; half of child deaths from malaria (54%) are estimated to have occurred in children under the age of two.
“We cannot afford to leave any effective tool unused in our fight against malaria, or we will see our hard-won progress slip away. Unitaid is pleased to announce this major effort to reach hundreds of thousands of young children with IPTi+ – a highly effective but greatly under-utilized intervention for malaria prevention. This latest investment rounds out Unitaid’s work to innovate on all the current antimalarial interventions and improve access we can reignite the fight against malaria and drive down the burden of disease,” said Dr Philippe Duneton, Executive Director of Unitaid.
Widespread adoption of IPTi has faced challenges including misperceptions about the effectiveness of the recommended drug, sulfadoxine-pyrimethamine, a lack of evidence on its efficacy in areas of moderate to high resistance, and a lack of enabling policies. As administration of IPTi can fall within the remit of child health, malaria, and immunization programs, unclear delineation of responsibilities has also contributed to unsuccessful adoption.
The IPTI+ project will address these challenges at a country and global level to accelerate adoption and scale-up of IPTi+ with sulfadoxine-pyrimethamine. At the country-level, the IPTi+ project will facilitate a country-led co-design process to design IPTi+ models specific to each country in Benin, Cameroon, Côte d’Ivoire, and Mozambique. These four countries represent diverse health systems, malaria transmission, SP resistance, routine health service access, and implementation of other seasonal antimalarial interventions.
“PSI is proud to be working with the Ministries of Health in Benin, Cameroon, Cote d’Ivoire, and Mozambique, as well as county-level and global malaria partners, and the London School of Hygiene & Tropical Medicine, to accelerate adoption and scale-up of IPTi+. PSI and our partners will engage and convene communities and stakeholders to co-design country-specific IPTi+ models that overcome known barriers to uptake; shape mixed health systems to bring IPTi+ closer to Sara, PSI’s archetypal consumer, and her family; and generate evidence on the impact of IPTi+,” said Karl Hoffman, President and CEO of PSI.
To ensure scalability of the IPTi+ models being developed, Unitaid is also expanding the scope of an existing and complementary grant, implemented by the not-for-profit product development partnership Medicines for Malaria Venture (MMV). In addition to collaborating with the IPTi+ Project to deliver existing formulations of SP, MMV will work with selected African manufacturers to support local production of properly dosed, dispersible, and quality-assured formulations of SP that are suitable for children to future-proof supply of the medicine.
The project will collect evidence on impact, cost-effectiveness, and feasibility of IPTi+ across variable settings to inform scale-up in target countries and beyond. In addition to piloting implementation models in the four focus countries, the IPTi+ project will generate policy, economic, and suitability evidence on IPTi+ in three additional countries.
“In the past five years, annually, there have been approximately 4 million malaria cases and 400,000 hospital admissions for malaria in children under 5 years in Cameroon. To address this, we hope that introducing IPTi+, in addition to the use of long-lasting insecticide nets, will enable us to further reduce the malaria incidence and hospital admissions contributing to healthier and happier families. The National Malaria Control Program is excited to work with the IPTi+ Project and two renowned public health institutions, PSI and LSHTM, to introduce and increase access to IPTi+ and ensure accurate monitoring and evaluation of IPTi+ in Cameroon,” said Dr. Dorothy Fosah Achu, Permanent Secretary, National Malaria Control Program, the Ministry of Public Health, Cameroon.
PSI will coordinate the project co-design and implementation in collaboration with Ministries of Health and country teams. The London School of Hygiene & Tropical Medicine (LSHTM) will lead research that will generate evidence to inform country and global-level adoption and scale-up of IPTi+.
 Malaria deaths among children under age 2 as a proportion of malaria deaths among children under age five estimated from Global Burden of Disease 2019 data.
Unitaid is a global health agency engaged in finding innovative solutions to prevent, diagnose, and treat diseases more quickly, cheaply, and effectively, in low- and middle-income countries. Its work includes funding initiatives to address major diseases such as HIV/AIDS, malaria, and tuberculosis, as well as HIV co-infections and co-morbidities such as cervical cancer and hepatitis C, and cross-cutting areas, such as fever management. Unitaid is now applying its expertise to address challenges in advancing new therapies and diagnostics for the COVID-19 pandemic, serving as a key member of the Access to COVID-19 Tools (ACT) Accelerator. Unitaid is hosted by the World Health Organization. www.unitaid.org
About Population Services International (PSI)
Population Services International (PSI) is a global nonprofit organization focused on encouraging healthy behaviors and delivering affordable health products and services around the world. We bring innovation to scale through our presence in 40+ countries and a network of over 10,000 health clinics and pharmacies. PSI takes a business approach to saving lives, designing effective, scalable, and sustainable solutions to the world’s biggest challenges in healthcare.
About the London School of Hygiene & Tropical Medicine (LSHTM)
The London School of Hygiene & Tropical Medicine (LSHTM) is a world-leading centre for research, postgraduate studies and continuing education in public and global health. LSHTM has a strong international presence with over 3,000 staff and 4,000 students working in the UK and countries around the world, and an annual research income of £180 million. LSHTM is one of the highest-rated research institutions in the UK, is partnered with two MRC University Units in The Gambia and Uganda, and was named University of the Year in the Times Higher Education Awards 2016. Our mission is to improve health and health equity in the UK and worldwide; working in partnership to achieve excellence in public and global health research, education and translation of knowledge into policy and practice.
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