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Researchers at the Mahidol-Oxford Research Unit (MORU) in Thailand performed the first comparative trials to unambiguously show artemisinin resistance in Plasmodium falciparum parasites in western Cambodia, as well as its emergence on the Thailand-Myanmar border. These studies emphasised the importance of urgent containment, leading to rapid responses from the World Health Organization (WHO) and international governments for the tracking and containment of drug-resistant malaria.
Malaria kills around 650,000 children a year but can be prevented by killing the mosquito vectors. As mosquitoes become resistant to insecticides the prevention measures can become ineffective. Research at the Liverpool School of Tropical Medicine (LSTM) led by Professor Hemingway FRS has been instrumental in the development of current World Health Organisation (WHO) guidelines to manage resistance, and has led to improved resistance diagnostics and novel monitoring software to integrate entomological and human health outcomes. LSTM's research led to the creation of the Innovative Vector Control Consortium (IVCC) which was established as an independent Product Development Partnership (PDP) in 2008. New, longer lasting formulations of insecticides developed by IVCC are now in operational use, and several novel public health insecticides are under development.
LSHTM researchers carried out the initial trials of intermittent preventive treatment in infants (IPTi), a strategy to improve malaria control in very young children. LSHTM staff were active in setting up and running a dedicated research consortium which developed and executed a research agenda to provide data to inform policy. School staff presented evidence to a series of WHO policy-making meetings which in 2009 recommended that IPTi should be included as part of routine malaria control. This policy, which has been adopted in one country and discussed by eight others, has the potential to benefit hundreds of millions of lives.
A substantial programme of research carried out by LSHTM has provided evidence for a major shift of strategy and progress in global efforts to eliminate malaria. As a result, WHO now recommends a policy designed to ensure medically-treated individuals are non-infectious to mosquitoes. In addition, drug development partnerships such as the Medicines for Malaria Venture now include transmission interruption in the target product profiles for new medicines. Several countries have made strategic decisions for the prevention of malaria transmission on the basis of the research, and the senior investigators act as advisers to international anti-malaria initiatives.
With over half a million malaria-related deaths every year, the existence of counterfeit antimalarial medication continues to have a devastating effect on malaria-related mortality and morbidity on a global scale. Primary investigations into this murderous trade, led by Dr Paul Newton at the University of Oxford's Centre for Tropical Medicine, have prompted criminal investigations, drug trafficking arrests, intervention from the World Health Organization, and have also led to the establishment of new screening facilities and mobile screening technology in affected areas. This research, and the interventions it has fuelled will save thousands of lives.
Malaria in Africa, traditionally diagnosed from fever symptoms, has been massively overdiagnosed, and other causes of fever missed. This research demonstrated the magnitude of overdiagnosis, undertook trials of rapid diagnostic tests, identified alternative bacterial diagnoses, completed economic appraisals and studied prescriber behaviour. The research underpinned a major change in policy by WHO (2010), substantial investments by the Global Fund to fight HIV, TB and Malaria (GFATM), and changed clinical practice, to direct antimalarials to malaria patients only. In one country alone, 516,576 courses of inappropriate artemisinin-based combination therapy (ACT) were averted, worth in excess of $1m.
UCL investigators have been at the forefront of characterising and assessing HIV drug resistance since 1990, soon after the very first HIV drug was licenced. There are currently more than 25 drugs available, and our work over the last 23 years has directly determined how best these therapies are used, and monitored in infected patients. We have extended our work to a global perspective, in conjunction with the current rollout of antiretroviral therapy to areas of the world devastated by the epidemic - work which now informs guidelines of the World Health Organisation (WHO), and has resulted in a marked reduction in mortality.
In spite of recent reductions in transmission, malaria continues to kill over half a million people annually. To assist in fighting the global burden of malaria, Kenya-based Oxford research team, the Malaria Public Health Department (MPHD) has spent the past decade analysing malaria risk, interventions, and control methods, to better define and target malaria. This research has been used to inform local governments, the World Health Organization (WHO), and international funding organisations about malaria risk, interventions and control methods to better define and target malaria.
Miltefosine is the first oral drug to be developed for the treatment of leishmaniasis, a worldwide parasitic infection with up to 12m cases. Also developed as a cancer drug, miltefosine was identified and tested for leishmaniasis therapy at LSHTM and has been added to WHO's essential medicines list as a result of subsequent clinical trials. It has been widely used for the treatment of visceral leishmaniasis (VL) in India, Nepal and Bangladesh, and for the cutaneous form of the disease in Latin America. Phase III and IV clinical trials of combination therapies including miltefosine have been carried out in India.
Research in West Africa by LSHTM and partners has shown that monthly treatment with effective antimalarial drugs during the rainy season provides children with a very high degree of personal protection against malaria, can be delivered on a large scale by community health workers at moderate cost, and with no serious side-effects. Based on this research, WHO now recommends that children living in Sahel areas where malaria is a major problem should receive such `seasonal malaria chemoprevention' (SMC) with sulfadoxine-pyrimethamine plus amodiaquine. Ten countries have incorporated SMC into their strategic plans for malaria control.