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Cao VAT, Nguyen TQ, Le Quyen D, Boon WPC, Moors EHM, Dondorp AM, de Haan F, Amaratunga C. Exploring the feasibility of introducing triple artemisinin-based combination therapy in the malaria treatment policy in Vietnam. Malar J 2023; 22:326. [PMID: 37898749 PMCID: PMC10613363 DOI: 10.1186/s12936-023-04763-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/22/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND This study investigates the processes regarding changing malaria treatment policies in Vietnam. Moreover, it explores the feasibility of introducing triple artemisinin-based combination therapy (TACT) in Vietnam to support the national malaria control and elimination plan. METHODS Data were collected via 12 in-depth interviews with key stakeholders, combined with a review of policy documents. RESULTS TACT is considered as a useful backup strategy in case future treatment failures with current artemisinin-based combination therapy (ACT) would occur. Moreover, TACT is also considered as a promising strategy to prevent the re-establishment of malaria. However, regulatory procedures and implementation timelines for TACT were expected to be lengthy. Therefore, strategies to engage national decision-makers, regulators, and suppliers should be initiated soon, stipulating the benefits of TACT deployment. In Vietnam, a procedure to apply for an import permit without registration that has previously been applied to the introduction of artesunate-pyronaridine was proposed to accelerate the introduction of TACT. Global-level support through the World Health Organization recommendations and prequalification were considered critical for supporting the introduction of TACT in Vietnam. CONCLUSIONS Appropriate approach strategies and early stakeholder engagement will be needed to accelerate the introduction of TACT in Vietnam.
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Affiliation(s)
- Van Anh Thi Cao
- The University of North Carolina Project Office, Hanoi, Vietnam.
| | - Thieu Quang Nguyen
- National Institute of Malariology, Parasitology and Entomology, Hanoi, Vietnam
| | | | - Wouter P C Boon
- Copernicus Institute of Sustainable Development, Utrecht University, Utrecht, The Netherlands
| | - Ellen H M Moors
- Copernicus Institute of Sustainable Development, Utrecht University, Utrecht, The Netherlands
| | - Arjen M Dondorp
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Freek de Haan
- Copernicus Institute of Sustainable Development, Utrecht University, Utrecht, The Netherlands
| | - Chanaki Amaratunga
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Turner HC, Quyen DL, Dias R, Huong PT, Simmons CP, Anders KL. An economic evaluation of Wolbachia deployments for dengue control in Vietnam. PLoS Negl Trop Dis 2023; 17:e0011356. [PMID: 37253037 DOI: 10.1371/journal.pntd.0011356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/06/2023] [Indexed: 06/01/2023] Open
Abstract
INTRODUCTION Dengue is a major public health challenge and a growing problem due to climate change. The release of Aedes aegypti mosquitoes infected with the intracellular bacterium Wolbachia is a novel form of vector control against dengue. However, there remains a need to evaluate the benefits of such an intervention at a large scale. In this paper, we evaluate the potential economic impact and cost-effectiveness of scaled Wolbachia deployments as a form of dengue control in Vietnam-targeted at the highest burden urban areas. METHODS Ten settings within Vietnam were identified as priority locations for potential future Wolbachia deployments (using a population replacement strategy). The effectiveness of Wolbachia deployments in reducing the incidence of symptomatic dengue cases was assumed to be 75%. We assumed that the intervention would maintain this effectiveness for at least 20 years (but tested this assumption in the sensitivity analysis). A cost-utility analysis and cost-benefit analysis were conducted. RESULTS From the health sector perspective, the Wolbachia intervention was projected to cost US$420 per disability-adjusted life year (DALY) averted. From the societal perspective, the overall cost-effectiveness ratio was negative, i.e. the economic benefits outweighed the costs. These results are contingent on the long-term effectiveness of Wolbachia releases being sustained for 20 years. However, the intervention was still classed as cost-effective across the majority of the settings when assuming only 10 years of benefits. CONCLUSION Overall, we found that targeting high burden cities with Wolbachia deployments would be a cost-effective intervention in Vietnam and generate notable broader benefits besides health gains.
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Affiliation(s)
- Hugo C Turner
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | | | - Reynold Dias
- World Mosquito Program, Monash University, Clayton, Australia
| | - Phan Thi Huong
- Department of Preventive Medicine, Ministry of Health, Hanoi, Vietnam
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Quyen DL, Thanh Le N, Van Anh CT, Nguyen NB, Hoang DV, Montgomery JL, Kutcher SC, Hoang Le N, Hien NT, Hue Kien DT, Rabaa M, O’Neill SL, Simmons CP, Anh DD, Anders KL. Epidemiological, Serological, and Virological Features of Dengue in Nha Trang City, Vietnam. Am J Trop Med Hyg 2018; 98:402-409. [PMID: 29313471 PMCID: PMC5929208 DOI: 10.4269/ajtmh.17-0630] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 10/31/2017] [Indexed: 11/07/2022] Open
Abstract
Vietnam is endemic for dengue. We conducted a series of retrospective and prospective studies to characterize the epidemiology of dengue and population mobility patterns in Nha Trang city, Vietnam, with a view to rational design of trials of community-level interventions. A 10-year time series of dengue case notifications showed pronounced interannual variability, as well as spatial heterogeneity in ward-level dengue incidence (median annual coefficient of variation k = 0.47). Of 451 children aged 1-10 years enrolled in a cross-sectional serosurvey, almost one-third had evidence of a past dengue virus (DENV) infection, with older children more likely to have a multitypic response indicative of past exposure to ≥ 1 serotype. All four DENV serotypes were detected in hospitalized patients during 8 months of sampling in 2015. Mobility data collected from 1,000 children and young adults via prospective travel diaries showed that, although all ages spent approximately half of their daytime hours (5:00 am-9:00 pm) at home, younger age groups (≤ 14 years) spent a significantly greater proportion of their time within 500 m of home than older respondents. Together these findings inform the rational design of future trials of dengue preventive interventions in this setting by identifying 1) children < 7 years as an optimal target group for a flavivirus-naive serological cohort, 2) children and young adults as the predominant patient population for a study with a clinical end point of symptomatic dengue, and 3) substantial spatial and temporal variations in DENV transmission, with a consequent requirement for a trial to be large enough and of long enough duration to overcome this heterogeneity.
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Affiliation(s)
- Duong Le Quyen
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
- Institute for Vector Borne Disease, Monash University, Clayton, Australia
| | - Nguyen Thanh Le
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Cao Thi Van Anh
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | | | - Dong Van Hoang
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | | | - Simon C. Kutcher
- Institute for Vector Borne Disease, Monash University, Clayton, Australia
| | - Nguyen Hoang Le
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | | | - Duong Thi Hue Kien
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Maia Rabaa
- Institute for Vector Borne Disease, Monash University, Clayton, Australia
| | - Scott L. O’Neill
- Institute for Vector Borne Disease, Monash University, Clayton, Australia
| | - Cameron P. Simmons
- Institute for Vector Borne Disease, Monash University, Clayton, Australia
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Department of Microbiology and Immunology, University of Melbourne, Doherty Institute, Melbourne, Australia
| | - Dang Duc Anh
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
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