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Situacao na America Latina
Roberto Montoya
PAHO/WHO
Implementacao de Terapias de Combinacao baseadas emArtemisinina (ACTs): o papel do ASMQ
Fiocruz, Farmanguinhos e DNDi.
Simposio Cientifico
91% casos
87% mortalidad
MQCQ
CQ
Malaria transmision area
AS+MQ
AS+SP
AS+MQ
ACT
AQ + SP
Q3d+Dox7d
Q7d+Dox7d
Official first line treatment for uncomplicated P. falciparum malaria. 2002
Malaria transmission area
Q3d+D7d / MQ
Other CT/ Monotherapy
AQ + SP/ AQ/ SP
Q7d+D7d/ Q5d
Official first line treatment for uncomplicated P. falciparum malaria. 2002
MQ
Malaria transmission area
Monoterapy
CQ
CQ
first line treatment for uncomplicated P. falciparum malaria. 2002
Latitu
de
RAVREDA
Latitu
de
Latitu
de
-85 -80 -75 -70 -65 -60 -55 -50 -45 -40
Longitude
-15
-10
-5
0
5
10
Latitu
de
2.1%
0.0%
0.0%
1.9%
Efficacy studies to ASU+SP
Avg. Cases Evaluated
47.00
50.00
55.00
61.00
0.0
Sum of % Therapeutic..
Latitu
de
Latitu
de
-85 -80 -75 -70
Longitude
-10
-5
0
5
10
Latitu
de
23.0%
38.0%
47.0%
15.0%
42.0%
57.0%
Efficacy studies to AQ
Avg. Cases Evaluated
12.00
20.00
30.00
40.00
50.00
60.00
0.0
Sum of % Therapeutic..
Combinaciones recomendadas:
• Combinaciones con derivados de artemisinina
– Artesunato + amodiaquina
– Artesunato + sulfadoxina-pirimetamina
– Artesunato + mefloquina
– Artemether-lumefantrine
Guias de tratamiento de la OMS
OMS recomienda el uso de CTDA y el cuidoso monitoreo de la
respuesta terapéutica
ASU+MQCQVenezuela
LUM+ATMQ 5dSuriname
SP+ASU ASU+MQ
CQ / SP / Q7d+T7d
Perú
Costa
d Amazonas
LUM+ATMQ5d+SPGuyana
SP+ASUCQEcuador
AQ+SP
ASU+MQ
LUM+ATM
CQ + SPColombia
LUM+ATMQ3d+D5dBrasil
ASU+MQQ7dBolivia
20071998Esquema
Esquemas de primera línea de tratamiento de malaria por P. falciparum
no complicada
Países amazónicos. 1998 y 2004
Primera linea de tratamiento de malaria por P. falciparum en la región amazónica
2006
ASU + SP
ASU + MQ
Coartem®
SP + AQ
Situacao na America Latina
Roberto Montoya
PAHO/WHO
Implementacao de Terapias de Combinacao baseadas emArtemisinina (ACTs): o papel do ASMQ
Fiocruz, Farmanguinhos e DNDi.
Simposio Cientifico
91% casos
87% mortalidad
MQCQ
CQ
Malaria transmision area
AS+MQ
AS+SP
AS+MQ
ACT
AQ + SP
Q3d+Dox7d
Q7d+Dox7d
Official first line treatment for uncomplicated P. falciparum malaria. 2002
Malaria transmission area
Q3d+D7d / MQ
Other CT/ Monotherapy
AQ + SP/ AQ/ SP
Q7d+D7d/ Q5d
Official first line treatment for uncomplicated P. falciparum malaria. 2002
MQ
Malaria transmission area
Monoterapy
CQ
CQ
first line treatment for uncomplicated P. falciparum malaria. 2002
Latitu
de
RAVREDA
Latitu
de
Latitu
de
-85 -80 -75 -70 -65 -60 -55 -50 -45 -40
Longitude
-15
-10
-5
0
5
10
Latitu
de
2.1%
0.0%
0.0%
1.9%
Efficacy studies to ASU+SP
Avg. Cases Evaluated
47.00
50.00
55.00
61.00
0.0
Sum of % Therapeutic..
Latitu
de
Latitu
de
-85 -80 -75 -70
Longitude
-10
-5
0
5
10
Latitu
de
23.0%
38.0%
47.0%
15.0%
42.0%
57.0%
Efficacy studies to AQ
Avg. Cases Evaluated
12.00
20.00
30.00
40.00
50.00
60.00
0.0
Sum of % Therapeutic..
Combinaciones recomendadas:
• Combinaciones con derivados de artemisinina
– Artesunato + amodiaquina
– Artesunato + sulfadoxina-pirimetamina
– Artesunato + mefloquina
– Artemether-lumefantrine
Guias de tratamiento de la OMS
OMS recomienda el uso de CTDA y el cuidoso monitoreo de la
respuesta terapéutica
ASU+MQCQVenezuela
LUM+ATMQ 5dSuriname
SP+ASU ASU+MQ
CQ / SP / Q7d+T7d
Perú
Costa
d Amazonas
LUM+ATMQ5d+SPGuyana
SP+ASUCQEcuador
AQ+SP
ASU+MQ
LUM+ATM
CQ + SPColombia
LUM+ATMQ3d+D5dBrasil
ASU+MQQ7dBolivia
20071998Esquema
Esquemas de primera línea de tratamiento de malaria por P. falciparum
no complicada
Países amazónicos. 1998 y 2004
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Year
0K
200K
400K
600K
Sum of P. vivax cases
0K
100K
200K
300K
Sum of P. falciparum cases
Peru and Bolivia
Suriname
ColombiaVenezuela
Brazil
Guyana and
Ecuador
Malaria in the Amazon Region and ACT introduction
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Sum of P. falciparum cas..
Sum of % P. falciparum
% of implementation
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Sum of P. falciparum cas..
Sum of % P. falciparum
% of implementation
Country / Year
Suriname
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
0K
5K
10K
15K
Sum of P. falciparum cas..
0%
50%
100%
Sum of % P. falciparum
0%
50%
100%
Sum of % of implementati..
10,187
11,685
10,648
13,957
9,906
12,078
5,575 5,189
1,663
278
87%
89%
86%
90%
87% 89% 90%
92%84%
45%
0% 0% 0% 0% 0%
100% 100% 100%100%
100%
ACT introduction
P. falciparum malaria and ACT introduction in Suriname
Sum of P. falciparum cases
Sum of % P. falciparum
% of implementation
Country / Year
Ecuador
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
0K
20K
40K
60K
Sum of P. falciparum cas..
0%
20%
40%
60%
Sum of % P. falciparum
0%
50%
100%
% of implementation
20,359
46,984
48,974
37,491
20,015
10,7245,891
2,212 1,596
1,158
51%
58%
47%
34%
23% 21% 21%
13%
16%
14%
0% 0% 0% 0% 0% 0% 0%
71%
100%100%
100%
ACT introduction
P. falciparum malaria and ACT introduction in Ecuador
Country / Year
Guyana
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
0K
10K
20K
Sum of P. falciparum cas..
0%
20%
40%
60%
Sum of % P. falciparum
0%
50%
100%
% of implementation
22,799
15,968
12,324
12,831
10,599
12,970
12,234
15,657
9,258
4,351
55%
59%
51%
47%
48% 47%43%
43%
47%
39%
0% 0% 0% 0% 0% 0% 0%
88%
100%100%
100%
ACT introduction
P. falciparum malaria and ACT introduction in Guyana
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Sum of P. falciparum cas..
Sum of % P. falciparum
% of implementation
Country / Year
Colombia
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
0K
50K
100K
150K
Sum of P. falciparum cas..
0%
20%
40%
60%
Sum of % P. falciparum
0%
50%
100%
Sum of % of implementati..
96,201
24,73637,563
93,633
89,753
126,350
44,367
39,709
46,147
30,065
54%
40%
35%
45% 46%
57%
38%
34%
38%
28%
0% 0% 0% 0% 0% 0% 0% 0%18%
65%
100%
ACT introduction
P. falciparum malaria and ACT introduction in Colombia
2003 2004 2005 2006 2007
date
STOELMANSEILAND
GAKABA
APOEMA
DRIETABIKI
LANGATABIKI
KWAMALASAMUTU
BROWNSWEG
AFOBAKKA
NJ JACOB KONDRE
NASON
GODORO
AGAIGONI
BROKOPONDO
0
200
0
200
0
200
0
200
0
200
0
200
0
200
0
200
0
200
0
200
0
200
0
200
0
200
cs
ation
the C
linic
lem
enta
the a
ll t
GF im
pl
ACT in
ACT introduced
Policlinics with more than 500 cases
Sum of Data
≤ 10.0
50.0
100.0
150.0
222.0
10.0
Sum of Data
The trend of sum of Data with date broken down by Name. Color shows sum of Data. Size shows sum of Data. The view is filtered on Name, which has multiple members selected.
Narino - Colombia
�Acceso
�Uso
�Calidad
Planificacion de necesidades
Capacitacion en gestion
Guias de manejo de
medicamentos
Monitoreo del acceso y uso en
los puestos de diagnostico
Laboratorios de referencia
Uso de Minilabs
No Si
EL CHARCO
FRANCISCO PIZARRO
LA TOLA
MOSQUERA
OLAYA HERRERA
SANTA BARBARA
TUMACO
1
1
99
17
21
12
9
9
15
N de puestos donde hubo extracción del Coartem del blister
Count of Number of Records broken down by COext comp blister vs. MUNICIPIO. The view is filtered on MUNICIPIO, which keeps 7 members.
no si
EL CHARCO
FRANCISCO PIZARRO
LA TOLA
MOSQUERA
OLAYA HERRERA
SANTA BARBARA
TUMACO
1
1
99
17
22
12
9
8
15
N de puestos donde hubo fraccionamiento de comprimidos
de Coartem
Count of Number of Records broken down by Cofraccionamiento (group) vs. MUNICIPIO. The view is filtered on MUNICIPIO, which keeps 7 members.
0 50 100 150 200
Count of Number of Records
EL CHARCO JOSE ANTONIO GARCES
FRANCISCO PIZARRO FREDY SALAZAR
LA TOLAJOSE ANTONIO GARCES
JOSE TERAPUES
MOSQUERA FREDY SALAZAR
OLAYA HERRERA IVAN LEMOS
SANTA BARBARA JOSE TARAPUES
TUMACO
DAMARIS JIMENEZ
JAIRO I. CASTILLO
JESUS CAICEDO
PATERSON
Grand Total
16
9
4
5
12
22
17
50
10
24
15
184
N de puestos de diagnóstico visitados por municipio y supervisor
Count of Number of Records for each SUPERVISOR broken down by MUNICIPIO. The view is filtered on MUNICIPIO, which keeps 7 members. The marks are labeled by count of Number of Records.
PAHO/WHO - Brasil
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