Artemisinin Resistance in Africa: its emergence and evolution in Rwanda

Artemisinin combination therapies (ACTs) are the mainstay antimalarial treatment combating Plasmodium falciparum malaria around the world. While resistance is widespread in Asia, it has not yet been observed in Africa where the majority of the global morbidity and mortality occurs. Artemisinin and ACT resistance in Africa would be a serious setback as there are no next-generation antimalarials ready for deployment. Recent reports in Rwanda of validated artemisinin resistance are of grave concern. A recent therapeutic efficacy study in Rwanda found a high prevalence of patients with delayed parasite clearance, which was associated with a validated artemisinin resistance mutation R561H in the K13 gene. Thus, it appears Africa is moving closer to fully formed resistance, as seen in Southeast Asia. New evidence shows that this mutation has arisen within Africa and was not spread from Asia, and thus, represents biology unique to Africa. Understanding these dynamics is critical to predicting the long-term effectiveness of ACTs and to evaluating and formulating effective control efforts. In this proposal the first goal is to understand the extent of spread and how quickly it is changing with time. This project will leverage an extensive collaborative network within Rwanda and in surrounding countries to perform large scale sampling and genomics studies across Rwanda and neighboring areas in other countries over time to map and study the spread of resistance. This will be accomplished using high-throughput targeted sequencing allowing us to genotype tens of thousands of samples. The final goal is to use the information from the above aims to build a model and predict the future spread of resistance. Together, this study will provide a comprehensive view of evolving resistance in Rwanda and provide actionable information for public health.

NIH project details

Drug Resistance
Modeling

Aug 2021 — Jul 2025

$1.52M

Rwanda