{
  "abstract": "Malaria treatment failures associated with reduced efficacy of chloroquine (CQ) and amodiaquine (AQ) antimalarial drugs emerged in Rwanda during the 1980s, prompting the policy shift towards adopting artemisinin-based combination therapies in 2006 as an alternative. However, recent findings from malaria surveillance and therapeutic efficacy studies have revealed a countrywide increase in antimalarial drug resistance. Particularly, artemether-lumefantrine (AL) efficacy has significantly decreased, probably due to the emergence of Plasmodium falciparum (Pf) genomic mutations. To mitigate the current drug resistance, Rwanda has adopted targeted multiple first-line therapies. Through the national malaria control program, antimalarial drugs were deployed in accordance with the reported resistance profile. A significant rise in Pfkelch13 mutations, particularly A675V associated with AL resistance, was mainly reported in the western region; therefore, artesunate-pyronaridine was recommended. Dihydroartemisinin-piperaquine was considered in eastern and central regions, where R561H mutations were predominant. On the contrary, AL was maintained in the southern region, where the prevalence of the R561H mutation was low. Insights from this data-driven model will inform its extension to other malaria-endemic countries facing emerging Pf genetic diversity.",
  "authors": [
    {
      "affiliations": [
        "Rwanda Biomedical Center, Kigali, Rwanda"
      ],
      "name": "Claude Mambo Muvunyi"
    },
    {
      "affiliations": [
        "Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia",
        "Repolicy Research Centre, Kigali, Rwanda"
      ],
      "name": "Pierre Gashema"
    },
    {
      "affiliations": [
        "Rwanda Biomedical Center, Kigali, Rwanda"
      ],
      "name": "Aimable Mbituyumuremyi"
    },
    {
      "affiliations": [
        "Repolicy Research Centre, Kigali, Rwanda",
        "Quality Management Division, Rwanda FDA, Kigali, Kigali City, Rwanda"
      ],
      "name": "Patrick Gad IRADUKUNDA"
    },
    {
      "affiliations": [
        "Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia"
      ],
      "name": "Emmanuel Edwar Siddig"
    },
    {
      "affiliations": [
        "Rwanda Biomedical Center, Kigali, Rwanda"
      ],
      "name": "Jean Damascene Niyonzima"
    },
    {
      "affiliations": [
        "Rwanda Biomedical Center, Kigali, Rwanda"
      ],
      "name": "Emmanuel Hakizimana"
    },
    {
      "affiliations": [
        "Jhpiego Kigali, Rwanda, Kigali, Rwanda"
      ],
      "name": "Noella Umulisa"
    },
    {
      "affiliations": [
        "Harvard University, Cambridge, Massachusetts, USA"
      ],
      "name": "Abdisalan Mohamed Noor"
    },
    {
      "affiliations": [
        "World Health Organization Kigali, Rwanda, Kigali, Rwanda"
      ],
      "name": "Jules Mugabo Semahore"
    },
    {
      "affiliations": [
        "Rwanda Biomedical Center, Kigali, Rwanda"
      ],
      "name": "Albert Tuyishime"
    },
    {
      "affiliations": [
        "Rwanda Biomedical Center, Kigali, Rwanda"
      ],
      "name": "Jean de Dieu HARELIMANA"
    },
    {
      "affiliations": [
        "Rwanda Biomedical Center, Kigali, Rwanda"
      ],
      "name": "Jeanne Umuhire"
    },
    {
      "affiliations": [
        "Republic of Rwanda Ministry of Health, Kigali, Kigali City, Rwanda"
      ],
      "name": "Yvan Butera"
    },
    {
      "affiliations": [
        "Republic of Rwanda Ministry of Health, Kigali, Kigali City, Rwanda"
      ],
      "name": "Sabin Nsanzimana"
    }
  ],
  "title": "Strategies for mitigating emerging artemisinin-based antimalarial drug resistance in Rwanda: a promising approach for managing therapies in malaria-endemic countries",
  "uid": "9875a925-d96c-5208-917c-31d6c976de73"
}