Skip to Navigation
London School of Hygiene & Tropical Medicine Malaria Centre

Malaria research in drug development, deployment and resistance

A surveillance system and drug forensic network to monitor the quality and authenticity of artemisinin combination treatments in Africa.

LSHTM investigators:
Harparkash Kaur, Albert van Wyk, Naiela Malik, Caroline Lynch & Shunmay Yeung.
External collaborators:
Facundo Fernandez (Georgia Tech. School of Chemistry and Biochemistry, USA); Michael Green (Centers for Disease Control and Prevention, USA); Paul Newton (Centre for Clinical Vaccinology and Tropical Medicine, UK, Mahosot Hospital, Lao PDR & LSHTM, UK).
Funding body:
The Bill & Melinda Gates Foundation though the ACT Consortium.

The lack of reliable estimates of suspect antimalarial drugs – particularly that of Artemisinin Combination Therapies (ACTs) in malaria-endemic countries poses an enormous threat to malaria patients.

To contribute to the tackling of this problem, our project aims to provide robust estimates of sub-standard, counterfeit and degraded artemisinin containing drugs and to develop standardised methodologies for sampling.  To assist in classifying whether the drugs are degraded due to environmental impact rather than manufacturing practices, we are carrying out the ageing of ACTs in field and laboratory based studies(see picture).

We have used a range of sampling strategies to collect drugs from public and private healthcare providers in Rwanda, Cambodia, Ghana and Tanzania, with sampling in other locations currently underway.

All samples are logged onto a database, the packages scanned and, tablets weighed and measured. Qualitative (mass spectrometry, near infrared and Raman spectroscopy) and quantitative (high performance liquid chromatography and high performance liquid chromatography-mass spectroscopy) content analyses are conducted.

Thus far around 5,000 drugs have been analysed. Preliminary content analyses indicate a number of samples fall below the internationally recommended thresholds for their stated API with variations found to occur both between and within batches of the same brand. Following cross verification between the three collaborating laboratories, the results will be shared with the national authorities and stored on the “Counterfeit Drug Forensic Network – CODFIN” database.