In the Asia-Pacific region, the monitoring of the efficacy of antimalarial drugs including artemisinins and artemisinin-based combination therapies (ACTs) has become a routine activity of the national malaria programs using a standardized WHO therapeutic efficacy study (TES) protocol. It aims to identify early signs of resistance of recommended treatment regimens to drive evidence-based review and update of a country's national drug policy. The 4th Meeting of the BBINS Malaria Drug Resistance Monitoring Network (Bangladesh, Bhutan, India, Nepal and Sri Lanka) convened in New Delhi, India on 15–16 October 2019. The discussions highlighted the results of therapeutic efficacy studies including updates on molecular markers for drug resistance, showing that the 1st-line artemisinin-based combinations therapies (ACT) in all countries are currently effective against both P. falciparum and P. vivax malaria; countries to further strengthen The Meeting of the Bangladesh, Bhutan, malaria microscopy QA; and adopt iDES for monitoring of malaria drug efficacy in areas with low malaria cases as part of the programme's elimination surveillance activities. India, Nepal, Sri Lanka (BBINS) Also discussed were workplans for continuing studies over the next two years. Malaria Drug Resistance Monitoring Network A Report New Delhi, India, 15–16 October 2019 SEA-MAL-283 SEA-MAL-283 The Meeting of the Bangladesh, Bhutan, India, Nepal, Sri Lanka (BBINS) Malaria Drug Resistance Monitoring Network A Report New Delhi, India, 15–16 October 2019 The Meeting of the Bangladesh, Bhutan, India, Nepal, Sri Lanka (BBINS) Malaria Drug Resistance Monitoring Network SEA-MAL-283 © World Health Organization 2020 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO license (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this license, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. 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Contents Page Abbreviations............................................................................................................................... v Summary ....................................................................................................................................vii 1. Background .......................................................................................................................... 1 2. Objectives of the meeting were: ........................................................................................... 1 3. Proceedings .......................................................................................................................... 2 4. Session 1: Technical updates ................................................................................................ 2 4.1 Updates on antimalarial drug resistance, artemisinin resistance ............................... 2 4.2 Regional updates and review of TES studies in BBINS ............................................. 3 4.3 Different drug efficacy surveillance systems: routine TES, integrated drug efficacy surveillance (iDES) in the context of elimination, and importation .............. 4 4.4 A brief overview of the TES protocol template ........................................................ 5 5. Session 2: Country Presentations on TES .............................................................................. 6 5.1 Bangladesh (Dr Nazrul Islam, National Malaria Elimination and ATD Control Program) ........................................................................................................................... 6 5.2 India (Dr Avdhesh Kumar, National Director, NVBDCP) ......................................... 7 5.3 India (Dr Praveen K. Bharti, Scientist-E, NIRTH and Dr Kuldeep Singh, Scientist-B & Officer-in-charge, ICMR-NIMR) ......................................................... 8 6. Session 3. Country presentations on iDES ........................................................................... 11 6.1 Bhutan (Mr Singay Dukpa, Laboratory Officer, VDCP) .......................................... 11 6.2 Maldives (Aishath Jaleela, Director, Pharmaceuticals, Food and Drug Authority) ... 11 6.3 Sri Lanka (Dr Muzrif Munas, CCP, Anti-Malaria Campaign and Dr Priyani Dharmawardena, Regional Malaria Officer, Ministry of Health) ............ 12 7. Session 4: Updates on quality control and molecular markers ............................................ 13 7.1 Quality control in TES and iDES: implementation challenges (Dr Maria Dorina Bustos) ...................................................................................... 13 7.2 Phenotypic and genotypic monitoring of resistance: GMS experience (Dr Benoit Witkowski, Pasteur Institute, Cambodia) .............................................. 14 7.3 Role of the Malaria Elimination Research Alliance and ICMR in supporting the TES network in the SEA Region (Dr Manju Rahi, ICMR) .................................. 15 8. Session 5: Harmonization of treatment regimen and evidence to policy (Panel discussion chaired by Dr Kamini Mendis) ................................................................ 16 9. Session 6: Presentation of country plans and budget: TES + MM and iDES ........................ 16 1 10. Session 7: Conclusion and recommendations ..................................................................... 18 10.1 Conclusions of the Meeting: ................................................................................. 18 10.2 Recommendations made to the countries of the BBINS Network .......................... 18 10.3 Recommendations made to WHO ..................................................................................... 19 Annexes 1. Agenda .............................................................................................................................. 20 2. List of participants .............................................................................................................. 22 12 Abbreviations ACD active case detection ACPR adequate clinical and parasitological response ACT artemisinin-based combination therapy AL artemether-lumefantrine API annual parasite incidence AS artesunate BBINS Bangladesh, Bhutan, India, Nepal, Sri Lanka CDS Communicable Diseases Department CQ chloroquine DHA dihydroartemisinin ECA external competency assessment ERC Ethics Review Committee ETF early treatment failure GMP Global Malaria Programme GMS Greater Mekong Subregion GTS Global Technical Strategy ICF informed consent forms iDES integrated Drug Efficacy Surveillance K13 Kelch 13 LCF late clinical failure LPF late parasitological