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University of California San Francisco |
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New team members join the UCSF Malaria Elimination Initiative (MEI) |
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The MEI is excited to welcome Dr. Mercy Opiyo, Dr. Steve Gowelo, Avery Seefeld, and Le Phan as new members of its team! |
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As an Entomologist at the MEI, Dr. Mercy Opiyo provides technical expertise, capacity building, and mentorship on entomological surveillance and vector control to national malaria control programs (NMCPs) and local partners in sub-Saharan Africa. She has previously worked as a Medical Entomologist with several institutions, including the Barcelona Institute for Global Health (ISGlobal) in Spain; the Manhiça Health Research Centre (CISM) in Mozambique; the Ifakara Health Institute (IHI) in Tanzania; and the International Centre of Insect Physiology and Ecology (icipe), Kenya in collaboration with the Liverpool School of Tropical Medicine (LSTM), UK. Beginning in early 2022, Mercy will be based in Mozambique.
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In his role as an Entomologist & Vector Control Program Manager at the MEI, Dr. Steve Gowelo works with vector control programs and partners to apply and scale methods associated with the MEI’s Entomological Surveillance Planning Tool (ESPT). He also coordinates the development, evaluation, and dissemination of the ESPT information and communications technology (ICT) tool. Prior to joining the MEI, Steve worked as a postdoctoral research fellow under the Partnership for Increasing the Impact of Vector Control (PIIVeC) at the Malaria Alert Centre (MAC) of the Kamuzu University of Health Sciences (KUHeS). Steve is currently based in Malawi.
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As the Operations Program Manager for the MEI, Avery Seefeld assists the team with all operational needs. Prior to joining the MEI, Avery supported efforts to advance maternal and reproductive health and rights around the world, serving as a Program Manager with the Global Legal Program at the Center for Reproductive Rights and a Program Coordinator within the UCSF Institute for Global Health Sciences (IGHS). She is currently based in New York, USA.
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In her role as the Asia Pacific Malaria Budget Advocacy Program Coordinator at the MEI, Le Phan leads the MEI’s joint malaria budget advocacy (MBA) implementation with the Asia Pacific Leaders Malaria Alliance and the Asia Pacific Malaria Elimination Network (APLMA/APMEN). Her work includes providing training and technical assistance, leading MBA monitoring and evaluation efforts, and supporting project management across activities of the MEI Advocacy, Financing, and Sustainability (AFS) team within the Asia Pacific. Previously, Le worked with PATH on non-communicable diseases and P. vivax malaria diagnosis and treatment, as well as with the Clinton Health Access Initiative (CHAI) on malaria surveillance in Vietnam. Le is currently based in Vietnam.
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Advancing the sustainability of malaria elimination: donor transition planning and budget advocacy |
With funding from the Bill & Melinda Gates Foundation (BMGF), the MEI provided technical assistance and capacity building to malaria-endemic countries under its Sustainability Model, guiding malaria programs on managing donor funding transitions and developing budget advocacy strategies. In Cambodia, the MEI partnered with the National Center for Parasitology, Entomology and Malaria Control to produce a publication entitled Sustaining Cambodia’s Malaria Response: An Assessment of Donor Transition Readiness and Budget Advocacy Opportunities. Likewise, Vietnam’s National Institute of Malariology, Parasitology and Entomology worked with the MEI to publish the Vietnam Malaria Transition and Sustainability Assessment alongside a Malaria Budget Advocacy strategy for the country. Under a new BMGF grant, the MEI will collaborate with the Asia Pacific Leaders Malaria Alliance and the Asia Pacific Malaria Elimination Network (APLMA/APMEN) Secretariat to scale the Sustainability Model across the region.
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Breakthrough ACTION at the Johns Hopkins Center for Communication Programs invited Amanda Marr Chung to speak at a recent webinar about the Leadership & Engagement for Improved Accountability & Delivery of Services Framework (LEAD). During the seminar, Amanda briefly summarized the project that the UCSF team and their Zimbabwean, South African, and British collaborators carried out in partnership with the national malaria control program (NMCP) in Zimbabwe. Implementing the LEAD Framework in Zimbabwe resulted in improved teamwork, motivation, and communication between different cadres of health workers, which in turn led to structural-level changes that can be adapted and scaled up in other contexts.
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Though most of Panamá is free from malaria, localized foci of transmission persist. In collaboration with the Ministry of Health and Clinton Health Access Initiative (CHAI), the MEI explored how government-led surveillance using the MEI’s Entomological Surveillance Planning Tool (ESPT) sought to address programmatically-relevant questions for the purpose of facilitating local vector control decision-making. The ESPT was used to design a sampling plan to investigate the suitability of long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) in Guna Yala, and to pinpoint gaps in protection against Anopheles bites. Results indicated early evening exophagic behavior of Anopheles vectors, absence of indoor resting behaviors, and presence of resistance to the primary insecticide used for IRS, highlighting critical gaps in protection. These findings demonstrate the need for directed entomological surveillance based on programmatic questions to generate entomological evidence that informs an adaptive malaria elimination strategy.
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In December 2021, the Asia Pacific Leaders Malaria Alliance (APLMA) released a thematic brief on the linkages between universal health coverage (UHC) and the fight against malaria in the Asia Pacific region. Co-authored by the Asia Pacific Malaria Elimination Network (APMEN), the MEI, and the Malaria Consortium, the brief highlights how malaria control and elimination programs can serve as entry points for strengthening primary healthcare systems while simultaneously benefitting from policies for the advancement of UHC. Examples from the region underscore the symbiotic relationship between malaria elimination and UHC in the areas of equitable service access, quality assurance of medicines, surveillance and response, and sustainable financing. The brief provides recommendations and resources that aim to guide malaria programs and Ministries of Health within the Asia Pacific as they seek to integrate malaria elimination programs and UHC initiatives. |
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MEI investigators collaborated with UCSF and Ugandan colleagues on an analysis regarding non-malarial effects of intensive malaria control. They found that in the historically high transmission setting of Tororo, the implementation of highly effective vector control interventions was followed by a marked reduction in antibiotic treatment of children. This added benefit of malaria control could have important implications for antibiotic prescribing practices, efforts to curtail antimicrobial resistance, and health system costs. |
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In collaboration with Chinese colleagues, the MEI published a commentary in a special issue of the The Lancet Public Health, celebrating the country's malaria-free certification from the World Health Organization. China's success in reducing malaria cases from over 30 million to zero in just 70 years is attributed to deliberate and responsive planning, evidence-based adaptation of global guidelines to suit local contexts, and strong leadership and innovation. The MEI congratulates its malaria partners in China on this tremendous achievement.
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In collaboration with the Thai Ministry of Public Health and the Thai and U.S. branches of the Armed Forces Research Institute of Medical Sciences, the MEI described findings from a joint civilian-military response to an outbreak of mostly Plasmodium vivax malaria cases in Sisaket Province. The outbreak, which mainly affected military personnel and rubber tappers working in highly forested areas, catalyzed joint civilian-military collaborations, including the integration of malaria elimination activities into the Royal Thai Army’s malaria strategic plan. This case study provides an example of how civilian and military public health systems can work together to advance national elimination goals in Southeast Asia and beyond.
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In a recently published paper, MEI researchers proposed the implementation of a Combined Quality and Process Improvement (CQPI) approach to improve malaria program management. A combined strategy involving quality improvement, quality management, and participative process improvement, CQPI aims to improve the effectiveness of malaria interventions, overcome operational barriers to intervention coverage, and accelerate elimination. Based on CQPI pilots in Eswatini and Zimbabwe, as well as subsequent testing in Namibia, the Leadership & Engagement for Improved Accountability & Delivery of Services Framework (LEAD) is available as a tool for reference and use. Results from these initial CQPI pilots and testing suggest that a malaria management strategy that prioritizes quality and participative process improvements at the district-level can strengthen teamwork and communication while empowering subnational staff to solve service delivery challenges.
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The global emergence and rapid spread of COVID-19 have raised concerns that the pandemic would result in global disruptions to malaria health and service delivery systems. UCSF and other researchers assessed the impact of the COVID-19 pandemic on routine malaria indicators at 17 rural health facilities in Uganda. Such indicators included total outpatient visits, malaria cases, non-malarial visits, proportion of patients with suspected malaria, proportion of patients tested using rapid diagnostic tests (RDTs), and proportion of malaria cases prescribed artemether-lumefantrine (AL). Using a quasi-experimental study design, researchers estimated the effects of the pandemic over two six-month COVID-19 time periods (April 2020-September 2020 and October 2020-March 2021). Results indicated that COVID-19 had no major effects on malaria disease burden and case management indicators, except for a modest decrease in the proportion of RDTs used for malaria diagnosis and the mean proportion of malaria cases prescribed AL from October 2020 to March 2021. |
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Long-lasting insecticidal nets (LLINs) are the main vector control tool for pregnant women, but their efficacy may be compromised, in part, due to pyrethroid resistance. A recent study published in the Malaria Journal by MEI, UCSF, and other investigators used quasi-experimental studies to evaluate the impact on pregnancy outcomes of a national LLIN campaign implemented by the Ugandan Ministry of Health. Within the scope of this campaign, a random subset of health subdistricts received LLINs treated with piperonyl butoxide (PBO), a chemical known to partially restore pyrethroid sensitivity. The study found that in this region of Uganda, where pyrethroid resistance is high, a mass LLIN campaign was associated with reduced stillbirth incidence. Effects of the campaign were greatest for women who would have received LLINs early in pregnancy. Meanwhile, results from comparing the effects of PBO and conventional LLINs on pregnancy outcomes were inconclusive, pointing to the need for future studies with larger sample sizes. |
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Malaria Elimination Initiative
UCSF Institute for Global Health Sciences
550 16th Street, 3rd Floor, Box 1224
San Francisco, CA 94158
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