Obtaining the relevant evidence (the work of the IPTi Consortium)

The IPTi Consortium was supported by the Bill & Melinda Gates Foundation to evaluate this new intervention for malaria control in infants. This is the first time that a potential malaria control tool has undergone such a thorough and robust evaluation taking promising research results through a full evaluation to implementation and public health impact. It is also likely to become a model of international collaboration and partnership in the development and evaluation of new control tools. The IPTi Consortium was a time limited collaboration of leading research centres in Africa, the US , Europe and Papua New Guinea together with the World Health Organisation (WHO) and UNICEF, who together developed a research agenda to fully evaluate this intervention within a 5 year program of work, the work started in 2004.

Appraising the evidence

IPTi has undergone reviews by two expert committees – the Technical Expert Group (TEG) convened by the WHO, and by a group of experts convened by the US Institute of Medicine (IOM). Both committees recommended (IOM in July 2008, TEG in April 2009) that IPTi should be implemented in areas of moderate to high malaria transmission, and with SP in areas where there is not very high level resistance to SP.

See the TEG and IOM reports are available at http://malaria.who.int/docs/IPTi/TEGConsultIPTiApr2009Report.pdf and www.iom.edu/CMS/3783/48783/56178.aspx respectively.

Next steps

As IPTi is delivered alongside the WHO's Expanded Programme for Immunisation (EPI). Research has demonstrated that IPTi delivered alongside EPI vaccines does not have a negative effect on responses to EPI vaccines or on people's attitudes to EPI. This data will be presented at the next meeting of the Strategic Advisory Group of Experts (SAGE) to the EPI in October 2009; the SAGE is the policy advisory body for EPI.

After a favourable review by the EPI / SAGE, the next steps for the policy recommendation would be for the Director General of the WHO to issue the recommendation.

Where to implement IPTi

The TEG and IOM recommend that IPTi should be implemented where there is a substantial burden of malaria infants, in areas of moderate to high malaria transmission. IPTi with SP should be implemented in areas of low to moderate parasite resistance to SP. The IPTi Consortium has developed a w eb-based decision-support tool of where to implement IPTi www.iptiwebtool.org

The interactive tool is intended to assist national and sub-national policy makers in making decisions about whether IPTi is an appropriate intervention for a given country or region, and to provide relevant information to support IPTi-related policy discussions. This tool is restricted to sub-Saharan Africa and selected Ocean Pacific countries (Papua New Guinea, the Solomon Islands, Vanuatu) where the burden of malaria is focussed on children.