Introduction: Despite seasonal malaria chemoprevention (SMC) being recommended in 2012, less than 5% of the 25 million eligible children benefited from SMC in 2014. Responding to this gap, Malaria Consortium in partnership with Unitaid launched the project ACCESS-SMC to support SMC in seven Sahelian countries (Burkina Faso, Chad, Guinea, Mali, Niger, Nigeria, The Gambia).
Aim: ACCESS-SMC aimed to demonstrate feasibility, safety and impact of SMC at scale. In three years, over 50 million treatments were distributed by the project, reaching a peak of 6.4 million children in 2016.
Methods: Sulfadoxine-pyrimethamine+amodiaquine (SP+AQ) was administered by community health workers through diverse distribution approaches. Evaluation included monitoring of coverage, safety, efficacy, impact, and resistance. Coverage was measured through cluster surveys. Case-control studies assessed drug efficacy, and baseline molecular markers’ surveys assessed the prevalence of resistance markers. Sentinel sites and HMIS data analyses assessed morbidity and mortality reductions. Cost analyses were performed to identify key SMC cost drivers.
Results: In each year, ACCESS-SMC reached approximately 90% of eligible children and around 70% received at least three monthly treatments. National pharmacovigilance systems were strengthened, and a safety review on SMC found no safety concerns with a very low incidence of severe adverse reactions. Prevalence of molecular markers of resistance to SMC drugs was low, consistent with high efficacy of monthly treatments observed in case control studies. Trends in national malaria HMIS data are consistent with substantial malaria case reduction in SMC implementation areas. ACCESS-SMC has averted approximately 6 million cases of malaria over two years, and 40,000 deaths. Costing studies revealed a weighted average cost of 3.4$ per child/year in 2016. ACCESS-SMC has secured transition funding for all project countries.
Conclusions: SMC is feasible at scale, affordable, safe and effective. As SMC continues to scale-up, more efforts are needed to reach all eligible children.