The Impact of Antimalarial Use on the Emergence and Transmission of Plasmodium falciparum Resistance: A Scoping Review of Mathematical Models.

The emergence and transmission of resistance to antimalarial treatments continue to hamper malaria elimination efforts. A scoping review was undertaken regarding the impact of antimalarial treatment in the human population on the emergence and transmission of Plasmodium falciparum resistance, to (i) describe the use of mathematical models used to explore this relationship; (ii) discuss model findings; and (iii) identify factors influencing the emergence and transmission of resistance. Search strategies were developed and deployed in six major databases. Thirty-seven articles met the eligibility criteria and were included in the review: nine articles modeled the emergence of resistance, 19 modeled the transmission of resistance, and nine modeled both the emergence and transmission. The proportion of antimalarial use within the population and the presence of residual drug concentrations were identified to be the main predictors of the emergence and transmission of resistance. Influencing factors pertaining to the human, parasite and mosquito populations are discussed. To ensure the prolonged therapeutic usefulness of antimalarial treatments, the effect of antimalarial drug use on the emergence and transmission of resistance must be understood, and mathematical models are a useful tool for exploring these dynamics.
Competing Interests: The authors declare no conflict of interest.