Treatment Efficacy of Dihydroartemisinin - Piperaquine for Uncomplicated Plasmodium falciparum and Plasmodium vivax Malaria in Timika, Papua, Indonesia

Sep 30, 2026

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Dihydroartemisinin–piperaquine (DP) is the first-line therapy for uncomplicated malaria in Timika, Papua, Indonesia, and has also been used for intermittent preventive treatment in pregnancy (IPTp-DP) since February 2022. This study evaluated DP efficacy for uncomplicated Plasmodium falciparum and Plasmodium vivax malaria in the general population 15 months after IPTp-DP introduction. Between May and December 2023, 75 patients each with P. falciparum and P. vivax received supervised DP for 3 days, with daily and then weekly clinical/laboratory follow-up for 6 weeks. Molecular genotyping distinguished recrudescence from reinfection and screened resistance markers. Follow-up completion included 68 P. falciparum and 58 P. vivax cases. The day-42 cumulative risk of same-species recurrence was low (PCR-adjusted 1.5% for P. falciparum; unadjusted 5.2% for P. vivax), no parasitemia was observed on day 3, and key resistance indicators were not detected. No evidence of high treatment failure or selection of resistant parasites was observed at current IPTp-DP coverage, supporting the need for ongoing monitoring.

LanguageEnglish

CategoryHealthcare

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Abstract

Introduction

Am. J. Trop. Med. Hyg., 114(1), 2026, pp. 115–122 doi:10.4269/ajtmh.25-0291 Copyright © 2026 The author(s) Treatment Efficacy of Dihydroartemisinin–Piperaquine for Uncomplicated Plasmodium falciparum and Plasmodium vivax Malaria in Timika, Papua, Indonesia Noy Norman Kambuaya,1 Muhammad Syawal Satria Ramli,1 Freis Candrawati,1 Enny Kenangalem,1 Pak Prayoga,1 Agatha Mia Puspitasari,2 Rintis Noviyanti,3 Leily Trianty,3 Ratni Indrawanti,4 Minerva Simatupang,5 Reynold R. Ubra,6 Jenny Hill,7 Firdaus Hafidz,7,8 and Jeanne Rini Poespoprodjo1,9,10* 1Timika Research Facility, Papuan Health and Community Development Foundation, Timika, Indonesia; 2Exeins Health Initiative, Jakarta, Indonesia; 3Eijkman Research Center for Molecular Biology-BRIN, Jakarta, Indonesia; 4Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia; 5Indonesian Ministry of Health, Jakarta, Indonesia; 6Mimika District Health Office, Timika, Indonesia; 7Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; 8Department ofHealth Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; 9Centre for Child Health-PRO, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; 10Mimika District Hospital, Timika, Indonesia Abstract. Dihydroartemisinin–piperaquine (DP), the first-line treatment for uncomplicated malaria in Timika, Papua, Indonesia, has also been used for intermittent preventive treatment in pregnancy (IPTp-DP) since February 2022. Concerns about the potential emergence of drug resistance associated with this dual policy prompted the present study, which was conducted to assess DP efficacy in treating uncomplicated Plasmodium falciparum (P. falciparum) and Plasmodium vivax (P. vivax) malaria in the general population 15 months after IPTp-DP was introduced. Between May and December 2023, the current study recruited 75 P. falciparum and 75 P. vivax malaria patients, who received supervised DP treatment for 3 days. Clinical and laboratory data were collected daily (on days 1, 2, 3, and 7) and then weekly for 6 weeks. Molecular analysis was performed to detect genetic markers of P. falciparum resistance to DP and distinguish between recrudescence and reinfection. A total of 68 P. falciparum and 58 P. vivax patients completed their day 42 follow-up. The cumulative risk of same-species recurrence by day 42 was 1.5%(95% CI: 0–7.9%) in P. falciparum patients (polymerase chain reaction-adjusted) and 5.2%(95% CI: 1.1–14.1%) for P. vivax patients (unadjusted) . No patients exhibited parasitemia on day 3. No P. falciparum isolates carried kelch 13 gene mutations or exhibited increased plasmepsin 2–3 copy numbers on either day 0 (0/75) or at recurrence (0/2). At the current level of IPTp-DP coverage (824 doses administered), there was no evidence of high treatment failure rates or the selection of resistant parasites inpatients with uncomplicated malaria treated with DP. Continuous monitoring of DP efficacy remains crucial for both treatment and chemoprevention. INTRODUCTION Malaria is a major public health problem in Timika, Papua Province, Indonesia, including in pregnant women. The annual parasite incidence (API) in 2022 was 440/1,000 population at risk, with Plasmodium falciparum (P. falciparum) and Plasmodium vivax (P. vivax) infections being similarly prevalent.1 The prevalence of malaria parasitemia at delivery in the area is high (16.8%), and infection is associated with adverse maternal and pregnancy outcomes.2 Sulfadoxine–pyrimethamine-resistant strains of P. falciparum and chloroquine-resistant strains of P. vivax are highly prevalent in this setting.3 Dihydroartemisinin–piperaquine (DP) has been the first-line treatment for uncomplicated malaria in Timika since March 2006, and across Indonesia since 2010. Even

FAQs

What is the purpose of this study in Timika, Papua?

To assess the efficacy of dihydroartemisinin–piperaquine (DP) for treating uncomplicated P. falciparum and P. vivax malaria in the general population 15 months after IPTp-DP was introduced.

How was DP administered and how long were patients followed?

Patients received supervised DP treatment for 3 days. Clinical and laboratory data were collected daily on days 1, 2, 3, and 7, and then weekly for 6 weeks (up to day 42).

Were resistance markers or treatment failures observed?

No patients showed parasitemia on day 3, and no evidence of high treatment failure rates or selection of resistant parasites was found at the reported IPTp-DP coverage; resistance markers such as kelch 13 mutations and increased plasmepsin 2–3 copy numbers were not detected.

Sep 30, 2026

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