Kenya may need to revise its malaria treatment policy amid growing evidence that the malaria parasite is developing resistance to the country’s current two-drug therapy.

Researchers are now recommending a triple-drug approach to preserve the effectiveness of malaria treatment and avoid a potential public health crisis.

The proposed regimen Triple Artemisinin-Based Combination Therapies (TACTs) would combine artemether-lumefantrine, Kenya’s current first-line treatment, with an additional partner drug such as piperaquine or amodiaquine.

Experts warn that if the current Artemisinin-based Combination Therapy (ACT) fails without a viable replacement, Kenya’s malaria control strategy could be severely undermined.

The recommendation comes from researchers at the Kenya Medical Research Institute (KEMRI) and Brown University, following the most comprehensive surveillance study of malaria drug resistance in East Africa to date.

Their findings, published on the preprint server MedRxiv, are based on an analysis of 642 blood samples collected from malaria patients across Kenya between 1998 and 2021.

The study found a sharp increase in genetic mutations that reduce the parasite’s susceptibility to lumefantrine after Kenya adopted artemether-lumefantrine in 2006. “We observed a rapid expansion of MDR1 mutations linked to reduced drug efficacy,” the researchers reported.

Despite Kenya having revised its malaria treatment policy multiple times over the past 25 years, the parasite appears to have consistently adapted often anticipating drug policy changes. Scientists are now urging continued genomic surveillance to help guide adaptive treatment strategies before resistance spirals out of control.

While no country has officially adopted TACTs as a first-line treatment, trials and contingency planning are underway in Southeast Asia. Cambodia, for instance, is preparing to incorporate the triple-drug approach into its national malaria elimination plan if resistance worsens.

The World Health Organization still recommends standard two-drug ACTs for uncomplicated malaria but notes that TACTs may be considered in regions where drug resistance has become widespread.

African nations, including Kenya, remain cautious, pending formal WHO endorsement and the availability of international funding.