FIG 1.

Annual P. falciparum cases in Peru (black line) from 1992 to 2020, with first-line treatment policy changes (data from the Centro Nacional de Epidemiología, Prevención y Control de Enfermedades [2020] Sistema de Atención de Solicitudes de Acceso a la Información Pública vía Internet del Ministerio de Salud [available at http://www.minsa.gob.pe/portada/transparencia/solicitud/]). Artemisinin combination therapies (ACTs) were first introduced into the Amazon region in Peru in 1999 and the North Coast in 2001, contributing to a dramatic decline in the number of cases. The combination of artesunate, mefloquine, and primaquine (AS+MQ+PQ) was the recommended first-line treatment in the Amazon region from the start (51), with continued high efficacy (107), and the combination of AS plus sulfadoxine-pyrimethamine (SP) was used on the North Coast. In 2015, AS+MQ+PQ became the recommended first-line treatment in the whole country (108). Peru reduced the malaria case incidence by ≥40% by 2010 using passive case detection (PCD), diagnosis by light microscopy (LM), and treatment with AS+MQ as the main components of the control program (109). In 2015, with the realization that PCD missed asymptomatic infections (110), focal screening and treatment were introduced, resulting in a further reduction in the malaria incidence (50). CQ+PQ, chloroquine plus primaquine; QN, quinine.