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. 2023 Sep 21;29(11):2775–2784. doi: 10.1038/s41591-023-02551-w

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© The Author(s) 2023

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 2 — The right-hand axis shows 12-month-smoothed malaria prevalence (PfPR_2–10). All strategies are evaluated over 10 years with year 0 corresponding to the year the strategy was first implemented. Shaded bands show IQR. a, Comparison between the status quo treatment of 3 d of AL therapy (AL3, darker lines) and 5 d of AL therapy (AL5). b, Comparison between AL5 and switching to DHA–PPQ (lighter lines) as first-line therapy. Note here that under DHA–PPQ prevalence drops early (to <2%) and later rises to nearly 3.5%. This occurs because piperaquine resistance evolves quickly and reaches >0.50 genotype frequencies after 3 years, resulting in high prevalence and high levels of treatment failure. c, Comparison between AL5 (darker colors) and an MFT policy using ASAQ (75% of treatments) and DHA–PPQ (25%). d, Comparison between AL5 (darker colors) and a rotation strategy where DHA–PPQ is used for 3 years and then replaced with an MFT policy using AL5 (50%) and ASAQ (50%). e, Comparison between AL5 (darker colors) and the triple therapy ALAQ. f, Comparison between AL5 (darker colors) and sequential courses of AL on days 0, 1 and 2 and DHA–PPQ on days 7, 8 and 9.