Figure 1.

Different long-term deployment strategies of when multiple ACTs are available. (A) A 5-year cycling strategy where each ACT is pre-scheduled to be used for 5 years exactly; after each 5-year period the national first-line recommendation is switched to a different ACT. (B) An adaptive cycling strategy, currently recommended by WHO, where ACTs (or other therapies) are replaced when 10% treatment failure is surpassed. This means that over long periods, different therapies will be used for different amounts of time. It also means that switches from an old therapy to a new one will typically occur with a delay, sometimes with a substantial delay if surveillance is delayed. (C) Multiple first-line therapies (MFT) deployed with random allocations of therapies to clinics, pharmacies, and other health facilities. In this scenario, three individuals in the same community could be simultaneously treated with three different ACTs. (D) MFT deployed by village or health post or health facility. In this scenario, a central point of contact in the health system—e.g., a village health worker, or a health facility director—would be responsible for ensuring that all malaria cases in their catchment area were treated with one ACT, chosen at a higher administrative level. (E) MFT deployed at the district or province level and coordinated nationally. In this scenario, distribution of different ACTs to different administrative regions would be controlled centrally by the National Malaria Control Program.