Fig 1.
Baseline results of model, 2018–2025.
Interventions begin in 2020 (solid line). The average duration of chemoprophylaxis is one year (dotted line at 2021). Results are shown for number of cases per month (Fig 1A and 1B), the proportion of new infections with multiple copy number pfmdr1, i.e. genotypic MQ resistance (Fig 1C and 1D), the proportion of new infections with multiple copy number pfpm2, i.e. genotypic PPQ resistance (Fig 1E and 1F), and the proportion of new infections with multiple copy numbers of both pfpm2 and pfmdr1, i.e. genotypic resistance to both MQ and PPQ (Fig 1G and 1H).
Fig 2.
Sensitivity Analysis 1—increased fitness and decreased probability of treatment success given joint resistance, 2018–2025.
Interventions begin in 2020 (solid line). The average duration of chemoprophylaxis is one year (dotted line at 2021).
Fig 3.
Sensitivity Analysis 2 –equal probability of DP and ASMQ treatment success with pfpm2 and pfmdr1, respectively, 2018–2025.
Interventions begin in 2020 (solid line). The average duration of chemoprophylaxis is one year (dotted line at 2021).
Fig 4.
Sensitivity Analysis 3—the fitness of jointly resistant strains is increased; the probability of DP-MQ successfully treating jointly resistant strains is decreased; and the probability of successful treatment of resistant strains with DP is forced to equal that with ASMQ.
Interventions begin in 2020 (solid line). The average duration of chemoprophylaxis is one year (dotted line at 2021).
Fig 5.
Model states and transitions related to drug susceptible and genotypically PPQ-resistant infections.
Mosquitoes are not shown. The disease states are as follows: S, susceptible to malaria; E: exposed to malaria, not yet infectious: Is: infectious and symptomatic, Rt: recovered from malaria (i.e. no longer infectious) and protected by reinfection by prophylactic effect of treatment drug; R: recovered from malaria with partial immunity; Ia: infectious and asymptomatic. Subscript pr denotes prophylaxis. Superscript n denotes no drug resistance; superscript p denotes genotypic PPQ resistance. Entry to and exit from the model population, acquisition of resistance, and superinfection/recombination not shown.