Fig. 1: TACT longitudinal impact on 580Y frequency and treatment failure rate.

Comparison of artemisinin-combination therapy (ACT) and triple artemisinin-combination therapy (TACT) deployment at 1% Plasmodium falciparum parasite ratio (PfPR) and 50% treatment coverage, with dihydroartemisinin-piperaquine used as the baseline ACT before TACTs are deployed at year zero; gray lines (medians from 100 simulations) show the evolution of the pfkelch13 580Y allele or treatment failure rates under continued dihydroartemisinin-piperaquine use. Red lines show how these processes are slowed down by deployment of artesunate-mefloquine-piperaquine (ASMQ-PPQ). Blue lines show how these processes are slowed down by deployment of artemether-lumefantrine-amodiaquine (ALAQ). All shaded areas show interquartile ranges. Panels above each graph show an individual’s relative risk of 580Y infection (under TACT deployment versus ACT deployment) after 2, 5, and 10 years of deployment; bars show 95% confidence intervals and dots indicate the median, assuming a sample size of n = 1000. Results for baseline artesunate-amodiaquine and artemether-lumefantrine use are shown in Supplementary Figs. 52 and 53.