Fig. 5: Impact of TACT implementation delay on elimination prospects.

Assuming a low-transmission setting with 0.1% Plasmodium falciparum parasite ratio (PfPR) where dihydroartemisinin-piperaquine is used as first-line therapy, we simulate a switch to artemether-lumefantrine-amodiaquine at year 0, assuming 50% treatment coverage. The probability of reaching elimination for each elimination threshold is given by the colored lines which indicate different delays in triple artemisinin-based combination therapy (TACT) adoption. Assuming no delay in switching to TACTs, the probability of attaining a PfPR of ≤0.01% was 96%. The corresponding probability is 56% when a 5-year delay in TACT implementation is imposed.