In the current study, three experimental approaches aiming at reducing malaria transmission will be tested. The study will cover two transmission season (2019 and 2020) and the interventions will vary by season. More specifically, in the 2019 transmission season (June-December) (Year 1), community case management of malaria (CCM) will be implemented in all eight villages as improved standard of care; in the 2020 transmission season (Year 2), the eight study villages will be divided into 4 study arms. CCM will continue in all villages; two villages will continue with CCM only (Arm 1, control); the three other pairs of villages will receive active fever screening and treatment (Arm 2); monthly mass screening and treatment (MSAT) (Arm 3); and mass drug administration (MDA) during the last 3 months of the dry season (April-June) (Arm 4). For MDA, the whole population (except for those not fulfilling the entry criteria) will be treated with a full course of dihydroartemisinin-piperaquine (DP) (320/40mg and 160/20mg piperaquine/ dihydroartemisinin per tablet) per manufacturer's guidelines (once daily for 3 days and according to body weight). The MDA treatment will be repeated 3 times at monthly intervals.
In the current study, the investigators will first improve access to care in all villages by implementing community-based clinical case management (CCM) (year 1). In this year, the investigators will quantify gametocyte carriage and transmission from clinical cases passively recruited by CCM, and gametocyte carriage and transmission from asymptomatic infections detected in community surveys. These data will support the interpretation of the main study outcomes in year 2 when the investigators will directly compare the effect of CCM on the human reservoir of infection as compared to three different approaches, namely i) active fever screening and treatment that should detect symptomatic infections for early treatment; ii) Mass Screening and Treatment (MSAT) that will systematically screen, using point-of-care diagnostics, the whole population, with infected individuals immediately treated; and iii) mass drug administration (MDA) that will treat the whole population with a full course of an antimalarial treatment.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
DIAGNOSTIC
Masking
NONE
Enrollment
4,000
Community Case Management (CCM), consisting of community health workers able to diagnose malaria by standard RDTs and treating positive individuals with artemether-lumefantrine (AL), according to national guidelines.
Consists of weekly visits by trained VHW who will screen for fever by taking the axillary temperature. If the body temperature is ≥37.5°C, a standard RDT will be performed and, if positive, the individual will be treated with AL, according to national guidelines.
CCM plus monthly screening of the whole population with high sensitive RDT (HS-RDT); positive individuals will be treated with AL regardless of symptoms (MSAT).
CCM plus 3 monthly rounds of MDA with dihydroartemisinin-piperaquine (DP) starting during the dry season, before the malaria transmission season starts.
Medical research Council Unit The Gambia at LSHTM
Basse Santa Su, The Gambia
RECRUITINGParasite prevalence by molecular detection at the end of study (cross-sectional survey).
The primary outcome measure is parasite prevalence in the cross-sectional survey conducted at the end of the transmission season of year 2.
Time frame: 16 weeks
Parasite density by molecular detection at the end of study (cross-sectional survey).
The primary outcome measure is parasite density (parasite/µL) in the cross-sectional survey conducted at the end of the transmission season of year 2.
Time frame: 16 weeks
Gametocyte prevalence by molecular methods at the end of study (cross-sectional survey).
Gametocyte prevalence in quantitative polymerase chain reaction (qPCR) detected infections is assessed by molecular methods and compared between arms.
Time frame: 16 weeks
Gametocyte density by molecular methods at the end of study (cross-sectional survey).
Gametocyte density (gametocytes/µL) in qPCR detected infections is assessed by molecular methods and compared between arms.
Time frame: 16 weeks
Gametocyte prevalence of male and female gametocytes by molecular methods among P. falciparum infections at all study visits.
Gametocyte prevalence of male and female gametocytes will be assessed by molecular methods and compared between study arms.
Time frame: Throughout study, an average of 18 months
Gametocyte density of male and female gametocytes by molecular methods among P. falciparum infections at all study visits.
Gametocyte density of male and female gametocytes will be assessed by molecular methods and compared between study arms.
Time frame: Throughout study, an average of 18 months
Incidence of malaria infections
Regular visits by weekly active case detection and monthly screening will result in the identification of malaria infections that are not detected during CCM. Number of infections detected in each arm will be quantified and compared between arms.
Time frame: Throughout study, an average of 18 months
Infectivity of P. falciparum infections to mosquitoes
For a selection of infections, infectiousness to mosquitoes is assessed by membrane feeding assays.
Time frame: Throughout study, an average of 18 months
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