Chaccour Carlos J, Alonso Sergi, Zulliger Rose, Wagman Joe, Saifodine Abuchahama, Candrinho Baltazar, Macete Eusébio, Brew Joe, Fornadel Christen, Kassim Hidayat, Loch Lourdes, Sacoor Charfudin, Varela Kenyssony, Carty Cara L, Robertson Molly, Saute Francisco
ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.
BMJ Glob Health. 2018 Jan 30;3(1):e000610. doi: 10.1136/bmjgh-2017-000610. eCollection 2018.
Most of the reduction in malaria prevalence seen in Africa since 2000 has been attributed to vector control interventions. Yet increases in the distribution and intensity of insecticide resistance and higher costs of newer insecticides pose a challenge to sustaining these gains. Thus, endemic countries face challenging decisions regarding the choice of vector control interventions.
A cluster randomised trial is being carried out in Mopeia District in the Zambezia Province of Mozambique, where malaria prevalence in children under 5 is high (68% in 2015), despite continuous and campaign distribution of long-lasting insecticide-treated nets (LLINs). Study arm 1 will continue to use the standard, LLIN-based National Malaria Control Programme vector control strategy (LLINs only), while study arm 2 will receive indoor residual spraying (IRS) once a year for 2 years with a microencapsulated formulation of pirimiphos-methyl (Actellic 300 CS), in addition to the standard LLIN strategy (LLINs+IRS). Prior to the 2016 IRS implementation (the first of two IRS campaigns in this study), 146 clusters were defined and stratified per number of households. Clusters were then randomised 1:1 into the two study arms. The public health impact and cost-effectiveness of IRS intervention will be evaluated over 2 years using multiple methods: (1) monthly active malaria case detection in a cohort of 1548 total children aged 6-59 months; (2) enhanced passive surveillance at health facilities and with community health workers; (3) annual cross-sectional surveys; and (4) entomological surveillance. Prospective microcosting of the intervention and provider and societal costs will be conducted. Insecticide resistance status pattern and changes in local Anopheline populations will be included as important supportive outcomes.
By evaluating the public health impact and cost-effectiveness of IRS with a non-pyrethroid insecticide in a high-transmission setting with high LLIN ownership, it is expected that this study will provide programmatic and policy-relevant data to guide national and global vector control strategies.
NCT02910934.
自2000年以来，非洲疟疾流行率的大幅下降主要归功于病媒控制干预措施。然而，杀虫剂抗性的分布范围和强度不断增加，以及新型杀虫剂成本更高，这对维持这些成果构成了挑战。因此，疟疾流行国家在选择病媒控制干预措施方面面临着艰难的决策。
在莫桑比克赞比西亚省的莫佩亚区正在进行一项整群随机试验，尽管长期持续分发长效驱虫蚊帐（LLINs），但该地区5岁以下儿童的疟疾流行率仍很高（2015年为68%）。研究组1将继续采用基于LLINs的标准国家疟疾控制规划病媒控制策略（仅使用LLINs），而研究组2除标准LLINs策略（LLINs+IRS）外，将在两年内每年接受一次使用微囊化甲基嘧啶磷制剂（Actellic 300 CS）进行的室内滞留喷洒（IRS）。在2016年实施IRS之前（本研究中的两次IRS活动中的第一次），根据家庭数量定义并分层了146个群组。然后将群组以1:1的比例随机分为两个研究组。将使用多种方法在两年内评估IRS干预措施的公共卫生影响和成本效益：（1）对总共1548名6至59个月大的儿童进行每月一次的主动疟疾病例检测；（2）加强在卫生设施以及通过社区卫生工作者进行的被动监测；（3）年度横断面调查；以及（4）昆虫学监测。将对干预措施以及提供者和社会成本进行前瞻性微观成本核算。杀虫剂抗性状况模式以及当地按蚊种群的变化将作为重要的支持性结果纳入。
通过在LLINs使用率高的高传播环境中评估使用非拟除虫菊酯类杀虫剂的IRS的公共卫生影响和成本效益，预计本研究将提供与规划和政策相关的数据，以指导国家和全球病媒控制策略。
NCT02910934。
