Kenya Medical Research Institute (KEMRI), Centre for Global Health Research, Kisumu, Kenya.
Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
Malar J. 2019 Jul 29;18(1):255. doi: 10.1186/s12936-019-2896-6.
Malaria transmission is high in western Kenya and the asymptomatic infected population plays a significant role in driving the transmission. Mathematical modelling and simulation programs suggest that interventions targeting asymptomatic infections through mass testing and treatment (MTaT) or mass drug administration (MDA) have the potential to reduce malaria transmission when combined with existing interventions.
This paper describes the study site, capacity development efforts required, and lessons learned for implementing a multi-year community-based cluster-randomized controlled trial to evaluate the impact of MTaT for malaria transmission reduction in an area of high transmission in western Kenya.
The study partnered with Kenya's Ministry of Health (MOH) and other organizations on community sensitization and engagement to mobilize, train and deploy community health volunteers (CHVs) to deliver MTaT in the community. Within the health facilities, the study availed staff, medical and laboratory supplies and strengthened health information management system to monitor progress and evaluate impact of intervention.
More than 80 Kenya MOH CHVs, 13 clinical officers, field workers, data and logistical staff were trained to carry out MTaT three times a year for 2 years in a population of approximately 90,000 individuals. A supply chain management was adapted to meet daily demands for large volumes of commodities despite the limitation of few MOH facilities having ideal storage conditions. Modern technology was adapted more to meet the needs of the high daily volume of collected data.
In resource-constrained settings, large interventions require capacity building and logistical planning. This study found that investing in relationships with the communities, local governments, and other partners, and identifying and equipping the appropriate staff with the skills and technology to perform tasks are important factors for success in delivering an intervention like MTaT.
肯尼亚西部疟疾传播率较高，无症状感染者在推动传播方面发挥着重要作用。数学建模和模拟程序表明，通过大规模检测和治疗（MTaT）或大规模药物管理（MDA）干预无症状感染，与现有干预措施结合，有可能降低疟疾传播。
本文描述了研究地点、实施一项多年社区为基础的集群随机对照试验所需的能力建设工作以及经验教训，以评估在肯尼亚西部高传播地区进行 MTaT 以减少疟疾传播的影响。
该研究与肯尼亚卫生部（MOH）和其他组织合作，开展社区宣传和参与活动，动员、培训和部署社区卫生志愿者（CHVs）在社区中提供 MTaT。在卫生设施内，研究提供了工作人员、医疗和实验室用品，并加强了卫生信息管理系统，以监测进展并评估干预措施的影响。
80 多名肯尼亚 MOH CHVs、13 名临床医生、现场工作人员、数据和后勤人员接受了培训，以便在大约 90000 人的人群中每年进行三次 MTaT，持续两年。尽管一些 MOH 设施的储存条件不理想，但适应了供应链管理，以满足大量商品的日常需求。适应了现代技术以满足高日常数据量的需求。
在资源有限的环境中，大型干预措施需要进行能力建设和物流规划。本研究发现，投资于与社区、地方政府和其他合作伙伴的关系，以及确定和装备具有执行任务所需技能和技术的适当工作人员，是成功实施 MTaT 等干预措施的重要因素。
