Malaria Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia.
Global Malaria Programme, World Health Organization, Geneva, Switzerland.
Am J Trop Med Hyg. 2023 Dec 20;110(4_Suppl):82-93. doi: 10.4269/ajtmh.22-0720. Print 2024 Apr 2.
Many countries pursuing malaria elimination implement "reactive" strategies targeting household members and neighbors of index cases to reduce transmission. These strategies include reactive case detection and treatment (RACDT; testing and treating those positive) and reactive drug administration (RDA; providing antimalarials without testing). We conducted systematic reviews of RACDT and RDA to assess their effect on reducing malaria transmission and gathered evidence about key contextual factors important to their implementation. Two reviewers screened titles/abstracts and full-text records using defined criteria (Patient = those in malaria-endemic/receptive areas; Intervention = RACDT or RDA; Comparison = standard of care; Outcome = malaria incidence/prevalence) and abstracted data for meta-analyses. The Grading of Recommendations, Assessment, Development, and Evaluations approach was used to rate certainty of evidence (CoE) for each outcome. Of 1,460 records screened, reviewers identified five RACDT studies (three cluster-randomized controlled trials [cRCTs] and two nonrandomized studies [NRS]) and seven RDA studies (six cRCTs and one NRS); three cRCTs comparing RDA to RACDT were included in both reviews. Compared with RDA, RACDT was associated with nonsignificantly higher parasite prevalence (odds ratio [OR] = 1.85; 95% CI: 0.96-3.57; one study) and malaria incidence (rate ratio [RR] = 1.30; 95% CI: 0.94-1.79; three studies), both very low CoE. Compared with control or RACDT, RDA was associated with non-significantly lower parasite incidence (RR = 0.73; 95% CI: 0.36-1.47; 2 studies, moderate CoE), prevalence (OR = 0.78; 95% CI: 0.52-1.17; 4 studies, low CoE), and malaria incidence (RR = 0.93; 95% CI: 0.82-1.05; six studies, moderate CoE). Evidence for reactive strategies' impact on malaria transmission is limited, especially for RACDT, but suggests RDA might be more effective.
许多正在消除疟疾的国家实施“反应性”策略，针对索引病例的家庭成员和邻居进行目标定位，以减少传播。这些策略包括反应性病例检测和治疗（RACDT；对阳性病例进行检测和治疗）和反应性药物管理（RDA；在不进行检测的情况下提供抗疟药物）。我们对 RACDT 和 RDA 进行了系统评价，以评估它们对减少疟疾传播的影响，并收集了对其实施具有重要意义的关键背景因素的证据。两位审查员使用定义的标准（患者=疟疾流行/接受地区的人群；干预=RACDT 或 RDA；比较=标准护理；结局=疟疾发病率/患病率）筛选标题/摘要和全文记录，并对 meta 分析进行数据提取。使用推荐评估、制定与评估分级方法（Grading of Recommendations, Assessment, Development, and Evaluations approach）对每个结局的证据确定性（CoE）进行评级。在筛选的 1460 条记录中，审查员确定了 5 项 RACDT 研究（3 项群组随机对照试验[cRCT]和 2 项非随机研究[NRS]）和 7 项 RDA 研究（6 项 cRCT 和 1 项 NRS）；3 项比较 RDA 与 RACDT 的 cRCT 同时被这两项综述纳入。与 RDA 相比，RACDT 与寄生虫患病率的升高（比值比[OR] = 1.85；95%置信区间：0.96-3.57；1 项研究）和疟疾发病率（风险比[RR] = 1.30；95%置信区间：0.94-1.79；3 项研究）显著相关，但 CoE 均为极低。与对照或 RACDT 相比，RDA 与寄生虫发病率的降低（RR = 0.73；95%置信区间：0.36-1.47；2 项研究，CoE 为中等）、患病率（OR = 0.78；95%置信区间：0.52-1.17；4 项研究，CoE 为低）和疟疾发病率（RR = 0.93；95%置信区间：0.82-1.05；6 项研究，CoE 为中等）显著相关。关于反应性策略对疟疾传播影响的证据有限，特别是关于 RACDT 的证据，但表明 RDA 可能更有效。
