H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia.
National Center for Immunization and Respiratory Diseases, Influenza Division, Epidemiology and Prevention Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
Am J Trop Med Hyg. 2024 Jul 9;111(3):490-497. doi: 10.4269/ajtmh.23-0844. Print 2024 Sep 4.
Malaria continues to be a major source of morbidity and mortality in sub-Saharan Africa. Timely, accurate, and effective case management is critical to malaria control. Proactive community case management (ProCCM) is a new strategy in which a community health worker "sweeps" a village, visiting households at defined intervals to proactively provide diagnostic testing and treatment if indicated. Pilot experiments have shown the potential of ProCCM for controlling malaria transmission; identifying the best strategy for administering ProCCM in terms of interval timings and number of sweeps could lead to further reductions in malaria infections. We developed an agent-based simulation to model malaria transmission and the impact of various ProCCM strategies. The model was validated using symptomatic prevalence data from a ProCCM pilot study in Senegal. Various ProCCM strategies were tested to evaluate the potential for reducing parasitologically confirmed symptomatic malaria cases in the Senegal setting. We found that weekly ProCCM sweeps during a 21-week transmission season could reduce cases by 36.3% per year compared with no sweeps. Alternatively, two initial fortnightly sweeps, seven weekly sweeps, and finally four fortnightly sweeps (13 sweeps total) could reduce confirmed malaria cases by 30.5% per year while reducing the number of diagnostic tests and corresponding costs by about 33%. Under a highly seasonal transmission setting, starting the sweeps early with longer duration and higher frequency would increase the impact of ProCCM, though with diminishing returns. The model is flexible and allows decision-makers to evaluate implementation strategies incorporating sweep frequency, time of year, and available budget.
疟疾仍是撒哈拉以南非洲地区发病率和死亡率的主要原因。及时、准确、有效的病例管理对于控制疟疾至关重要。主动社区病例管理（ProCCM）是一种新策略，社区卫生工作者会“扫荡”村庄，按规定间隔访问家庭，如果有需要，主动提供诊断检测和治疗。试点实验表明 ProCCM 控制疟疾传播的潜力；确定 ProCCM 管理策略在间隔时间和扫荡次数方面的最佳策略可能会进一步减少疟疾感染。我们开发了一个基于代理的模拟模型来模拟疟疾传播和各种 ProCCM 策略的影响。该模型使用塞内加尔 ProCCM 试点研究的症状流行率数据进行了验证。测试了各种 ProCCM 策略，以评估在塞内加尔环境中减少寄生虫学确认的有症状疟疾病例的潜力。我们发现，在 21 周的传播季节中，每周进行 ProCCM 扫荡可以使每年的病例减少 36.3%，而不进行扫荡。或者，最初进行两次每两周一次的扫荡、七次每周一次的扫荡，最后进行四次每两周一次的扫荡（总共 13 次扫荡），每年可以减少 30.5%的确诊疟疾病例，同时减少约 33%的诊断测试和相应成本。在高度季节性传播环境下，早期开始扫荡，持续时间更长且频率更高，将增加 ProCCM 的效果，但收益递减。该模型具有灵活性，允许决策者评估包含扫荡频率、一年中的时间和可用预算的实施策略。
