Ba Konko Ciré El-Hadji, Roh Michelle E, Diallo Abdoulaye, Gadiaga Tidiane, Seck Amadou, Thiam Sylla, Gaye Seynabou, Diallo Ibrahima, Lo Aminata Colle, Diouf Elhadji, Ba Omar Gallo, Gueye Alioune Badara, Fogelson Ari, Wu Xue, Milligan Paul, Kibuka Tabitha, Hama Moustapha, Eckert Erin, Thwing Julie, Bennett Adam, Gosling Roly, Hwang Jimee, Sene Doudou, Ba Fatou, Cissé Bayal, Sturm-Ramirez Katharine, Hsiang Michelle S, Ndiaye Jean Louis
Université Iba Der Thiam de Thiès, Thiès, Senegal.
US President's Malaria Initiative Impact Malaria, Washington DC, USA.
medRxiv. 2024 Jul 18:2024.07.17.24310593. doi: 10.1101/2024.07.17.24310593.
In Africa, the scale-up of malaria control interventions, including seasonal malaria chemoprevention (SMC), has dramatically reduced malaria burden, but progress toward malaria elimination has stalled. We evaluated mass drug administration (MDA) as a strategy to accelerate reductions in malaria incidence in Senegal.
We conducted an open-label, cluster-randomised controlled trial in a low-to-moderate transmission setting of Tambacounda, Senegal. Eligible villages had a population size between 200-800. All villages received pyrethroid-piperonyl butoxide bednets and proactive community case management of malaria at baseline. Sixty villages were randomised 1:1 to either three cycles of MDA with dihydroartemisinin-piperaquine+single-low dose primaquine administered to individuals aged ≥3 months, six-weeks apart starting the third week of June (intervention), or standard-of-care, which included three monthly cycles of SMC with sulfadoxine-pyrimethamine+amodiaquine administered to children aged 3-120 months starting end of July (control). MDA and SMC were delivered door-to-door. The primary outcome was clinical malaria incidence in all ages assessed during the peak transmission season (July-December), the year after intervention. Here, we report safety, coverage, and impact outcomes during the intervention year. The trial is registered at ClinicalTrials.Gov (NCT04864444).
Between June 21, 2021 and October 3, 2021, 6505, 7125, and 7250 participants were administered MDA and 3202, 3174, and 3146 participants were administered SMC across cycles. Coverage of ≥1 dose of MDA drugs was 79%, 82%, and 83% across cycles. During the transmission season of the intervention year, MDA was associated with a 55% [95% CI: 28%-72%] lower incidence of malaria compared to control (MDA: 93 cases/1000 population; control: 173 cases/1000 population). No serious adverse events were reported in either arm.
In low-to-moderate malaria transmission settings with scaled-up malaria control interventions, MDA with dihydroartemisinin-piperaquine+single-low dose primaquine is effective and well-tolerated for reducing malaria incidence. Further analyses will focus on the sustainability of this reduction.
United States President's Malaria Initiative.
在非洲，包括季节性疟疾化学预防（SMC）在内的疟疾控制干预措施的扩大显著减轻了疟疾负担，但疟疾消除工作进展停滞。我们评估了大规模药物给药（MDA）作为加速塞内加尔疟疾发病率下降的策略。
我们在塞内加尔坦巴昆达的低至中度传播地区进行了一项开放标签、整群随机对照试验。符合条件的村庄人口规模在200 - 800人之间。所有村庄在基线时均接受了拟除虫菊酯 - 胡椒基丁醚蚊帐以及疟疾的积极社区病例管理。60个村庄按1:1随机分为两组，一组对年龄≥3个月的个体每六周进行一次，共三个周期的双氢青蒿素 - 哌喹 + 单低剂量伯氨喹的MDA给药，从6月的第三周开始（干预组）；另一组为标准治疗组，包括从7月底开始对3 - 120个月的儿童进行三个月周期的磺胺多辛 - 乙胺嘧啶 + 阿莫地喹的SMC给药（对照组）。MDA和SMC均逐户提供。主要结局是干预后一年传播高峰期（7月至12月）评估的所有年龄段的临床疟疾发病率。在此，我们报告干预年期间的安全性、覆盖率和影响结局。该试验已在ClinicalTrials.Gov注册（NCT04864444）。
在2021年6月21日至2021年10月3日期间，各周期接受MDA给药的参与者分别为6505、7125和7250人，接受SMC给药的参与者分别为3202、3174和3146人。各周期≥1剂MDA药物的覆盖率分别为79%、82%和83%。在干预年的传播季节，与对照组相比，MDA使疟疾发病率降低了55%[95%置信区间：28% - 72%]（MDA：93例/1000人口；对照组：173例/1000人口）。两组均未报告严重不良事件。
在疟疾控制干预措施扩大的低至中度疟疾传播地区，双氢青蒿素 - 哌喹 + 单低剂量伯氨喹的MDA对降低疟疾发病率有效且耐受性良好。进一步分析将聚焦于这种降低效果的可持续性。
美国总统疟疾倡议。
