评估有吸引力的靶向糖饵，一种针对疟疾的新型户外病媒控制策略：来自马里西南部一项整群随机开放标签平行组对照试验的结果。

Evaluation of Attractive Targeted Sugar Baits, a new outdoor vector control strategy against malaria: Results from a cluster randomised open-label parallel arm controlled trial in Southwestern Mali.

作者信息

Sarrassat Sophie, Toure Mahamoudou, Diarra Ayouba, Keita Makan, Coulibaly Hamady, Arou Abdoul Zamilou, Traore Mohamed, Tangara Cheick Oumar, Bradley John, Muller Gunter, Majambere Silas, Beier John C, Vontas John, Traore Sekou F, Diop Samba, Kleinschmidt Immo, Doumbia Seydou

机构信息

Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom.

University Clinical Research Centre, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali.

出版信息

J Infect. 2025 Jul;91(1):106524. doi: 10.1016/j.jinf.2025.106524. Epub 2025 Jun 5.

DOI:10.1016/j.jinf.2025.106524

PMID:40482859

Abstract

BACKGROUND

The Attractive Targeted Sugar Bait (ATSB) is a new malaria outdoor vector control tool targeting sugar-feeding behaviours of vector mosquitoes. In Mali, a two-year open-label two-arm cluster randomised controlled trial compared the efficacy and safety of ATSB plus insecticide treated mosquito nets (ITN) versus ITN alone on malaria burden.

METHODS

76 clusters were formed, of which 38 were randomly allocated to the intervention. Cohort studies and household surveys were performed to assess clinical malaria incidence (primary outcome) in children aged 5 to 14 years and malaria infection prevalence in individuals aged 6 months or older, respectively. Primary analyses were performed on an intention-to-treat basis. The trial was designed to detect a minimum 30% reduction in the two outcomes over a two-year period with a power of at least 80%. The trial is registered at ClinicalTrial.gov (NCT04149119).

FINDINGS

The proportion of sleeping buildings with at least 2 ATSB ranged between 70% and 80%. Coverage of ATSB in good condition was lower (50% or less). Over the two-year trial period, the clinical malaria incidence rate in the control and intervention arm was 0.726 and 0.660 cases per person-year, respectively, with no statistical evidence for an intervention effect (Incidence Rate Ratio (IRR) = 0.90; 95%CI 0.77, 1.05; p = 0.188). Malaria infection prevalence was approximately 37% in both arms (Odds Ratio (OR) = 0.96; 95%CI 0.76, 1.21; p = 0.729). In clusters with coverage of stations in good condition above 80%, there was evidence for a 26% reduction in malaria incidence compared to control clusters after controlling for confounders (adjusted IRR = 0.74; 95%CI 0.61, 0.90; p = 0.002).

INTERPRETATION

Overall, the trial did not demonstrate evidence of additional protection against malaria of ATSB compared to using ITN alone. Suboptimal coverage and maintenance of ATSB in good condition in the field may explain the lack of an intervention effect.

摘要

背景

有吸引力的靶向糖饵（ATSB）是一种针对媒介蚊虫取食行为的新型疟疾户外病媒控制工具。在马里，一项为期两年的开放标签双臂整群随机对照试验比较了ATSB加杀虫剂处理蚊帐（ITN）与单独使用ITN对疟疾负担的疗效和安全性。

方法

形成了76个群组，其中38个被随机分配到干预组。分别进行队列研究和家庭调查，以评估5至14岁儿童的临床疟疾发病率（主要结局）和6个月及以上个体的疟疾感染率。主要分析基于意向性分析。该试验旨在检测在两年期间这两个结局至少降低30%，检验效能至少为80%。该试验已在ClinicalTrial.gov注册（NCT04149119）。

结果

至少有2个ATSB的睡眠建筑比例在70%至80%之间。状况良好的ATSB覆盖率较低（50%或更低）。在两年的试验期内，对照组和干预组的临床疟疾发病率分别为每人年0.726例和0.660例，没有统计学证据表明存在干预效果（发病率比（IRR）=0.90；95%置信区间0.77，1.05；p=0.188）。两组的疟疾感染率均约为37%（优势比（OR）=0.96；95%置信区间0.76，1.21；p=0.729）。在状况良好的站点覆盖率高于80%的群组中，在控制混杂因素后，有证据表明与对照群组相比疟疾发病率降低了26%（调整后的IRR=0.74；95%置信区间0.61，0.90；p=0.002）。