Malaria Clinical Trial
Official title:
Assessing the Effectiveness of Mass Drug Administration (MDA) With Dihydroartemisinin + Piperaquine for Reducing Malaria Parasite Infection Prevalence and Incidence in Southern Province Zambia
To quantify the relative effectiveness, cost, and cost-effectiveness of fMDA and MDA with DHAp against no mass treatment for reducing P. falciparum parasite prevalence, confirmed OPD malaria case incidence and cohort infection incidence in areas of high and low malaria transmission and in a program-relevant manner that will permit adoption and adaptation for wider-scale deployment.
To quantify the relative effectiveness, cost, and cost-effectiveness of fMDA and MDA with
DHAp against no mass treatment for reducing P. falciparum parasite prevalence, confirmed OPD
malaria case incidence and cohort infection incidence in areas of high and low malaria
transmission and in a program-relevant manner that will permit adoption and adaptation for
wider-scale deployment.
In areas stratified by high and low malaria transmission, are 2 rounds of fMDA and MDA with
DHAp more effective than no mass treatment (current standard of care) at reducing malaria
parasite prevalence, health facility confirmed case incidence and community infection
incidence over a 12 month period
- Null hypothesis (H0): There is no benefit of 2 rounds of fMDA or MDA with DHAp over
current standard of care (national policy of case management) at reducing malaria
parasite prevalence, health facility confirmed case incidence and community infection
incidence over a 12 month period.
- Research hypothesis (HR): 2 rounds of fMDA and MDA with DHAp during the low transmission
season will be significantly more effective than no mass treatment (standard of care) at
reducing malaria parasite prevalence, health facility confirmed case incidence and
community infection incidence over a 12 month period.
The research objectives are:
1. In areas stratified by high and low malaria transmission, evaluate the relative
effectiveness of 2 rounds of fMDA with DHAp (fMDA arm), 2 rounds of community-wide MDA
with DHAp (MDA arm) and no mass treatment (current standard of care - control arm) on
the outcomes of reducing malaria parasite prevalence, confirmed case incidence and
infection incidence over a 12 month period;
2. In areas stratified by high and low malaria transmission, assess the percent of health
facility catchment areas (HFCA) with fMDA and MDA interventions that are able to reduce
annual confirmed malaria case incidence to below 25 cases per 1,000 catchment
population, which would permit the transition to a passive case investigation approach
for malaria elimination;
3. Quantify the population coverage of the fMDA and MDA interventions in the study areas,
including the identification of systematic barriers to achieving high coverage, under
best programmatic efforts using directly observed treatment (DOT) to assure full
treatment;
4. Assess and compare the cost and cost-effectiveness of fMDA and MDA with DHAp to no mass
treatment in areas of high and low transmission;
5. Assess the adherence of taking a full course of DHAp by the fMDA and MDA interventions
in areas of high and low transmission, under best programmatic efforts using DOT to
assure full treatment;
6. Assess the clearance of asexual stage parasites at day 7 following the administration of
DHAp under the best programmatic efforts using DOT to assure full treatment; and
7. Assess the acceptability of participating in the fMDA and MDA interventions among
community members and health care leaders in areas of high and low transmission.
The study population includes:
Population of ~560,000 people in ~112,000 households in 60 health facility catchment areas
near Lake Kariba in Southern Province.
Cluster randomized controlled trial in high and low transmission areas will be used to
evaluate the fMDA and MDA interventions against current standard of care for the effect on
population-wide parasite prevalence (RDT and more sensitive assay), community cohort
infection incidence and routinely collected confirmed malaria case incidence.
The primary outcomes are:
1. Parasite prevalence during the high transmission season among children <6 years old
(excluding neonates <1 month)
2. Pf infection incidence rate among individuals ≥3 months
3. Total and confirmed outpatient (OPD) malaria case incidence and inpatient (IPD) malaria
case incidence among all ages
4. RDT test positivity rate from fMDA and MDA interventions (plus control group)
5. Population coverage of the fMDA and MDA interventions at each round
The entire population will be included in the study; interventions will be grouped/assigned
randomly according to health facility catchment area (n= 60 health facilities), matched on
potential confounding factors. Household surveys in the high transmission season before and
after the interventions will be used for ascertaining malaria parasite prevalence. A
longitudinal cohort will be used for ascertaining the infection incidence rate. The health
system rapid reporting system will be used for ascertaining confirmed malaria case incidence.
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