Evaluating the feasibility and effectiveness of Reactive Targeted Parasite Elimination vs. Reactive Case Detection as a community level intervention in response to a passively identified index case: a cluster randomised controlled trial in Namibia

Evaluating the feasibility and effectiveness of Reactive Targeted Parasite Elimination vs. Reactive Case Detection as a community level intervention in response to a passively identified index case: a cluster randomised controlled trial in Namibia

Objectives

This is a cluster randomised controlled trial with factorial study design comparing the impact of reactive community-based malaria interventions:

  1. presumptive treatment (or TPE, targeted parasite elimination, mass drug administration) versus reactive case detection (RACD), and
  2. reactive IRS (indoor residual spraying) versus control on the incidence of malaria in Namibia.

Arm 1: RACD as per program + RDT screening and treatment

Arm 2: RACD + IRS with Actellic CS to EA after first reported cases

Arm 3: Focal MDA (household and immediate neighbors) in response to a case

Arm 4: Focal MDA + IRS with Actellic CS

Primary aim: To compare the impact of focal MDA versus RACD, and reactive IRS versus no reactive IRS, on incidence of confirmed, passively identified malaria cases.

Secondary aims:

Effectiveness

  1. To compare the impact of each intervention package (focal MDA+/- reactive IRS, RACD +/-reactive IRS) on:
  • Prevalence of infection, among all ages, as detected by quantitative polymerase chain reaction (qPCR)
  • Seroprevalence, among all ages, measured by ELISA 

Feasibility:

  1. To compare operational coverage, and determine the feasibility of reaching 80% coverage, for each intervention package;
  2. To compare safety of the intervention packages;
  3. To compare the acceptability of the interventions, individually and as packages;
  4. To compare the costs and cost-effectiveness of the interventions, individually and as packages;
  5. To measure medication adherence in both focal MDA and RACD arms.

PI Institution(s)

Principal Investigator (PI)

Funding source(s)

Partner(s)

Abstract

In recent years, many countries, including Namibia, have experienced reductions in malaria transmission in association with the scale-up of effective interventions and are now moving towards malaria elimination. In malaria control, the goal is to reduce the clinical burden of malaria. In malaria elimination, the aim is to interrupt transmission, and it becomes necessary to address not only symptomatic malaria, but also asymptomatic infections that contribute to transmission. Since malaria transmission is highly geographically heterogeneous, elimination activities should target hot spots, or areas where the risk of future infection is highest. Hence, in the transition from control to elimination, enhanced surveillance and response is necessary to target hot spots with interventions to interrupt transmission.

*Partly funded under the BMGF Grant OPP1160129

* A cross sectional survey done in Namibia in 2017 served as the endline survey for this study and was also used to evaluate the uRDT.

Evaluation of Targeted Parasite Elimination (TPE) in Namibia

Key facts

  • Dates
    Sep 2015 to Dec 2017
    Funding information
    Supported by Novartis Foundation A122666, Horchow Family Fund 5300375400 and BMGF OPP1160129
    Country
    • Namibia

MESA tags

  • Methodology
    Entomology, Operational research
    Theme(s)
    Asymptomatic reservoir, Drug-based strategies, Elimination strategies, Foci, Surveillance