Reactive focal drug administration associated with decreased malaria transmission in an elimination setting: Serological evidence from the cluster-randomized CoRE study

• DOI: 10.1371/journal.pgph.0001295
• Publication Date: 2022-12-05T18:24:16Z
• Authors: Daniel J. Bridges; John M. Miller; Victor Chalwe; Hawela Moonga; Busiku Hamainza; Richard W. Steketee; Brenda Mambwe; Conceptor Mulube; Lindsey Wu; Kevin K. A. Tetteh; Chris Drakeley; Sandra Chishimba; Mulenga Mwenda; Kafula Silumbe; David A. Larsen
• Keywords: 03 medical and health sciences; 0302 clinical medicine; Public aspects of medicine; RA1-1270; 3. Good health; Research Article

Efforts to eliminate malaria transmission need evidence-based strategies. However, accurately assessing end-game elimination strategies is challenging due the low level of and rarity infections. We hypothesised that presumptively treating individuals during reactive case detection (RCD) would reduce serology more sensitively detect this change over standard approaches. conducted a cluster randomised control trial (NCT02654912) presumptive focal drug administration (RFDA-intervention) compared care, test treat (RFTAT-control) in Southern Province, Zambia-an area seasonal (overall incidence ~3 per 1,000). measured routine from health facilities as well PCR parasite prevalence / antimalarial seroprevalence an endline cross-sectional population survey. No significant difference was identified data by polymerase chain reaction (PCR) had insufficient numbers infections (i.e., 16 among 6,276 children) assess intervention. Comparing long-term serological markers, we found 19% (95% CI = 4-32%) reduction seropositivity for RFDA intervention using differences approach incorporating positivity age. also 37% 2-59%) short-term markers post-only comparison. These analyses provide compelling evidence both has impact on appropriate strategy. Furthermore, provides sensitive measure changes other approaches miss, particularly very settings. Trial Registration: Registered at www.clinicaltrials.gov (NCT02654912, 13/1/2016).