Abstract
BackgroundVector control tools have contributed significantly to a reduction in malaria burden since 2000, primarily through insecticidal-treated bed nets (ITNs) and indoor residual spraying. In the face of increasing insecticide resistance in key malaria vector species, global progress in malaria control has stalled. Innovative tools, such as dual active ingredient (dual-AI) ITNs that are effective at killing insecticide-resistant mosquitoes have recently been introduced. However, large-scale uptake has been slow for several reasons, including higher costs and limited evidence on their incremental effectiveness and cost-effectiveness. The present report describes the design of several observational studies aimed to determine the effectiveness and cost-effectiveness of dual-AI ITNs, compared to standard pyrethroid-only ITNs, at reducing malaria transmission across a variety of transmission settings.MethodsObservational pilot studies are ongoing in Burkina Faso, Mozambique, Nigeria, and Rwanda, leveraging dual-AI ITN rollouts nested within the 2019 and 2020 mass distribution campaigns in each country. Enhanced surveillance occurring in select study districts include annual cross-sectional surveys during peak transmission seasons, monthly entomological surveillance, passive case detection using routine health facility surveillance systems, and studies on human behaviour and ITN use patterns. Data will compare changes in malaria transmission and disease burden in districts receiving dual-AI ITNs to similar districts receiving standard pyrethroid-only ITNs over three years. The costs of net distribution will be calculated using the provider perspective including financial and economic costs, and a cost-effectiveness analysis will assess incremental cost-effectiveness ratios for Interceptor® G2, Royal Guard®, and piperonyl butoxide ITNs in comparison to standard pyrethroid-only ITNs, based on incidence rate ratios calculated from routine data.ConclusionsEvidence of the effectiveness and cost-effectiveness of the dual-AI ITNs from these pilot studies will complement evidence from two contemporary cluster randomized control trials, one in Benin and one in Tanzania, to provide key information to malaria control programmes, policymakers, and donors to help guide decision-making and planning for local malaria control and elimination strategies. Understanding the breadth of contexts where these dual-AI ITNs are most effective and collecting robust information on factors influencing comparative effectiveness could improve uptake and availability and help maximize their impact.
Highlights
Vector control tools have contributed significantly to a reduction in malaria burden since 2000, primar‐ ily through insecticidal-treated bed nets (ITNs) and indoor residual spraying
Evidence shows that standard pyrethroid-only ITNs can still be effective at preventing malaria in regions with resistant vector populations [6]; as evidence of pyrethroid resistance mounts and documentation of the decreased ability of standard pyrethroidonly ITNs to control resistant mosquito populations increases, new classes of ITNs have been developed to perform against pyrethroid-resistant mosquitoes
This study focuses on evaluating the pilot distributions of Interceptor® G2 (IG2) taking place in Burkina Faso, Mozambique, Nigeria, and Rwanda, and Royal Guard® (RG) in Mozambique and Nigeria
Summary
Vector control tools have contributed significantly to a reduction in malaria burden since 2000, primar‐ ily through insecticidal-treated bed nets (ITNs) and indoor residual spraying. Evidence shows that standard pyrethroid-only ITNs (which here are synonymous with traditional long-lasting insecticidal nets, or LLINs) can still be effective at preventing malaria in regions with resistant vector populations [6]; as evidence of pyrethroid resistance mounts and documentation of the decreased ability of standard pyrethroidonly ITNs to control resistant mosquito populations increases, new classes of ITNs have been developed to perform against pyrethroid-resistant mosquitoes These include pyrethroid-based ITNs that contain the insecticide synergist piperonyl butoxide (PBO, which inhibits mosquito monooxygenase enzymes that can detoxify pyrethroids), as well as newer dual active ingredient (dual-AI) ITNs that combine a pyrethroid AI with a second from a different class of insecticide—most notably either the pyrrole chlorfenapyr, an insecticide that disrupts adenosine triphosphate synthesis, or the insect growth regulator pyriproxyfen, which disrupts mosquito development and reproduction. The dual active ingredient and piperonyl butoxide ITNs evaluated in this study have not demonstrated that they meet this standard
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