Effectiveness of the Innovative 1,7-Malaria Reactive Community-Based Testing and Response Approach (1, 7-mRCT) on Malaria Burden Reduction in Southeastern Tanzania

Abstract

Background: In 2015, a China-UK-Tanzania tripartite pilot project was implemented in south-eastern Tanzania to explore a new model to reduce the malaria burden with the aim of eventually scaling-up the approach in Africa. Chinese and Tanzanian teams have developed a locally-tailored malaria control approach screening for febrile cases in endemic villages on Day 1 followed by focal treatment of holoendemic villages within 7 days to stop transmission at the same phase of the plasmodium life-cycle. This 1,7-Reactive Community-based Testing and Response (1,7-mRCT) model can utilize existing health facility data and locally trained community-based health workers to conduct community-level testing and treatment. Methods: Matched malaria incidence pairs of control and intervention wards were chosen. The latter arm was selected for the 1,7-mRCT approach, while the control wards relied on long-lasting insecticide-treated bednets only. The 1,7-mRCT activities included community testing and treatment of malaria infection. Case-to-suspect ratios of malaria cases were aggregated at the village level weekly to identify the village with the highest ratio. Community-based mobile test stations (cMTS) were used for mass testing and treatment. The pilot project was implemented from September 2015 to June 2018 with 85 rounds of 1,7-mRCT implemented in the intervention wards. Comparing the two arms of approach we look for any change in malaria prevalence from the baseline to the endline survey. Besides we also studied the malaria incidence reported at the health facilities after interventions in the treated villages. Findings: Compared to the control wards, the 1,7-mRCT model significantly reduced the malaria infections by 66% (adjusted OR 0.34, 95%CI 0.26-0.44, p<0001) over and above the benefit of the bednets. Malaria prevalence in the intervention wards declined by 81% (from 26% (95% CI, 23.7-27.8), at the baseline to 4.9% (95% CI, 4.0-5.9) at the endline survey). In the villages receiving the 1,7-mRCT, the case ratio decreased by over 15.7% (95%CI, -33, 6) compared to pretreatment levels. Interpretation: The 1,7-mRCT approach resulted in a significant reduction of the malaria burden in the areas of moderate and high transmission in southern Tanzania. Thus, this locally tailored approach could accelerate malaria control and elimination efforts in Africa. The results provide the impetus for further evaluation of its effectiveness and scaling up of local adaptations to the 1-7mRCT approach in other high malaria burden countries including Tanzania across the African continent. Funding Statement: China-UK Global Health Support Programme (GHSP-CS-OP4-D02) funded by UK DFID. Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: The Medical Research Coordination Committee of the National Institute of Medical Research granted the permit to conduct the ethics approval for the study (NIMR/HQ/R.8a/Vol.IX/2005). Institution ethical approval was also obtained from the Ifakara Health Institute Institutional Review Board (IHI/IRB/No: 18-2015) and the Chinese Centre for Disease Control. Informed consent was obtained.