Abstract
BackgroundThe sterile insect technique and transgenic equivalents are considered promising tools for controlling vector-borne disease in an age of increasing insecticide and drug-resistance. Combining vector interventions with artemisinin-based therapies may achieve the twin goals of suppressing malaria endemicity while managing artemisinin resistance. While the cost-effectiveness of these controls has been investigated independently, their combined usage has not been dynamically optimized in response to ecological and epidemiological processes.ResultsAn optimal control framework based on coupled models of mosquito population dynamics and malaria epidemiology is used to investigate the cost-effectiveness of combining vector control with drug therapies in homogeneous environments with and without vector migration. The costs of endemic malaria are weighed against the costs of administering artemisinin therapies and releasing modified mosquitoes using various cost structures. Larval density dependence is shown to reduce the cost-effectiveness of conventional sterile insect releases compared with transgenic mosquitoes with a late-acting lethal gene. Using drug treatments can reduce the critical vector control release ratio necessary to cause disease fadeout.ConclusionsCombining vector control and drug therapies is the most effective and efficient use of resources, and using optimized implementation strategies can substantially reduce costs.
Highlights
The sterile insect technique and transgenic equivalents are considered promising tools for controlling vector-borne disease in an age of increasing insecticide and drug-resistance
Catalyzed by the Roll Back Malaria Initiative around the United National Millennium Development Goals, a widespread scale-up of coverage of these control interventions successfully reduced and locally eliminated malaria in sub-Saharan Africa; between 2000 and 2015, Plasmodium infection in endemic regions of Africa halved and the incidence of clinical disease fell by 40% [4]
This remarkable and widespread reduction is estimated to have averted 663 million clinical cases of malaria since 2000 [4]. These gains are fragile and they are increasingly threatened by the emergence of Plasmodium strains that are resistant to anti-malarial drugs and mosquitoes that are resistant to the insecticides used to kill them
Summary
The sterile insect technique and transgenic equivalents are considered promising tools for controlling vector-borne disease in an age of increasing insecticide and drug-resistance. Catalyzed by the Roll Back Malaria Initiative around the United National Millennium Development Goals, a widespread scale-up of coverage of these control interventions successfully reduced and locally eliminated malaria in sub-Saharan Africa; between 2000 and 2015, Plasmodium infection in endemic regions of Africa halved and the incidence of clinical disease fell by 40% [4]. This remarkable and widespread reduction is estimated to have averted 663 million clinical cases of malaria since 2000 [4]. These gains are fragile and they are increasingly threatened by the emergence of Plasmodium strains that are resistant to anti-malarial drugs and mosquitoes that are resistant to the insecticides used to kill them
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