Abstract
BackgroundSystematic treatment of all individuals living in the same compound of a clinical malaria case may clear asymptomatic infections and possibly reduce malaria transmission, where this is focal. High and sustained coverage is extremely important and requires active community engagement. This study explores a community-based approach to treating malaria case contacts.Methods/designThis is a cluster-randomized trial to determine whether, in low-transmission areas, treating individuals living in the same compound of a clinical malaria case with dihydroartemisinin-piperaquine can reduce parasite carriage and thus residual malaria transmission. Treatment will be administered through the local health system with the approach of encouraging community participation designed and monitored through formative research. The trial goal is to show that this approach can reduce in intervention villages the prevalence of Plasmodium falciparum infection toward the end of the malaria transmission season.DiscussionAdherence and cooperation of the local communities are critical for the success of mass treatment campaigns aimed at reducing malaria transmission. By exploring community perceptions of the changing trends in malaria burden, existing health systems, and reaction to self-administered treatment, this study will develop and adapt a model for community engagement toward malaria elimination that is cost-effective and fits within the existing health system.Trial registrationClinical trials.gov, NCT02878200. Registered on 25 August 2016.
Highlights
Systematic treatment of all individuals living in the same compound of a clinical malaria case may clear asymptomatic infections and possibly reduce malaria transmission, where this is focal
Adherence and cooperation of the local communities are critical for the success of mass treatment campaigns aimed at reducing malaria transmission
Trial objective The objective of this trial is to determine whether administering an antimalarial treatment to all individuals living in the same compound of clinical malaria cases would result in a lower prevalence of P. falciparum infection at the village level
Summary
Malaria morbidity and mortality have declined below levels previously thought unachievable in sub-Saharan Africa [14]. There is renewed interest in use of MDAs, contemporary reviews on their utility for malaria elimination raises questions regarding their costeffectiveness, sustainability, the increased drug pressure, and the potential for the emergence of drug-resistant parasites [3, 27] This has led to proposing focused approaches such as mass screening and treatment, available field diagnostic tests are not sufficiently sensitive to detect low-density infections [11]. The use of an iterative investigatory approach into the evolving local sociocultural, behavioral, and practical issues that affect malaria prevention and treatment has been proposed [16], and this could be applied in the context of a malaria elimination program targeting asymptomatic infections [32, 33] In this trial, we build on the already established concept of passive case detection to target for treatment individuals around the index case, and this will be done with the active involvement of patients, their family members, and existing community organizations to optimize adherence.
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