Abstract
SummaryBackgroundMass drug administration for elimination of Plasmodium falciparum malaria is recommended by WHO in some settings. We used consensus modelling to understand how to optimise the effects of mass drug administration in areas with low malaria transmission.MethodsWe collaborated with researchers doing field trials to establish a standard intervention scenario and standard transmission setting, and we input these parameters into four previously published models. We then varied the number of rounds of mass drug administration, coverage, duration, timing, importation of infection, and pre-administration transmission levels. The outcome of interest was the percentage reduction in annual mean prevalence of P falciparum parasite rate as measured by PCR in the third year after the final round of mass drug administration.FindingsThe models predicted differing magnitude of the effects of mass drug administration, but consensus answers were reached for several factors. Mass drug administration was predicted to reduce transmission over a longer timescale than accounted for by the prophylactic effect alone. Percentage reduction in transmission was predicted to be higher and last longer at lower baseline transmission levels. Reduction in transmission resulting from mass drug administration was predicted to be temporary, and in the absence of scale-up of other interventions, such as vector control, transmission would return to pre-administration levels. The proportion of the population treated in a year was a key determinant of simulated effectiveness, irrespective of whether people are treated through high coverage in a single round or new individuals are reached by implementation of several rounds. Mass drug administration was predicted to be more effective if continued over 2 years rather than 1 year, and if done at the time of year when transmission is lowest.InterpretationMass drug administration has the potential to reduce transmission for a limited time, but is not an effective replacement for existing vector control. Unless elimination is achieved, mass drug administration has to be repeated regularly for sustained effect.FundingBill & Melinda Gates Foundation.
Highlights
Despite the gains made towards elimination of Plasmodium falciparum malaria in the past 15 years, many countries still have endemic transmission[1] and are increasingly looking to new strategies to accelerate progress
In September, 2015, WHO’s Malaria Policy Advisory Committee recommended for the first time the use of Mass drug administration (MDA) in specific circumstances: when transmission is close to being interrupted, vector control, effective surveillance, and access to case management are at high coverage, and importation of infection is minimal; as a component of accelerated elimination in areas of the Greater Mekong Subregion, which are under threat of multidrug resistance; or for malaria epidemics or during complex emergencies.[6]
The four different models showed similar trends in the effects of MDA with time, substantial differences were noted in both simulated pre-intervention transmission and the magnitude of the effect
Summary
Despite the gains made towards elimination of Plasmodium falciparum malaria in the past 15 years, many countries still have endemic transmission[1] and are increasingly looking to new strategies to accelerate progress. In September, 2015, WHO’s Malaria Policy Advisory Committee recommended for the first time the use of MDA in specific circumstances: when transmission is close to being interrupted, vector control, effective surveillance, and access to case management are at high coverage, and importation of infection is minimal; as a component of accelerated elimination in areas of the Greater Mekong Subregion, which are under threat of multidrug resistance; or for malaria epidemics or during complex emergencies.[6] National malaria control programmes and partners need to decide what role, if any, MDA should have in control and elimination strategies. The best operational strategies for MDA and how best to combine MDA with other interventions need to be established
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