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Abstract
Mass treatment as a means to reducing P. falciparum malaria transmission was used during the first global malaria eradication campaign and is increasingly being considered for current control programmes. We used a previously developed mathematical transmission model to explore both the short and long-term impact of possible mass treatment strategies in different scenarios of endemic transmission. Mass treatment is predicted to provide a longer-term benefit in areas with lower malaria transmission, with reduced transmission levels for at least 2 years after mass treatment is ended in a scenario where the baseline slide-prevalence is 5%, compared to less than one year in a scenario with baseline slide-prevalence at 50%. However, repeated annual mass treatment at 80% coverage could achieve around 25% reduction in infectious bites in moderate-to-high transmission settings if sustained. Using vector control could reduce transmission to levels at which mass treatment has a longer-term impact. In a limited number of settings (which have isolated transmission in small populations of 1000–10,000 with low-to-medium levels of baseline transmission) we find that five closely spaced rounds of mass treatment combined with vector control could make at least temporary elimination a feasible goal. We also estimate the effects of using gametocytocidal treatments such as primaquine and of restricting treatment to parasite-positive individuals. In conclusion, mass treatment needs to be repeated or combined with other interventions for long-term impact in many endemic settings. The benefits of mass treatment need to be carefully weighed against the risks of increasing drug selection pressure.
Highlights
In the last few decades, antimalarial drugs that act against Plasmodium falciparum have been used primarily to avert severe morbidity and mortality
Since mass treatment would rarely be used as a single intervention, we explored the impact of a programme in which vector control is used simultaneously
We assume in all results that an artemisinin-combination therapies (ACTs) with a short half life is used for mass treatment and that coverage is 80%
Summary
In the last few decades, antimalarial drugs that act against Plasmodium falciparum have been used primarily to avert severe morbidity and mortality. Antimalarials have been given to asymptomatic parasite carriers, during historical malaria eradication programmes in the 1950s–1970s, with the aim of preventing onward transmission to mosquitoes and potentially interrupting transmission [1]. During the ongoing scale up of malaria interventions, a number of control agencies are reconsidering or piloting a mass treatment approach to aid transmission reductions (for example [2]). Past programmes had mixed success and were linked to increases in drug resistance [3,4], as well as requiring a relatively high level of resources. It is important to better understand the extent to which this intervention could reduce transmission across different endemic settings
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