Effectiveness of reactive focal mass drug administration and reactive focal vector control to reduce malaria transmission in the low malaria-endemic setting of Namibia: a cluster-randomised controlled, open-label, two-by-two factorial design trial.

摘要: Summary Background In low malaria-endemic settings, screening and treatment of individuals in close proximity to index cases, also known as reactive case detection (RACD), is practised for surveillance response. However, other approaches could be more effective reducing transmission. We aimed evaluate the effectiveness focal mass drug administration (rfMDA) vector control (RAVC) setting Zambezi (Namibia). Methods did a cluster-randomised controlled, open-label trial using two-by-two factorial design 56 enumeration area clusters randomly assigned these restricted randomisation four groups: RACD only, rfMDA RAVC plus RACD, or RAVC. involved rapid diagnostic testing with artemether-lumefantrine single-dose primaquine, presumptive artemether-lumefantrine, indoor residual spraying pirimiphos-methyl. Interventions were administered within 500 m cases. To interventions targeting parasite reservoir humans (rfMDA vs RACD), mosquitoes (RAVC no RAVC), both only), an intention-to-treat analysis was done. For each three comparisons, primary outcome cumulative incidence locally acquired malaria This registered ClinicalTrials.gov , number NCT02610400 . Findings Between Jan 1, 2017, Dec 31, 55 had 1118 eligible cases that led 342 covering 8948 individuals. The 30·8 per 1000 person-years (95% CI 12·8–48·7) received versus 38·3 (23·0–53·6) RACD; 30·2 (15·0–45·5) 38·9 (20·7–57·1) not receive RAVC; 25·0 (5·2–44·7) 41·4 (21·5–61·2) only. After adjusting imbalances baseline implementation factors, lower receiving than those (adjusted rate ratio 0·52 [95% 0·16–0·88], p=0·009), (0·48 [0·16–0·80], p=0·002), only (0·26 [0·10–0·68], p=0·006). No serious adverse events reported. Interpretation setting, RAVC, implemented alone combination, reduced transmission should considered alternatives elimination malaria. Funding Novartis Foundation, Bill & Melinda Gates Horchow Family Fund.