Study protocol for a cluster randomised controlled factorial design trial to assess the effectiveness and feasibility of reactive focal mass drug administration and vector control to reduce malaria transmission in the low endemic setting of Namibia

Oliver F. Medzihradsky, Immo Kleinschmidt, Davis Mumbengegwi, Kathryn W. Roberts, Patrick McCreesh, Mi Suk Kang Dufour, Petrina Uusiku, Stark Katokele, Adam Bennett, Jennifer Smith, Hugh Sturrock, Lisa M. Prach, Henry Ntuku, Munyaradzi Tambo, Bradley Didier, Bryan Greenhouse, Zaahira Gani, Ann Aerts, Roly Gosling, Michelle S. Hsiang

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5 Scopus citations

Abstract

Introduction To interrupt malaria transmission, strategies must target the parasite reservoir in both humans and mosquitos. Testing of community members linked to an index case, termed reactive case detection (RACD), is commonly implemented in low transmission areas, though its impact may be limited by the sensitivity of current diagnostics. Indoor residual spraying (IRS) before malaria season is a cornerstone of vector control efforts. Despite their implementation in Namibia, a country approaching elimination, these methods have been met with recent plateaus in transmission reduction. This study evaluates the effectiveness and feasibility of two new targeted strategies, reactive focal mass drug administration (rfMDA) and reactive focal vector control (RAVC) in Namibia. Methods and analysis This is an open-label cluster randomised controlled trial with 2×2 factorial design. The interventions include: rfMDA (presumptive treatment with artemether-lumefantrine (AL)) versus RACD (rapid diagnostic testing and treatment using AL) and RAVC (IRS with Acellic 300CS) versus no RAVC. Factorial design also enables comparison of the combined rfMDA+RAVC intervention to RACD. Participants living in 56 enumeration areas will be randomised to one of four arms: rfMDA, rfMDA+RAVC, RACD or RACD+RAVC. These interventions, triggered by index cases detected at health facilities, will be targeted to individuals residing within 500 m of an index. The primary outcome is cumulative incidence of locally acquired malaria detected at health facilities over 1 year. Secondary outcomes include seroprevalence, infection prevalence, intervention coverage, safety, acceptability, adherence, cost and cost-effectiveness. Ethics and dissemination Findings will be reported on clinicaltrials.gov, in peer-reviewed publications and through stakeholder meetings with MoHSS and community leaders in Namibia. Trial registration number NCT02610400; Pre-results.

Original languageEnglish (US)
Article numbere019294
JournalBMJ Open
Volume8
Issue number1
DOIs
StatePublished - Jan 1 2018

Keywords

  • Namibia
  • Plasmodium falciparum
  • artemether-lumefantrine
  • cluster randomisation
  • elimination
  • indoor residual spraying
  • low transmission
  • malaria
  • mass drug administration
  • pirimiphos-methyl
  • presumptive treatment
  • reactive case detection
  • vector control

ASJC Scopus subject areas

  • Medicine(all)

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    Medzihradsky, O. F., Kleinschmidt, I., Mumbengegwi, D., Roberts, K. W., McCreesh, P., Dufour, M. S. K., Uusiku, P., Katokele, S., Bennett, A., Smith, J., Sturrock, H., Prach, L. M., Ntuku, H., Tambo, M., Didier, B., Greenhouse, B., Gani, Z., Aerts, A., Gosling, R., & Hsiang, M. S. (2018). Study protocol for a cluster randomised controlled factorial design trial to assess the effectiveness and feasibility of reactive focal mass drug administration and vector control to reduce malaria transmission in the low endemic setting of Namibia. BMJ Open, 8(1), [e019294]. https://doi.org/10.1136/bmjopen-2017-019294