Autor: |
Roly Gosling, Mi-Suk Kang Dufour, Lisa M Prach, Bryan Greenhouse, Michelle S Hsiang, Kimberly Baltzell, Sibonakaliso Vilakati, Nontokozo Mngadi, Jade Benjamin-Chung, Nomcebo Dlamini, Brooke Whittemore, Khayelihle Bhangu, Nomcebo Nhlabathi, Calisile Malambe, Bongani Dlamini, Danica Helb, Gugu Maphalala, Deepa Pindolia, Muhindo Kalungero, Getahun Tesfa, Nyasatu Ntshalintshali, Simon Kunene |
Jazyk: |
angličtina |
Rok vydání: |
2021 |
Předmět: |
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Zdroj: |
BMJ Global Health, Vol 6, Iss 6 (2021) |
Druh dokumentu: |
article |
ISSN: |
2059-7908 |
DOI: |
10.1136/bmjgh-2021-005021 |
Popis: |
Introduction To reduce malaria transmission in very low-endemic settings, screening and treatment near index cases (reactive case detection (RACD)), is widely practised, but the rapid diagnostic tests (RDTs) used miss low-density infections. Reactive focal mass drug administration (rfMDA) may be safe and more effective.Methods We conducted a pragmatic cluster randomised controlled trial in Eswatini, a very low-endemic setting. 77 clusters were randomised to rfMDA using dihydroartemisin–piperaquine (DP) or RACD involving RDTs and artemether–lumefantrine. Interventions were delivered by the local programme. An intention-to-treat analysis was used to compare cluster-level cumulative confirmed malaria incidence among clusters with cases. Secondary outcomes included safety and adherence.Results From September 2015 to August 2017, 222 index cases from 47 clusters triggered 46 RACD events and 64 rfMDA events. RACD and rfMDA were delivered to 1455 and 1776 individuals, respectively. Index case coverage was 69.5% and 62.4% for RACD and rfMDA, respectively. Adherence to DP was 98.7%. No serious adverse events occurred. For rfMDA versus RACD, cumulative incidences (per 1000 person-years) of all malaria were 2.11 (95% CI 1.73 to 2.59) and 1.97 (95% CI 1.57 to 2.47), respectively; and of locally acquired malaria, they were 1.29 (95% CI 1.00 to 1.67) and 0.97 (95% CI 0.71 to 1.34), respectively. Adjusting for imbalance in baseline incidence, incidence rate ratio for rfMDA versus RACD was 0.95 (95% CI 0.55 to 1.65) for all malaria and 0.82 (95% CI 0.40 to 1.71) for locally acquired malaria. Similar results were obtained in a per-protocol analysis that excluded clusters with |
Databáze: |
Directory of Open Access Journals |
Externí odkaz: |
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