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Yukich J, Digre P, Scates S, Boydens L, Obi E, Moran N, Belemvire A, Chamorro M, Johns B, Malm KL, Kolyada L, Williams I, Asiedu S, Fomba S, Mihigo J, Boko D, Candrinho B, Muthoni R, Opigo J, Maiteki-Sebuguzi C, Rutazaana D, Shililu J, Muhanguzi A, Belay K, Kisubi J, Atuhairwe JA, Musonda P, Iwuchukwu N, Ngosa J, Chizema E, Zulu R, Kooma E, Miller J, Bennett A, Arnett K, Tynuv K, Gogue C, Wagman J, Richardson JH, Slutsker L, Robertson M. Incremental cost and cost-effectiveness of the addition of indoor residual spraying with pirimiphos-methyl in sub-Saharan Africa versus standard malaria control: results of data collection and analysis in the Next Generation Indoor Residual Sprays (NgenIRS) project, an economic-evaluation. Malar J 2022; 21:185. [PMID: 35690756 PMCID: PMC9188086 DOI: 10.1186/s12936-022-04160-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Malaria is a major cause of morbidity and mortality globally, especially in sub-Saharan Africa. Widespread resistance to pyrethroids threatens the gains achieved by vector control. To counter resistance to pyrethroids, third-generation indoor residual spraying (3GIRS) products have been developed. This study details the results of a multi-country cost and cost-effectiveness analysis of indoor residual spraying (IRS) programmes using Actellic®300CS, a 3GIRS product with pirimiphos-methyl, in sub-Saharan Africa in 2017 added to standard malaria control interventions including insecticide-treated bed nets versus standard malaria control interventions alone. Methods An economic evaluation of 3GIRS using Actellic®300CS in a broad range of sub-Saharan African settings was conducted using a variety of primary data collection and evidence synthesis methods. Four IRS programmes in Ghana, Mali, Uganda, and Zambia were included in the effectiveness analysis. Cost data come from six IRS programmes: one in each of the four countries where effect was measured plus Mozambique and a separate programme conducted by AngloGold Ashanti Malaria Control in Ghana. Financial and economic costs were quantified and valued. The main indicator for the cost was cost per person targeted. Country-specific case incidence rate ratios (IRRs), estimated by comparing IRS study districts to adjacent non-IRS study districts or facilities, were used to calculate cases averted in each study area. A deterministic analysis and sensitivity analysis were conducted in each of the four countries for which effectiveness evaluations were available. Probabilistic sensitivity analysis was used to generate plausibility bounds around the incremental cost-effectiveness ratio estimates for adding IRS to other standard interventions in each study setting as well as jointly utilizing data on effect and cost across all settings. Results Overall, IRRs from each country indicated that adding IRS with Actellic®300CS to the local standard intervention package was protective compared to the standard intervention package alone (IRR 0.67, [95% CI 0.50–0.91]). Results indicate that Actellic®300CS is expected to be a cost-effective (> 60% probability of being cost-effective in all settings) or highly cost-effective intervention across a range of transmission settings in sub-Saharan Africa. Discussion Variations in the incremental costs and cost-effectiveness likely result from several sources including: variation in the sprayed wall surfaces and house size relative to household population, the underlying malaria burden in the communities sprayed, the effectiveness of 3GIRS in different settings, and insecticide price. Programmes should be aware that current recommendations to rotate can mean variation and uncertainty in budgets; programmes should consider this in their insecticide-resistance management strategies. Conclusions The optimal combination of 3GIRS delivery with other malaria control interventions will be highly context specific. 3GIRS using Actellic®300CS is expected to deliver acceptable value for money in a broad range of sub-Saharan African malaria transmission settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04160-3.
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Affiliation(s)
| | | | | | | | | | | | - Allison Belemvire
- US President's Malaria Initiative, US Agency for International Development, Washington, DC, USA
| | | | - Benjamin Johns
- PMI VectorLink Project, Abt Associates, Rockville, MD, USA
| | - Keziah L Malm
- National Malaria Control Programme, Ministry of Health, Accra, Ghana
| | - Lena Kolyada
- PMI VectorLink Ghana Project, Abt Associates, Accra, Ghana
| | | | - Samuel Asiedu
- AngloGold Ashanti Malaria Control Limited, Accra, Ghana
| | - Seydou Fomba
- Programme National de Lutte Contre le Paludisme, Bamako, Mali
| | - Jules Mihigo
- US President's Malaria Initiative, US Agency for International Development, Bamako, Mali
| | - Desire Boko
- PMI VectorLink Mali Project, Abt Associates, Bamako, Mali
| | - Baltazar Candrinho
- National Malaria Control Programme, Ministry of Health, Maputo, Mozambique
| | - Rodaly Muthoni
- PMI VectorLink Mozambique, Abt Associates, Maputo, Mozambique
| | - Jimmy Opigo
- National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | | | - Damian Rutazaana
- National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | | | - Asaph Muhanguzi
- PMI VectorLink Uganda Project, Abt Associates, Kampala, Uganda
| | - Kassahun Belay
- US President's Malaria Initiative, US Agency for International Development, Kampala, Uganda
| | - Joel Kisubi
- US President's Malaria Initiative, US Agency for International Development, Kampala, Uganda
| | | | - Presley Musonda
- PMI VectorLink Zambia Project, Abt Associates, Lusaka, Zambia
| | | | | | | | - Reuben Zulu
- National Malaria Elimination Centre, Lusaka, Zambia
| | | | | | - Adam Bennett
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, CA, USA
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Eisele TP, Bennett A, Silumbe K, Finn TP, Porter TR, Chalwe V, Hamainza B, Moonga H, Kooma E, Chizema Kawesha E, Kamuliwo M, Yukich JO, Keating J, Schneider K, Conner RO, Earle D, Slutsker L, Steketee RW, Miller JM. Impact of Four Rounds of Mass Drug Administration with Dihydroartemisinin-Piperaquine Implemented in Southern Province, Zambia. Am J Trop Med Hyg 2020; 103:7-18. [PMID: 32618247 PMCID: PMC7416977 DOI: 10.4269/ajtmh.19-0659] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Over the past decade, Zambia has made substantial progress against malaria and has recently set the ambitious goal of eliminating by 2021. In the context of very high vector control and improved access to malaria diagnosis and treatment in Southern Province, we implemented a community-randomized controlled trial to assess the impact of four rounds of community-wide mass drug administration (MDA) and household-level MDA (focal MDA) with dihydroartemisinin-piperaquine (DHAP) implemented between December 2014 and February 2016. The mass treatment campaigns achieved relatively good household coverage (63-79%), were widely accepted by the community (ranging from 87% to 94%), and achieved very high adherence to the DHAP regimen (81-96%). Significant declines in all malaria study end points were observed, irrespective of the exposure group, with the overall parasite prevalence during the peak transmission season declining by 87.2% from 31.3% at baseline to 4.0% in 2016 at the end of the trial. Children in areas of lower transmission (< 10% prevalence at baseline) that received four MDA rounds had a 72% (95% CI = 12-91%) reduction in malaria parasite prevalence as compared with those with the standard of care without any mass treatment. Mass drug administration consistently had the largest short-term effect size across study end points in areas of lower transmission following the first two MDA rounds. In the context of achieving very high vector control coverage and improved access to diagnosis and treatment for malaria, our results suggest that MDA should be considered for implementation in African settings for rapidly reducing malaria outcomes in lower transmission settings.
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Affiliation(s)
- Thomas P Eisele
- Department of Tropical Medicine, Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Adam Bennett
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, California
| | - Kafula Silumbe
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Lusaka, Zambia
| | - Timothy P Finn
- Department of Tropical Medicine, Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Travis R Porter
- Department of Tropical Medicine, Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Victor Chalwe
- Institute for Medical Research and Training, University Teaching Hospital, Lusaka, Zambia
| | - Busiku Hamainza
- National Malaria Elimination Centre, Zambia Ministry of Health, Lusaka, Zambia
| | - Hawela Moonga
- National Malaria Elimination Centre, Zambia Ministry of Health, Lusaka, Zambia
| | - Emmanuel Kooma
- National Malaria Elimination Centre, Zambia Ministry of Health, Lusaka, Zambia
| | | | - Mulakwa Kamuliwo
- Zambia Ministry of Health, Southern Provincial Health Office, Choma, Zambia
| | - Joshua O Yukich
- Department of Tropical Medicine, Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Joseph Keating
- Department of Tropical Medicine, Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | | | | | - Duncan Earle
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Lusaka, Zambia
| | | | | | - John M Miller
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Lusaka, Zambia
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Porter TR, Finn TP, Silumbe K, Chalwe V, Hamainza B, Kooma E, Moonga H, Bennett A, Yukich JO, Steketee RW, Keating J, Miller JM, Eisele TP. Recent Travel History and Plasmodium falciparum Malaria Infection in a Region of Heterogenous Transmission in Southern Province, Zambia. Am J Trop Med Hyg 2020; 103:74-81. [PMID: 32618250 PMCID: PMC7416974 DOI: 10.4269/ajtmh.19-0660] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
As Zambia continues to reduce its malaria incidence and target elimination in Southern Province, there is a need to identify factors that can reintroduce parasites and sustain malaria transmission. To examine the relative contributions of types of human mobility on malaria prevalence, this analysis quantifies the proportion of the population having recently traveled during both peak and nonpeak transmission seasons over the course of 2 years and assesses the relationship between short-term travel and malaria infection status. Among all residents targeted by mass drug administration in the Lake Kariba region of Southern Province, 602,620 rapid diagnostic tests and recent travel histories were collected during four campaign rounds occurring between December 2014 and February 2016. Rates of short-term travel in the previous 2 weeks fluctuated seasonally from 0.3% to 1.2%. Travel was significantly associated with prevalent malaria infection both seasonally and overall (adjusted odds ratio [AOR]: 2.55; 95% CI: 2.28-2.85). The strength of association between travel and malaria infection varied by travelers' origin and destination, with those recently traveling to high-prevalence areas from low-prevalence areas experiencing the highest odds of malaria infection (AOR: 7.38). Long-lasting insecticidal net usage while traveling was associated with a relative reduction in infections (AOR: 0.74) compared with travelers not using a net. Although travel was directly associated with only a small fraction of infections, importation of malaria via human movement may play an increasingly important role in this elimination setting as transmission rates continue to decline.
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Affiliation(s)
- Travis R Porter
- Department of Tropical Medicine, Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Timothy P Finn
- Department of Tropical Medicine, Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Kafula Silumbe
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Lusaka, Zambia
| | - Victor Chalwe
- National Malaria Elimination Centre, Zambia Ministry of Health, Lusaka, Zambia
| | - Busiku Hamainza
- National Malaria Elimination Centre, Zambia Ministry of Health, Lusaka, Zambia
| | - Emmanuel Kooma
- National Malaria Elimination Centre, Zambia Ministry of Health, Lusaka, Zambia
| | - Hawela Moonga
- National Malaria Elimination Centre, Zambia Ministry of Health, Lusaka, Zambia
| | - Adam Bennett
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, California
| | - Joshua O Yukich
- Department of Tropical Medicine, Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | | | - Joseph Keating
- Department of Tropical Medicine, Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - John M Miller
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Lusaka, Zambia
| | - Thomas P Eisele
- Department of Tropical Medicine, Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
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Eisele TP, Bennett A, Silumbe K, Finn TP, Chalwe V, Kamuliwo M, Hamainza B, Moonga H, Kooma E, Chizema Kawesha E, Yukich J, Keating J, Porter T, Conner RO, Earle D, Steketee RW, Miller JM. Short-term Impact of Mass Drug Administration With Dihydroartemisinin Plus Piperaquine on Malaria in Southern Province Zambia: A Cluster-Randomized Controlled Trial. J Infect Dis 2017; 214:1831-1839. [PMID: 27923947 PMCID: PMC5142084 DOI: 10.1093/infdis/jiw416] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 08/30/2016] [Indexed: 01/26/2023] Open
Abstract
Background Mass drug administration (MDA) using dihydroartemisinin plus piperaquine (DHAp) represents a potential strategy to clear Plasmodium falciparum infections and reduce the human parasite reservoir. Methods A cluster-randomized controlled trial in Southern Province, Zambia, was used to assess the short-term impact of 2 rounds of community-wide MDA and household-level (focal) MDA with DHAp compared with no mass treatment. Study end points included parasite prevalence in children, infection incidence, and confirmed malaria case incidence. Results All end points significantly decreased after intervention, irrespective of treatment group. Parasite prevalence from 7.71% at baseline to 0.54% after MDA in lower-transmission areas, resulting in an 87% reduction compared with control (adjusted odds ratio, 0.13; 95% confidence interval, .02–.92;P = .04). No difference between treatment groups was observed in areas of high transmission. The 5-month cumulative infection incidence was 70% lower (crude incidence rate ratio, 0.30; 95% confidence interval, .06–1.49; P = .14) and 58% lower (0.42; .18–.98;P = .046) after MDA compared with control in lower- and higher-transmission areas, respectively. No significant impact of focal MDA was observed for any end point. Conclusions Two rounds of MDA with DHAp rapidly reduced infection prevalence, infection incidence, and confirmed case incidence rates, especially in low-transmission areas. Clinical Trials Registration NCT02329301.
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Affiliation(s)
- Thomas P Eisele
- Center for Applied Malaria Research and Evaluation, Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Adam Bennett
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco
| | - Kafula Silumbe
- PATH-Malaria Control and Elimination Partnership in Africa (MACEPA), National Malaria Control Centre, Chainama Hospital College Grounds
| | - Timothy P Finn
- Center for Applied Malaria Research and Evaluation, Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Victor Chalwe
- Institute for Medical Research and Training, University Teaching Hospital
| | - Mulakwa Kamuliwo
- National Malaria Control Centre, Zambia Ministry of Health, Chainama Hospital, Lusaka
| | - Busiku Hamainza
- National Malaria Control Centre, Zambia Ministry of Health, Chainama Hospital, Lusaka
| | - Hawela Moonga
- National Malaria Control Centre, Zambia Ministry of Health, Chainama Hospital, Lusaka
| | - Emmanuel Kooma
- Zambia Ministry of Health, Southern Provincial Health Office, Choma
| | | | - Joshua Yukich
- Center for Applied Malaria Research and Evaluation, Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Joseph Keating
- Center for Applied Malaria Research and Evaluation, Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Travis Porter
- Center for Applied Malaria Research and Evaluation, Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | | | - Duncan Earle
- PATH-Malaria Control and Elimination Partnership in Africa (MACEPA), National Malaria Control Centre, Chainama Hospital College Grounds
| | | | - John M Miller
- PATH-Malaria Control and Elimination Partnership in Africa (MACEPA), National Malaria Control Centre, Chainama Hospital College Grounds
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