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Highly effective vector control can reduce malaria burden significantly, but individuals with parasitemia provide a potential reservoir for onward transmission. We performed an empirical, non-parametric simulation based on cohort data from Tororo District, Uganda—an area with historically high but recently reduced malaria transmission—to estimate the effects of mass drug administration (MDA) and test-and-treat on parasite prevalence. We estimate that a single round of MDA would have accelerated declines in parasite prevalence dramatically over 2 years (cumulative parasite prevalence ratio [PPR], 0.34). This decline was mostly during the first year of administration (PPR, 0.23) and waned by 23 months (PPR, 0.74). Test-and-treat using a highly sensitive diagnostic had nearly the same effect as MDA at 1 year (PPR, 0.27) and required many fewer treatments. The impact of test-and-treat using a standard diagnostic was modest (PPR, 0.58 at 1 year). Our analysis suggests that in areas experiencing a dramatic reduction in malaria prevalence, MDA or test-and-treat with a highly sensitive diagnostic may be an effective way of reducing or eliminating the infectious reservoir temporarily. However, for sustained benefits, repeated rounds of the intervention or additional interventions are required.
Financial support: The primary study was funded by the NIH as part of the International Centers of Excellence in Malaria Research program (grant no. U19AI089674). J. I. N. is supported by the Fogarty International Center (Emerging Global Leader Award, grant no. K43TW010365). E. A. is supported by the Fogarty International Center of the NIH (award no. D43TW010526).
Disclaimer: The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Authors’ addresses: Joaniter I. Nankabirwa and Moses R. Kamya, Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda, and Infectious Disease Research Collaboration, Kampala, Uganda, E-mails: email@example.com and firstname.lastname@example.org. Emmanuel Arinaitwe, John Rek, and Peter Olwoch, Infectious Disease Research Collaboration, Kampala, Uganda, E-mails: email@example.com, firstname.lastname@example.org, and email@example.com. Jessica Briggs, Philip J. Rosenthal, Isabel Rodriguez-Barraquer, Grant Dorsey, and Bryan Greenhouse, Department of Infectious Diseases, School of Medicine, University of California, San Francisco, CA, E-mails: firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, and firstname.lastname@example.org. David L. Smith, Department of Health Metrics Sciences, University of Washington, Seattle, WA, email@example.com.