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Simulating the Impacts of Augmenting Intensive Vector Control with Mass Drug Administration or Test-and-Treat Strategies on the Malaria Infectious Reservoir

Joaniter I. NankabirwaDepartment of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda;
Infectious Disease Research Collaboration, Kampala, Uganda;

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Emmanuel ArinaitweInfectious Disease Research Collaboration, Kampala, Uganda;

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Jessica BriggsDepartment of Infectious Diseases, School of Medicine, University of California, San Francisco, California;

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John RekInfectious Disease Research Collaboration, Kampala, Uganda;

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Philip J. RosenthalDepartment of Infectious Diseases, School of Medicine, University of California, San Francisco, California;

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Moses R. KamyaDepartment of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda;
Infectious Disease Research Collaboration, Kampala, Uganda;

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Peter OlwochInfectious Disease Research Collaboration, Kampala, Uganda;

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David L. SmithDepartment of Health Metrics Sciences, University of Washington, Seattle, Washington

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Isabel Rodriguez-BarraquerDepartment of Infectious Diseases, School of Medicine, University of California, San Francisco, California;

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Grant DorseyDepartment of Infectious Diseases, School of Medicine, University of California, San Francisco, California;

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Bryan GreenhouseDepartment of Infectious Diseases, School of Medicine, University of California, San Francisco, California;

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ABSTRACT.

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.

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Author Notes

Address correspondence to Joaniter I. Nankabirwa, Makerere University College of Health Sciences/Infectious Diseases Research Collaboration. E-mail: jnankabirwa@yahoo.co.uk

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: jnankabirwa@yahoo.co.uk and mkamya@infocom.co.ug. Emmanuel Arinaitwe, John Rek, and Peter Olwoch, Infectious Disease Research Collaboration, Kampala, Uganda, E-mails: earinaitwe@idrc-uganda.org, jrek@idrc-uganda.org, and polwoch@idrc-uganda.org. 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: jessica.briggs@ucsf.edu, philip.rosenthal@ucsf.edu, isabel.rodriguez@ucsf.edu, grant.dorsey@ucsf.edu, and bryan.greenhouse@ucsf.edu. David L. Smith, Department of Health Metrics Sciences, University of Washington, Seattle, WA, smitdave@gmail.com.

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