Fighting fire with fire: mass antimalarial drug administrations in an era of antimalarial resistance

Seidlein, Lorenz von; Dondorp, Arjen M.

doi:10.1586/14787210.2015.1031744

Cited by 79 publications

(102 citation statements)

References 138 publications

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“…At present, targeted MDA is considered the most promising strategy to stop the spread of artemisinin-resistant P. falciparum parasites in the Greater Mekong subregion 40 . In the Southeast Asian setting, targeting populations at the village level is being trialled 20 .…”

Section: Mda In Southeast Asiamentioning

confidence: 99%

Assessing the impact of next-generation rapid diagnostic tests on Plasmodium falciparum malaria elimination strategies

Slater

Ross

Ouédraogo

et al. 2015

Nature

129

143

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P lasmodium falciparum malaria was responsible for an estimated 584,000 (range 367,000-755,000) deaths in 2013, most of which occurred in young children in sub-Saharan Africa 1 . Although the burden has reduced in response to global efforts to increase the provision of proven malaria interventions such as insecticide-treated bed nets and access to health care and treatment 1 , it remains high. One of the challenges in reducing malaria transmission is the long duration of infection in the human host, which in semi-immune individuals may persist for a year or more 2 . In particular, although infection often leads to disease in naive individuals, those with sufficient acquired immunity can harbour parasites -and hence be onwardly infectious to mosquitoes -without exhibiting symptoms 3 . One option for speeding the decline in transmission could be to target the asymptomatic reservoir of infection 4 by providing either periodic mass-screen-and-treat (MSAT) programmes, focal MSAT or a reactive strategy in which individuals living in the vicinity of an identified clinical case are screened and treated. However, the extent to which such strategies are able to reduce the infectious reservoir will depend on the extent to which the diagnostic used to identify infected individuals also detects those who are onwardly infectious. Another form of targeting could take place at the population level (for example a village) where mass interventions are deployed if the population prevalence *These authors contributed equally.

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Section: Mda In Southeast Asiamentioning

confidence: 99%

Assessing the impact of next-generation rapid diagnostic tests on Plasmodium falciparum malaria elimination strategies

Slater

Ross

Ouédraogo

et al. 2015

Nature

129

143

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“…The possibility of these parasites spreading to Africa – a potential public health disaster – has prompted a shift from malaria control to elimination in South East Asia [1–4]. As part of a package of interventions, referred to as Targeted Malaria Elimination (TME), mass antimalarial administration – the presumptive treatment of an entire community to interrupt completely local malaria transmission – is currently under study across the region [5]. …”

Section: Introductionmentioning

confidence: 99%

“…To promote coverage, programs of mass drug administration (MDA) often incorporate community engagement [5–7,11,13]. Most scientific reports of mass antimalarial administration however offer little detail on how community engagement is designed and what activities it entails [11].…”

Section: Introductionmentioning

confidence: 99%

“…To achieve this, an intensification of malaria prevention and control activities – such as MDA – are required [5]. Understanding effective community engagement to accompany such efforts is imperative to ensure their uptake in the target communities.…”

Section: Introductionmentioning

confidence: 99%

“…Under direct observation, the ‘intervention’ villages received dihydroartemisinin piperaquine (DHAP) and a single low dose primaquine on the first day and DHAP alone was provided on the second and third days during each of the three monthly rounds of treatment. Blood samples were collected before the mass antimalarial administration and then quarterly for 12 months to detect Plasmodium infections [5] (Figure 2).

Figure 2.Schematic representation of TME and CE activities. …”

Section: Introductionmentioning

confidence: 99%

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Elements of effective community engagement: lessons from a targeted malaria elimination study in Lao PDR (Laos)

Adhikari

Pell

Phommasone

et al. 2017

Global Health Action

107

186

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Background: Mass drug (antimalarial) administration (MDA) is currently under study in Southeast Asia as part of a package of interventions referred to as targeted malaria elimination (TME). This intervention relies on effective community engagement that promotes uptake and adherence in target communities (above 80%). Objective: Based on the experienced of designing and implementing the community engagement for TME in Laos, in this article we aim to present the elements of effective community engagement for mass antimalarial administration. Methods: The design and implementation of community engagement, which took place from September 2015 to August 2016 was recorded as field notes, meeting minutes and photographs. These data underwent qualitative content analysis. Results: The community engagement strategy that accompanied TME in Laos was successful in terms of contributing to high levels of participation in mass anti-malarial administration (above 85%). Based on the experience of designing and implementing the community engagement, five key elements were identified: (1) stakeholder and authority engagement, which proceeded from national level, to regional/district and local level; (2) local human resources, particularly the recruitment of local volunteers who were integral to the design and implementation of activities in the study villages; (3) formative research, to rapidly gain insight into the local social and economic context; (4) responsiveness whereby the approach was adapted according to the needs of the community and their responses to the various study components; and (5) sharing control/leadership with the community in terms of decisions on the organization of TME activities. Conclusions: The community engagement that accompanied TME in Laos had to deal with challenges of implementing a complex study in remote and linguistically isolated villages. Despite these challenges, the study recorded high population coverage. Lessons learnt from this experience are useful for studies and intervention programs in diverse contexts.

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Ethics and Antimalarial Drug Resistance

Cheah

Parker

Day

2020

Ethics and Drug Resistance: Collective Responsibility for Global Public Health

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There has been impressive progress in malaria control and treatment over the past two decades. One of the most important factors in the decline of malaria-related mortality has been the development and deployment of highly effective treatment in the form of artemisinin-based combination therapies (ACTs). However, recent reports suggest that these gains stand the risk of being reversed due to the emergence of ACT resistance in the Greater Mekong Subregion and the threat of this resistance spreading to Africa, where the majority of the world’s malaria cases occur, with catastrophic consequences. This chapter provides an overview of strategies proposed by malaria experts to tackle artemisinin-resistant malaria, and some of the most important practical ethical issues presented by each of these interventions. The proposed strategies include mass antimalarial drug administrations in selected populations, and mandatory screening of possibly infected individuals prior to entering an area free of artemisinin-resistant malaria. We discuss ethical issues such as tensions between the wishes of individuals versus the broader goal of malaria elimination, and the risks of harm to interventional populations, and conclude by proposing a set of recommendations.

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Fighting fire with fire: mass antimalarial drug administrations in an era of antimalarial resistance

Cited by 79 publications

References 138 publications

Assessing the impact of next-generation rapid diagnostic tests on Plasmodium falciparum malaria elimination strategies

Assessing the impact of next-generation rapid diagnostic tests on Plasmodium falciparum malaria elimination strategies

Elements of effective community engagement: lessons from a targeted malaria elimination study in Lao PDR (Laos)

Ethics and Antimalarial Drug Resistance

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