Malaria Control by Mass Drug Administration With Artemisinin Plus Piperaquine on Grande Comore Island, Union of Comoros

Abstract

Background Mass drug administration (MDA) is a powerful tool for malaria control, but the medicines to use, dosing, number of rounds, and potential selection of drug resistance remain open questions. Methods Two monthly rounds of artemisinin-piperaquine (AP), each comprising two daily doses, were administered across the seven districts of Grande Comore Island. In three districts, low-dose primaquine (PMQLD) was also given on the first day of each monthly round. Plasmodium falciparum malaria rates, mortality, parasitemias, adverse events, and genetic markers of potential drug resistance were evaluated. Results Average population coverages of 80–82% were achieved with AP in four districts (registered population 258,986) and AP+PMQLD in three districts (83,696). The effectiveness of MDA was 96.27% (95% CI: 95.27, 97.06%; p<0.00001) in the four AP districts and 97.46% (95% CI: 94.54%, 98.82%; p<0.00001) in the three AP+PMQLD districts. In comparative statistical modeling, the effectiveness of the two monthly rounds on Grande Comore Island was nearly as high as that of three monthly rounds of AP or AP+PMQLD in our earlier study on Anjouan Island. Surveys of pre-MDA and post-MDA samples showed no significant changes in PfK13 polymorphism rates, but low rates of PfCRT M343L and G353V raise concern as these mutations have been linked to piperaquine resistance. Conclusions MDA with two monthly rounds of two daily doses of AP was highly effective on Grande Comore Island. The feasibility and lower expenses of this two-month vs. three-month regimen of AP may offer advantages for MDA programs in appropriate settings.