Effectiveness of a lambda-cyhalothrin bednet impregnation against forest/border malaria in northwest Thailand

A cohort study was carried out in Mae Sariang district close to Thai-Myanmar border. This was aimed at measuring the pattern and size of movements as well as their relevance to malaria illness. Overall 494 people in 95 households were randomly selected from 5 small villages. They were fortnightly visited and interviewed by interpreters on the details of activities causing them to spend nights outside the village. A malaria illness was detected by the case detection systems already available. The results showed that short term movements during the transmission season were common. About 74% of villagers moved at least once. An average of 11% of their nights were spent outside the villages. Adult males predominated. The commonest and second most common reasons for movements were agricultural (41%) and forest (17%) activities respectively. Movements carried a 7.8 times higher risk than staying in the village (p < 0.01). Forest work (including illegal) had about 6 times higher risk than the other activities (p < 0.05). A randomise placebo control trial of a lambda-cyhalothrin bednet impregnation, on a community basis, was also carried out in the same area. This was aimed at measuring the effectiveness of the insecticide treated bednet programme and involved 12 pairs of small villages, called bans in Thai. The outcome measure was a malaria incidence, detected by the existing case detection system, and a prevalence of parasitaemia detected by mass blood surveys,once a year during the transmission period. The outcome measures were collected 12 months before and 16 months after the impregnation. A bednet fund programme was introduced in the first year and also evaluated using the baseline incidence rate. The programme significantly increased the availability and use of bednets. These resulted in about 28% effectiveness against malaria incidence and the density of persons/bednet was directly related with malaria incidence (r = 0.48, p<0.05). In the second year, bans in each pair were randomly allocated either a lambda-cyhalothrin or placebo bednet impregnation. The post-impregnation data showed a small and slow trend of 26% effectiveness. This was not statistically significant. However, the significant effect of 84% reduction was detected amongst adult males after the second impregnation. There was no significant effect on the prevalence of parasitaemia. The sleeping patterns, prevalence of bednet use, dosage and coverage of the impregnation, side-effects and washing rates were also studied. The possible mechanisms of the effect are discussed

Facilitating a transition from compulsory detention of people who use drugs towards voluntary community-based drug dependence treatment and support services in Asia

Evidence indicates that detention of people who use drugs in compulsory centers in the name of treatment is common in Cambodia, China, Indonesia, Lao PDR, Malaysia, Myanmar, Philippines, Thailand, and Vietnam. The expansion of such practices has been costly, has not generated positive health outcomes, and has not reduced supply or demand for illicit drugs. United Nations agencies have convened several consultations with government and civil society stakeholders in order to facilitate a transition to voluntary evidence- and community-based drug dependence treatment and support services. In an effort to support such efforts, an informal group of experts proposes a three-step process to initiate and accelerate national-level transitions. Specifically, the working group recommends the establishment of a national multisectoral decision-making committee to oversee the development of national transition plans, drug policy reform to eliminate barriers to community-based drug dependence treatment and support services, and the integration of community-based drug dependence treatment in existing national health and social service systems.In parallel, the working group recommends that national-level transitions should be guided by overarching principles, including ethics, human rights, meaningful involvement of affected communities, and client safety, as well as good governance, transparency, and accountability. The transition also represents an opportunity to review the roles and responsibilities of various agencies across the public health and public security sectors in order to balance the workload and ensure positive results. The need to accelerate national-level transitions to voluntary community-based drug dependence treatment and support services is compelling--on economic, medical, sustainable community development, and ethical grounds--as extensively documented in the literature. In this context, the expert working group fully endorses initiation of a transition towards voluntary evidence- and community-based drug dependence treatment and support services across the region, as well as the steady scale-down of compulsory centers for drug users.Components of voluntary community-based drug dependence treatment and support services are being implemented in Cambodia, China, Indonesia, Malaysia, and Thailand. However, significant technical and financial support will be required to be allocated from national budgets and by international development agencies in order to complete the transition and reduce the reliance on detention of people who use drugs in Asia

Not just the needle: The state of HIV-prevention science among substance users and future directions

Successes in preventing HIV transmission among substance using populations have focused primarily among injection drug users, which have produced measurable reductions in HIV incidence and prevalence. By contrast, the majority of substances used worldwide are administered by non-injectable means, and there is a dearth of HIV prevention interventions that target non-injecting substance users. Increased surveillance of trends in substance use, especially cocaine (including crack) and methamphetamine in addition to new and emerging substances (e.g., synthetic cannabinoids, cathinones and other amphetamine analogs) are needed to develop and scale-up effective and robust interventions for populations at risk for HIV-transmission via sexual behaviors related to non-injection substance use. Strategies are needed that address unique challenges to HIV prevention for substance users who are HIV-infected and those who are HIV- uninfected and at high risk. We propose a research agenda that prioritizes: (1) ) combination HIV prevention strategies in substance users; (2) behavioral HIV prevention programs that reduce sexual transmission behaviors in non-treatment seeking individuals; (3) medical and/or behavioral treatments for substance abuse that reduce/eliminate substance-related sexual transmission behaviors; and (4) structural interventions to reduce HIV incidence