A qualitative look at bed net access and use in Burkina Faso, Mozambique, Nigeria, and Rwanda following piloted distributions of dual-active ingredient insecticide-treated nets

Background: Universal coverage with insecticide-treated nets (ITNs) is important for malaria control and elimination. The emergence and intensification of insecticide resistance threatens progress made through the deployment of these interventions and has required the development of newer, more expensive ITN types. Understanding malaria prevention behaviour, including barriers and facilitators to net access and use, can support effective decision-making for the promotion and distribution of ITNs. Methods: In-depth interviews and focus group discussions were conducted in 3 to 4 villages per district, in 13 districts across Burkina Faso, Mozambique, Nigeria and Rwanda from 2019 to 2022. Interviews were conducted in the local language, translated and transcribed in English, French or Portuguese. Transcripts were coded and analysed using Nvivo and ATLAS.ti. Results: ITNs were obtained from mass distribution campaigns, antenatal care and immunization visits, and purchased on the private market in some locations. While there were divergent perspectives in whether the number of distributed nets were adequate, participants consistently expressed concerns of bias, discrimination, and a lack of transparency with the distribution process. ITNs were frequently used alongside other malaria prevention methods. The primary motivation for use was malaria prevention. While some participants reported using nets nightly throughout the year, other participants reported seasonal use, both due to the perceived higher density of mosquitoes and discomfort of sleeping under a net in the increased heat. Other barriers to consistent net use included activities that take place away from the home, sleeping patterns and arrangements, and sensitivity to the insecticides on the nets. Conclusions: ITNs remain an important malaria control intervention. To ensure adequate and increased net access, distribution campaigns should consider family structures, available sleeping spaces, and other bed sharing preferences when identifying the number of nets needed for distribution. In addition, campaigns should allow for multiple options for net distribution points and timing to accommodate households remote to health services. Continuous distribution channels and complimentary distribution through the private sector could help fill gaps in coverage. Solutions are needed for outdoor malaria transmission, including alternative designs for ITNs, and improving access to complementary personal protective measures

Design and methods for a quasi-experimental pilot study to evaluate the impact of dual active ingredient insecticide-treated nets on malaria burden in five regions in sub-Saharan Africa

Background:Vector control tools have contributed significantly to a reduction in malaria burden since 2000, primar‑ily through insecticidal‑treated bed nets (ITNs) and indoor residual spraying. In the face of increasing insecticide resist‑ance in key malaria vector species, global progress in malaria control has stalled. Innovative tools, such as dual active ingredient (dual‑AI) ITNs that are effective at killing insecticide‑resistant mosquitoes have recently been introduced. However, large‑scale uptake has been slow for several reasons, including higher costs and limited evidence on their incremental effectiveness and cost‑effectiveness. The present report describes the design of several observational studies aimed to determine the effectiveness and cost‑effectiveness of dual‑AI ITNs, compared to standard pyre‑throid‑only ITNs, at reducing malaria transmission across a variety of transmission settings.Methods:Observational pilot studies are ongoing in Burkina Faso, Mozambique, Nigeria, and Rwanda, leveraging dual‑AI ITN rollouts nested within the 2019 and 2020 mass distribution campaigns in each country. Enhanced surveil‑lance occurring in select study districts include annual cross‑sectional surveys during peak transmission seasons, monthly entomological surveillance, passive case detection using routine health facility surveillance systems, and studies on human behaviour and ITN use patterns. Data will compare changes in malaria transmission and disease burden in districts receiving dual‑AI ITNs to similar districts receiving standard pyrethroid‑only ITNs over three years. The costs of net distribution will be calculated using the provider perspective including financial and economic costs, and a cost‑effectiveness analysis will assess incremental cost‑effectiveness ratios for Interceptor® G2, Royal Guard®, and piperonyl butoxide ITNs in comparison to standard pyrethroid‑only ITNs, based on incidence rate ratios calcu‑lated from routine data.Conclusions:Evidence of the effectiveness and cost‑effectiveness of the dual‑AI ITNs from these pilot studies will complement evidence from two contemporary cluster randomized control trials, one in Benin and one in Tanzania, to provide key information to malaria control programmes, policymakers, and donors to help guide decision‑making and planning for local malaria control and elimination strategies. Understanding the breadth of contexts where these dual‑AI ITNs are most effective and collecting robust information on factors influencing comparative effectiveness could improve uptake and availability and help maximize their impact

Improving HIV/STD Partner Services: Assessment of Barriers and Facilitators of Three New Activities at the Mississippi State Department of Health

Thesis (Master's)--University of Washington, 2018Introduction: Mississippi has one of the most severe HIV epidemics in the United States. At the Mississippi State Department of Health (MSDH), the partner services program has not routinely integrated HIV-related activities into sexually transmitted disease (STD) partner services to identify undiagnosed HIV infection among sex partners of cases, nor has it routinely performed activities to identify previous HIV-positive individuals with an STD who are out of care. Additionally, the promotion of pre-exposure prophylaxis (PrEP) has not been integrated into Disease Intervention Specialist (DIS) case work. These new activities have the potential to substantially bend the curve of the HIV epidemic in Mississippi. The goal of this analysis was to identify: I) the time required to implement the three new HIV-related activities; and II) the barriers and facilitators of integrating the three new HIV-related activities into STD partner services. Together these two analyses were designed to determine the long-term feasibility of the integration of the new activities statewide. Methods: We used two methods to identify barriers and facilitators of integrating the three new HIV-related activities into STD partner services: staff interviews and a time and motion study of DIS. We also used two methods to estimate time spent on partner services activities: the time and motion study and individual case tracking. Results: The average amount of time actively working on a case for STD partner services without the new activities was about 3.25 hours. With the addition of three new HIV-related activities, the time varied from 3.75 hours to 4.5 hours per case. DIS noted that the activities were well integrated into their daily workload, but anecdotally stated it was an increase in the number of cases that they handle. DIS generally had a very positive perception of the new activities. However, DIS’ thoughts on effectiveness were mixed. Discussion: This analysis represents the first time that systematic collection of time spent on partner services activities has been completed for the partner services program at the MSDH. While gonorrhea and chlamydia cases are the target of the new activities, they are the lowest priority for DIS. This means that DIS are often following up on gonorrhea and chlamydia cases several days after the client has been tested and treated—reducing the likelihood that the DIS will be able to successfully contact the client for an interview. The results of this study can be used to conduct a costing study. Future investigations focused on the effectiveness of the new activities, costing, and the distribution of duration of tasks may provide a more accurate picture of time spent on tasks not only for the new activities, but also the existing STD partner services program

MOESM1 of Modeling the potential impact of emerging innovations on achievement of Sustainable Development Goals related to maternal, newborn, and child health

Additional file 1. Sources on epidemiologic data

MINT-data-v20230208

A public repository for the model simulation data used in MINT, the malaria intervention tool, found here. This dataset contains 2,540,160 model simulations from a malaria transmission dynamics model varying mosquito bionomics, malaria prevalence, transmission seasonality, history of insecticide-treated nets and indoor residual spraying, and projected vector control coverage. The dataset was created by running the model, varying parameters to represent the diversity of settings in malaria-endemic sub-Saharan Africa, and the projections resulting from these simulations are incorporated into Version 2 of the online malaria decision-making tool MINT. Full details of this update to MINT can be found in the article "Projecting Epidemiological Benefit of Pyrethroid-Pyrrole Insecticide Treated Nets Against Malaria" (Churcher et al. 2023)