2 research outputs found
Mass testing and treatment for malaria followed by weekly fever screening, testing and treatment in Northern Senegal: feasibility, cost and impact.
BACKGROUND NlmCategory: BACKGROUND content:
Population-wide interventions using malaria testing and
treatment might decrease the reservoir of Plasmodium falciparum
infection and accelerate towards elimination. Questions remain
about their effectiveness and evidence from different
transmission settings is needed. - Label: METHODS NlmCategory:
METHODS content: "A pilot quasi-experimental study to evaluate a
package of population-wide test and treat interventions was
conducted in six health facility catchment areas (HFCA) in the
districts of Kanel, Lingu\xC3\xA8re, and Ran\xC3\xA9rou
(Senegal). Seven adjacent HFCAs were selected as comparison.
Villages within the intervention HFCAs were stratified according
to the 2013 incidences of passively detected malaria cases, and
those with an incidence\xE2\x80\x89\xE2\x89\xA5\xE2\x80\x8915
cases/1000/year were targeted for a mass test and treat (MTAT)
in September 2014. All households were visited, all consenting
individuals were tested with a rapid diagnostic test (RDT), and,
if positive, treated with dihydroartemisinin-piperaquine. This
was followed by weekly screening, testing and treatment of fever
cases (PECADOM++) until the end of the transmission season in
January 2015. Villages with lower incidence received only
PECADOM++ or case investigation. To evaluate the impact of the
interventions over that transmission season, the incidence of
passively detected, RDT-confirmed malaria cases was compared
between the intervention and comparison groups with a
difference-in-difference analysis using negative binomial
regression with random effects on HFCA." - Label: RESULTS
NlmCategory: RESULTS content: "During MTAT, 89% (2225/2503) of
households were visited and 86% (18,992/22,170) of individuals
were tested, for a combined 77% effective coverage. Among those
tested, 291 (1.5%) were RDT positive (range 0-10.8 by village),
of whom 82% were\xE2\x80\x89<\xE2\x80\x8920\xC2\xA0years old
and 70% were afebrile. During the PECADOM++ 40,002 visits were
conducted to find 2784 individuals reporting fever, with an RDT
positivity of 6.5% (170/2612). The combination of interventions
resulted in an estimated 38% larger decrease in malaria case
incidence in the intervention compared to the comparison group
(adjusted incidence risk ratio\xE2\x80\x89=\xE2\x80\x890.62, 95%
CI 0.45-0.84, p\xE2\x80\x89=\xE2\x80\x890.002). The cost of the
MTAT was $14.3 per person." - Label: CONCLUSIONS NlmCategory:
CONCLUSIONS content: It was operationally feasible to conduct
MTAT and PECADOM++ with high coverage, although PECADOM++ was
not an efficient strategy to complement MTAT. The modest impact
of the intervention package suggests a need for alternative or
complementary strategies
Mass testing and treatment for malaria followed by weekly fever screening, testing and treatment in Northern Senegal: feasibility, cost and impact.
BACKGROUND: Population-wide interventions using malaria testing and treatment might decrease the reservoir of Plasmodium falciparum infection and accelerate towards elimination. Questions remain about their effectiveness and evidence from different transmission settings is needed. METHODS: A pilot quasi-experimental study to evaluate a package of population-wide test and treat interventions was conducted in six health facility catchment areas (HFCA) in the districts of Kanel, Linguère, and Ranérou (Senegal). Seven adjacent HFCAs were selected as comparison. Villages within the intervention HFCAs were stratified according to the 2013 incidences of passively detected malaria cases, and those with an incidence ≥ 15 cases/1000/year were targeted for a mass test and treat (MTAT) in September 2014. All households were visited, all consenting individuals were tested with a rapid diagnostic test (RDT), and, if positive, treated with dihydroartemisinin-piperaquine. This was followed by weekly screening, testing and treatment of fever cases (PECADOM++) until the end of the transmission season in January 2015. Villages with lower incidence received only PECADOM++ or case investigation. To evaluate the impact of the interventions over that transmission season, the incidence of passively detected, RDT-confirmed malaria cases was compared between the intervention and comparison groups with a difference-in-difference analysis using negative binomial regression with random effects on HFCA. RESULTS: During MTAT, 89% (2225/2503) of households were visited and 86% (18,992/22,170) of individuals were tested, for a combined 77% effective coverage. Among those tested, 291 (1.5%) were RDT positive (range 0-10.8 by village), of whom 82% were < 20 years old and 70% were afebrile. During the PECADOM++ 40,002 visits were conducted to find 2784 individuals reporting fever, with an RDT positivity of 6.5% (170/2612). The combination of interventions resulted in an estimated 38% larger decrease in malaria case incidence in the intervention compared to the comparison group (adjusted incidence risk ratio = 0.62, 95% CI 0.45-0.84, p = 0.002). The cost of the MTAT was $14.3 per person. CONCLUSIONS: It was operationally feasible to conduct MTAT and PECADOM++ with high coverage, although PECADOM++ was not an efficient strategy to complement MTAT. The modest impact of the intervention package suggests a need for alternative or complementary strategies