Combining organophosphate-treated wall linings and long-lasting insecticidal nets fails to provide additional control over long-lasting insecticidal nets alone against multiple insecticide-resistant <i>Anopheles gambiae</i> in Côte d’Ivoire: an experimental hut trial

Abstract

&lt;b&gt;Background&lt;/b&gt; Insecticide-treated wall lining (ITWL) is a new concept in malaria vector control. Some &lt;i&gt;Anopheles gambiae&lt;/i&gt; populations in West Africa have developed resistance to all the main classes of insecticides. It needs to be demonstrated whether vector control can be improved or resistance managed when non-pyrethroid ITWL is used alone or together with long-lasting insecticidal nets (LLINs) against multiple insecticide-resistant vector populations.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Methods&lt;/b&gt; Two experimental hut trials were carried out as proofs of concept to evaluate pirimiphos methyl (p-methyl)-treated plastic wall lining (WL) and net wall hangings (NWH) used alone and in combination with LLINs against multiple insecticide-resistant &lt;i&gt;An. Gambiae&lt;/i&gt; in Tiassalé, Côte d’Ivoire. Comparison was made to commercial deltamethrin WL and genotypes for &lt;i&gt;kdr&lt;/i&gt; and &lt;i&gt;ace-1R&lt;/i&gt; resistance were monitored.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Results&lt;/b&gt; The &lt;i&gt;kdr&lt;/i&gt; and &lt;i&gt;ace-1R&lt;/i&gt; allele frequencies were 0.83 and 0.44, respectively. &lt;i&gt;Anopheles gambiae&lt;/i&gt; surviving discriminating concentrations of deltamethrin and p-methyl in WHO resistance tests were 57 and 96%, respectively. Mortality of free-flying &lt;i&gt;An. Gambiae&lt;/i&gt; in huts with p-methyl WL and NWH (66 and 50%, respectively) was higher than with pyrethroid WL (32%; P &lt; 0.001). Mortality with LLIN was 63%. Mortality with the combination of LLIN plus p-methyl NWH (61%) or LLIN plus p-methyl WL (73%) did not significantly improve upon the LLIN alone or p-methyl WL or NWH alone. Mosquitoes bearing the &lt;i&gt;ace-1R&lt;/i&gt; were more likely to survive exposure to p-methyl WL and NWH. Selection of heterozygote and homozygote &lt;i&gt;ace-1R&lt;/i&gt; or &lt;i&gt;kdr&lt;/i&gt; genotypes was not less likely after exposure to combined LLIN and p-methyl treatments than to single p-methyl treatment. Blood-feeding rates were lower in huts with the pyrethroid LLIN (19%) than with p-methyl WL (72%) or NWH (76%); only LLIN contributed to personal protection.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Conclusions&lt;/b&gt; Combining p-methyl WL or NWH with LLINs provided no improvement in &lt;i&gt;An. Gambiae&lt;/i&gt; control or personal protection over LLIN alone in southern Côte d’Ivoire; neither did the combination manage resistance. Additional resistance mechanisms to &lt;i&gt;kdr&lt;/i&gt; and &lt;i&gt;ace-1R&lt;/i&gt; probably contributed to the survival of pyrethroid and organophophate-resistant mosquitoes. The study demonstrates the challenge that malaria control programmes will face if resistance to multiple insecticides continues to spread.&lt;p&gt;&lt;/p&gt