Last Updated

07 Apr 2021

Evaluating the feasibility and effectiveness of Reactive Targeted Parasite Elimination vs. Reactive Case Detection as a community level intervention in response to a passively identified index case: a cluster randomised controlled trial in Namibia

Objectives

This is a cluster randomised controlled trial with factorial study design comparing the impact of reactive community-based malaria interventions:

  1. presumptive treatment (or TPE, targeted parasite elimination, mass drug administration) versus reactive case detection (RACD), and
  2. reactive IRS (indoor residual spraying) versus control on the incidence of malaria in Namibia.

Arm 1: RACD as per program + RDT screening and treatment

Arm 2: RACD + IRS with Actellic CS to EA after first reported cases

Arm 3: Focal MDA (household and immediate neighbours) in response to a case

Arm 4: Focal MDA + IRS with Actellic CS

Primary aim: To compare the impact of focal MDA versus RACD, and reactive IRS versus no reactive IRS, on the incidence of confirmed, passively identified malaria cases.

Secondary aims:

Effectiveness: 

  1. To compare the impact of each intervention package (focal MDA+/- reactive IRS, RACD +/-reactive IRS) on:
  • Prevalence of infection, among all ages, as detected by quantitative polymerase chain reaction (qPCR)
  • Seroprevalence, among all ages, measured by ELISA 

Feasibility:

  1. To compare operational coverage, and determine the feasibility of reaching 80% coverage, for each intervention package;
  2. To compare the safety of the intervention packages;
  3. To compare the acceptability of the interventions, individually and as packages;
  4. To compare the costs and cost-effectiveness of the interventions, individually and as packages;
  5. To measure medication adherence in both focal MDA and RACD arms.
Principal Investigator
Rationale and Abstract

In recent years, many countries, including Namibia, have experienced reductions in malaria transmission in association with the scale-up of effective interventions and are now moving towards malaria elimination. In malaria control, the goal is to reduce the clinical burden of malaria. In malaria elimination, the aim is to interrupt transmission, and it becomes necessary to address not only symptomatic malaria, but also asymptomatic infections that contribute to transmission. Since malaria transmission is highly geographically heterogeneous, elimination activities should target hot spots, or areas where the risk of future infection is highest. Hence, in the transition from control to elimination, enhanced surveillance and response is necessary to target hot spots with interventions to interrupt transmission.

ClinicalTrials.gov Identifier: NCT02610400

Study Design
Study Type : Interventional  (Clinical Trial)
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: None (Open Label)
Primary Purpose: Treatment