Population-wide malaria testing and treatment with rapid diagnostic tests and artemether-lumefantrine in Southern Zambia: A community randomized step-wedge control trial design

Active parasite detection may be a potentially useful alternative to Mass Drug Administration (MDA), where individuals with a parasite infection, including those that are asymptomatic, are identified with a rapid diagnostic test (RDT) and then treated with an effective antimalarial such as an artemisinin-based combination therapy (ACT). Although RDTs have known limitations in sensitivity for infection detection, they are the only currently available tests capable of providing immediate results in field settings for treatment decisions. In addition to clearing asexual stage parasites, ACTs are effective against immature gametocytes, and have been shown to reduce the carriage time of gametocytes in infected individuals. When combined with sustained high vector control coverage, a population-wide MTAT intervention may be useful in limiting onward transmission from infected individuals and thereby significantly reducing malaria transmission.

A community randomized step-wedge control trial design was used to assess the impact of the three dry-season MTAT rounds on reducing health facility malaria case incidence and parasite infection prevalence in children. During each MTAT round, community health workers (CHWs) systematically went door to door and screened all individuals in their target areas using Ministry of Health (MoH) approved RDTs. For those individuals testing positive, CHWs administered a treatment regimen of artemether-lumefantrine according to MoH treatment guidelines.

A qualitative study to understand health workers and community perceptions regarding the MTAT campaign was also undertaken, along with a cost-effectiveness analysis of the intervention.

Drug-based Strategies
Impact of Interventions
Social Science

Dec 2011 — Jul 2013

Zambia

Mass Test and Treat (MTaT) strategies