Reactive household-based self-administered treatment against residual malaria transmission: a cluster randomised trial
The study evaluates a novel approach to decrease and possibly stop residual malaria transmission by combining targeted treatment of potential malaria carriers (focal MDA approach) with a strong community involvement.
The main research questions are:
- whether malaria patients (or their parents for children) can administer a full course of antimalarial treatment provided at health facilities to all individuals living in their households and,
- if treating all household members of clinical malaria cases can reduce and possibly eliminate residual malaria transmission where this is already low.
A cluster (village)-randomized trial is planned. In the first year, formative research consisting of a mixed-methods approach, combining qualitative (participant observation, in-depth interviews, case studies and focus group discussions) and quantitative research will be applied to gain an in-depth comprehension of the study setting as well as community- based participatory techniques to improve participation in the intervention and adherence to the treatment. The data generated will be used to adapt the intervention to the local context in order to obtain the best possible adherence and compliance to treatment. The final RHOST will be implemented during the second year of intervention.
The primary outcome will be the prevalence of malaria infection (determined by molecular methods) in all age groups at the end of the second intervention year. Other outcomes include the incidence of clinical malaria; prevalence of antimalarial drug resistance molecular markers; impact on the local health system; treatment coverage; and comprehension and acceptability of the intervention, cost and cost-effectiveness analysis.
Treating people carrying malaria parasites irrespective of clinical symptoms has been one of the ways for interrupting transmission. However, such programmes can be challenging and depend on factors such as the risk of being infected but without symptoms and adherence of the communities to treatment. The planned study combines targeted treatment of households of malaria patients; identified as potential malaria carriers, with a strong involvement of existing organizations/structures in the communities and health system. The intervention will be tested through a community-based, clustered randomized trial where malaria patients diagnosed in health facilities will be given sufficient antimalarials to treat all household contacts. The messages that will underpin the intervention will be adapted to the local context through a formative research. At the end of the study, the team will measure the effect the intervention on carriage of malaria parasites, the impact on the health system, the incremental cost and cost-effectiveness of the intervention and adherence rates achieved by the approach.