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Kositz C, Vasileva H, Mohammed N, Achan J, Dabira ED, D'Alessandro U, Bradley J, Marks M. Risk factors for non-participation in ivermectin and dihydroartemisinin-piperaquine mass drug administration for malaria control in the MASSIV trial. Malar J 2024; 23:54. [PMID: 38383367 PMCID: PMC10882911 DOI: 10.1186/s12936-024-04878-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 02/10/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Mass Drug Administration (MDA) has become a mainstay for the control of several diseases over the last two decades. Successful implementation of MDA programmes requires community participation and can be threatened by systematic non-participation. Such concerns are particularly pertinent for MDA programmes against malaria, as they require multi-day treatment over several consecutive months. Factors associated with non-participation to the MDA campaign with ivermectin (IVM) and dihydroartemisinin-piperaquine (DHP) implemented within the MASSIV cluster randomized trial were determined. METHODS Coverage data was extracted from the MASSIV trial study database, with every datapoint being a directly observed therapy (DOT). A complete month of MDA was classified as receiving all three daily doses of treatment. For both ivermectin and DHP, ordinal logistic regression was used to identify individual and household level variables associated with non-participation. RESULTS For ivermectin, 51.5% of eligible participants received all 3 months of treatment while 30.7% received either one or two complete months. For DHP, 56.7% of eligible participants received all 3 months of treatment and 30.5% received either one or two complete months. Children aged 5-15 years and adults aged more than 50 years were more likely to receive at least one complete month of MDA than working age adults, both for ivermectin (aOR 4.3, 95% CI 3.51-5.28 and aOR of 2.26, 95% CI 1.75-2.95) and DHP (aOR 2.47, 95%CI 2.02-3.02 and aOR 1.33, 95%CI 1.01-1.35), respectively. Members of households where the head received a complete month of MDA were more likely to themselves have received a complete month of MDA, both for ivermectin (aOR 1.71, 95%CI 1.35-2.14) and for DHP (aOR 1.64, 95%CI 1.33-2.04). CONCLUSION Personal and household-level variables were associated with participation in the MDA programme for malaria control. Specific strategies to (increase participation amongst some groups may be important to ensure maximum impact of MDA strategies in achieving malaria elimination. TRIAL REGISTRATION The MASSIV trial is registered under NCT03576313.
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Affiliation(s)
- Christian Kositz
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK.
| | - Hristina Vasileva
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| | - Nuredin Mohammed
- Disease Control and Elimination, Medical Research Council Unit Gambia at the London School of Hygiene and Tropical Medicine (MRCG at LSHTM), Fajara, The Gambia
| | - Jane Achan
- Disease Control and Elimination, Medical Research Council Unit Gambia at the London School of Hygiene and Tropical Medicine (MRCG at LSHTM), Fajara, The Gambia
| | - Edgard Diniba Dabira
- Disease Control and Elimination, Medical Research Council Unit Gambia at the London School of Hygiene and Tropical Medicine (MRCG at LSHTM), Fajara, The Gambia
| | - Umberto D'Alessandro
- Disease Control and Elimination, Medical Research Council Unit Gambia at the London School of Hygiene and Tropical Medicine (MRCG at LSHTM), Fajara, The Gambia
| | - John Bradley
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
- Hospital for Tropical Diseases, University College London Hospital, London, UK
- Division of Infection and Immunity, University College London, London, UK
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Djimde M, Tshiongo JK, Muhindo HM, Tinto H, Sevene E, Traore M, Vala A, Macuacua S, Kabore B, Dabira ED, Erhart A, Diakite H, Keita M, Piqueras M, González R, Menendez C, Dorlo TP, Sagara I, Mens P, Schallig H, D'Alessandro U, Kayentao K. Efficacy and safety of pyronaridine-artesunate (PYRAMAX) for the treatment of P. falciparum uncomplicated malaria in African pregnant women (PYRAPREG): study protocol for a phase 3, non-inferiority, randomised open-label clinical trial. BMJ Open 2023; 13:e065295. [PMID: 37813539 PMCID: PMC10565244 DOI: 10.1136/bmjopen-2022-065295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 08/31/2023] [Indexed: 10/13/2023] Open
Abstract
INTRODUCTION Malaria infection during pregnancy increases the risk of low birth weight and infant mortality and should be prevented and treated. Artemisinin-based combination treatments are generally well tolerated, safe and effective; the most used being artemether-lumefantrine (AL) and dihydroartemisinin-piperaquine (DP). Pyronaridine-artesunate (PA) is a new artemisinin-based combination. The main objective of this study is to determine the efficacy and safety of PA versus AL or DP when administered to pregnant women with confirmed Plasmodium falciparum infection in the second or third trimester. The primary hypothesis is the pairwise non-inferiority of PA as compared with either AL or DP. METHODS AND ANALYSIS A phase 3, non-inferiority, randomised, open-label clinical trial to determine the safety and efficacy of AL, DP and PA in pregnant women with malaria in five sub-Saharan, malaria-endemic countries (Burkina Faso, Democratic Republic of the Congo, Mali, Mozambique and the Gambia). A total of 1875 pregnant women will be randomised to one of the treatment arms. Women will be actively monitored until Day 63 post-treatment, at delivery and 4-6 weeks after delivery, and infants' health will be checked on their first birthday. The primary endpoint is the PCR-adjusted rate of adequate clinical and parasitological response at Day 42 in the per-protocol population. ETHICS AND DISSEMINATION This protocol has been approved by the Ethics Committee for Health Research in Burkina Faso, the National Health Ethics Committee in the Democratic Republic of Congo, the Ethics Committee of the Faculty of Medicine and Odontostomatology/Faculty of Pharmacy in Mali, the Gambia Government/MRCG Joint Ethics Committee and the National Bioethics Committee for Health in Mozambique. Written informed consent will be obtained from each individual prior to her participation in the study. The results will be published in peer-reviewed open access journals and presented at (inter)national conferences and meetings. TRIAL REGISTRATION NUMBER PACTR202011812241529.
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Affiliation(s)
- Moussa Djimde
- Malaria Research and Training Center, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Japhet Kabalu Tshiongo
- Département of Tropical Médecine, Universite de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Hypolite Mavoko Muhindo
- Department of Tropical Medicine, Universite de Kinshasa Faculte de Medecine, Kinshasa, Democratic Republic of Congo
| | - Halidou Tinto
- Institut de Recherche en Sciences de la Santé (IRSS) - Unité de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - Esperanca Sevene
- Centro de Investigacao em Saude de Manhica, Manhica, Mozambique
- Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Maminata Traore
- Institut de Recherche en Sciences de la Santé (IRSS) - Unité de Recherche Clinique de Nanoro, Ouagadougou, Burkina Faso
| | - Anifa Vala
- Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique
| | - Salesio Macuacua
- Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique
| | - Berenger Kabore
- Institut de Recherche en Sciences de la Santé (IRSS) - Unité de Recherche Clinique de Nanoro, Ouagadougou, Burkina Faso
| | - Edgard Diniba Dabira
- MRC Unit The Gambia (MRCG) at the London School of Hygiene and Tropical Medicine, The Gambia London, UK
| | - Annette Erhart
- MRC Unit The Gambia (MRCG) at the London School of Hygiene and Tropical Medicine, The Gambia London, UK
| | - Hamadoun Diakite
- Malaria Research and Training Center, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Mohamed Keita
- Faculty of Medicine Odontostomatology, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | | | | | | | - Thomas Pc Dorlo
- Netherlands Cancer Institute / Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Pharmacy, Uppsala University, Uppsala, UK
| | - Issaka Sagara
- Malaria Research and Training Center, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Petra Mens
- Amsterdam University Medical Centres, Academic Medical Centre at the University of Amsterdam (AMC), Amsterdam, The Netherlands
| | - Henk Schallig
- Amsterdam University Medical Centres, Academic Medical Centre at the University of Amsterdam (AMC), Amsterdam, The Netherlands
| | | | - Kassoum Kayentao
- Malaria Research and Training Center, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
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Dabira ED, Fehr A, Beloum N, Van Geertruyden JP, Achan J, Erhart A, Martinez-Alvarez M, D'Alessandro U. Perceptions and acceptability of the controlled human malaria infection (CHMI) model in The Gambia: a qualitative study. Sci Rep 2023; 13:8708. [PMID: 37248260 DOI: 10.1038/s41598-023-35752-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 05/23/2023] [Indexed: 05/31/2023] Open
Abstract
Controlled human malaria infection (CHMI) studies, i.e. the deliberate infection of healthy volunteers with malaria parasites to study immune response and/or test drug or vaccine efficacy, are increasingly being conducted in malaria endemic countries, including in sub-Saharan Africa. However, there have been few studies on the perceptions and acceptability of CHMI by the local communities. This qualitative study assessed the perception and acceptability of such studies in The Gambia following the first CHMI study conducted in the country in March-May 2018. Data were collected through non-participant observation, in-depth interviews and focus group discussions and analyzed using NVivo 12 software with an inductive-deductive approach. Sixty-seven participants were involved, including volunteers enrolled in the CHMI, community stakeholders and members of the Gambian Ethics Committee. Respondents expressed a positive view about CHMI. Key motivating factors for participation were the financial compensation, comprehensive health checks, and willingness to support malaria research. Risks associated with participation were considered low. Concerns raised included the frequency of bleeding and the blood volume collected.
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Affiliation(s)
- Edgard Diniba Dabira
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine (MRCG at LSHTM), Fajara, The Gambia.
- Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.
| | - Alexandra Fehr
- London School of Hygiene and Tropical Medicine, London, UK
| | - Nathalie Beloum
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine (MRCG at LSHTM), Fajara, The Gambia
| | | | | | - Annette Erhart
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine (MRCG at LSHTM), Fajara, The Gambia
| | - Melisa Martinez-Alvarez
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine (MRCG at LSHTM), Fajara, The Gambia
| | - Umberto D'Alessandro
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine (MRCG at LSHTM), Fajara, The Gambia
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Soumare HM, Dabira ED, Camara MM, Jadama L, Gaye PM, Kanteh S, Jawara EA, Njie AK, Sanneh F, Ndiath MO, Lindsay SW, Conteh B, Ceesay S, Mohammed N, Ooko M, Bradley J, Drakeley C, Erhart A, Bousema T, D'Alessandro U. Entomological impact of mass administration of ivermectin and dihydroartemisinin-piperaquine in The Gambia: a cluster-randomized controlled trial. Parasit Vectors 2022; 15:435. [PMID: 36397132 PMCID: PMC9673448 DOI: 10.1186/s13071-022-05557-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/16/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Vector control interventions in sub-Saharan Africa rely on insecticide-treated nets and indoor residual spraying. Insecticide resistance, poor coverage of interventions, poor quality nets and changes in vector behavior threaten the effectiveness of these interventions and, consequently, alternative tools are needed. Mosquitoes die after feeding on humans or animals treated with ivermectin (IVM). Mass drug administration (MDA) with IVM could reduce vector survival and decrease malaria transmission. The entomological impact of MDA of combined IVM and dihydroartemisinin-piperaquine was assessed in a community-based, cluster-randomized trial. METHODS A cluster-randomized trial was implemented in 2018 and 2019 in 32 villages in the Upper River Region, The Gambia. The with the inhabitants of 16 intervention villages eligible to receive three monthly rounds of MDA at the beginning of the malaria transmission season. Entomological surveillance with light traps and human landing catches (HLC) was carried out during a 7- to 14-day period after each round of MDA, and then monthly until the end of the year. The mosquitocidal effect of IVM was determined by direct membrane feeding assays. RESULTS Of the 15,017 mosquitoes collected during the study period, 99.65% (n = 14,965) were Anopheles gambiae sensu lato (An. gambiae s.l.), comprising Anopheles arabiensis (56.2%), Anopheles coluzzii (24.5%), Anopheles gambiae sensu stricto (An. gembiae s.s.; 16.0%) and Anopheles funestus sensu lato (An. funestus s.l.; 0.35%). No effect of the intervention on vector parity was observed. Vector density determined on light trap collections was significantly lower in the intervention villages in 2019 (adjusted incidence rate ratio: 0.39; 95% confidence interval [CI]: 0.20, 0.74; P = 0.005) but not in 2018. However, vector density determined in HLC collections was similar in both the intervention and control villages. The entomological inoculation rate was significantly lower in the intervention villages than in the control villages (odds ratio: 0.36, 95% CI: 0.19, 0.70; P = 0·003). Mosquito mortality was significantly higher when blood fed on IVM-treated individuals up to 21 days post-treatment, particularly in adults and individuals with a higher body mass index. CONCLUSION Mass drug administration with IVM decreased vector density and the entomological inoculation rate while the effect on vector parity was less clear. Survival of mosquitoes fed on blood collected from IVM-treated individuals was significantly lower than that in mosquitoes which fed on controls. The influence of host characteristics on mosquito survivorship indicated that dose optimization could improve IVM efficacy. Future detailed entomological evaluation trials in which IVM is administered as stand-alone intervention may elucidate the contribution of this drug to the observed reduction in transmission.
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Affiliation(s)
- Harouna M Soumare
- Medical Research Council Unit The Gambia at the London, School of Hygiene and Tropical Medicine, Banjul, The Gambia.
| | - Edgard Diniba Dabira
- Medical Research Council Unit The Gambia at the London, School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Muhammed M Camara
- Medical Research Council Unit The Gambia at the London, School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Lamin Jadama
- Medical Research Council Unit The Gambia at the London, School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Pa Modou Gaye
- Medical Research Council Unit The Gambia at the London, School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Sainey Kanteh
- Medical Research Council Unit The Gambia at the London, School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Ebrima A Jawara
- Medical Research Council Unit The Gambia at the London, School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Amie Kolleh Njie
- Medical Research Council Unit The Gambia at the London, School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Fatou Sanneh
- Medical Research Council Unit The Gambia at the London, School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Mamadou Ousman Ndiath
- Medical Research Council Unit The Gambia at the London, School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | | | - Bakary Conteh
- Medical Research Council Unit The Gambia at the London, School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Sainey Ceesay
- Medical Research Council Unit The Gambia at the London, School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Nuredin Mohammed
- Medical Research Council Unit The Gambia at the London, School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Michael Ooko
- Medical Research Council Unit The Gambia at the London, School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - John Bradley
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Chris Drakeley
- Faculty of Infectious & Tropical Diseases, The London School of Hygiene and Tropical Medicine, London, UK
| | - Annette Erhart
- Medical Research Council Unit The Gambia at the London, School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Teun Bousema
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Umberto D'Alessandro
- Medical Research Council Unit The Gambia at the London, School of Hygiene and Tropical Medicine, Banjul, The Gambia
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Dabira ED, Soumare HM, Lindsay SW, Conteh B, Ceesay F, Bradley J, Kositz C, Broekhuizen H, Kandeh B, Fehr AE, Nieto-Sanchez C, Ribera JM, Peeters Grietens K, Smit MR, Drakeley C, Bousema T, Achan J, D'Alessandro U. Mass Drug Administration With High-Dose Ivermectin and Dihydroartemisinin-Piperaquine for Malaria Elimination in an Area of Low Transmission With High Coverage of Malaria Control Interventions: Protocol for the MASSIV Cluster Randomized Clinical Trial. JMIR Res Protoc 2020; 9:e20904. [PMID: 33211022 PMCID: PMC7714640 DOI: 10.2196/20904] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/28/2020] [Accepted: 08/03/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND With a decline in malaria burden, innovative interventions and tools are required to reduce malaria transmission further. Mass drug administration (MDA) of artemisinin-based combination therapy (ACT) has been identified as a potential tool to further reduce malaria transmission, where coverage of vector control interventions is already high. However, the impact is limited in time. Combining an ACT with an endectocide treatment that is able to reduce vector survival, such as ivermectin (IVM), could increase the impact of MDA and offer a new tool to reduce malaria transmission. OBJECTIVE The study objective is to evaluate the impact of MDA with IVM plus dihydroartemisinin-piperaquine (DP) on malaria transmission in an area with high coverage of malaria control interventions. METHODS The study is a cluster randomized trial in the Upper River Region of The Gambia and included 32 villages (16 control and 16 intervention). A buffer zone of ~2 km was created around all intervention clusters. MDA with IVM plus DP was implemented in all intervention villages and the buffer zones; control villages received standard malaria interventions according to the Gambian National Malaria Control Program plans. RESULTS The MDA campaigns were carried out from August to October 2018 for the first year and from July to September 2019 for the second year. Statistical analysis will commence once the database is completed, cleaned, and locked. CONCLUSIONS This is the first cluster randomized clinical trial of MDA with IVM plus DP. The results will provide evidence on the impact of MDA with IVM plus DP on malaria transmission. TRIAL REGISTRATION ClinicalTrials.gov NCT03576313; https://clinicaltrials.gov/ct2/show/NCT03576313. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/20904.
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Affiliation(s)
- Edgard Diniba Dabira
- Medical Research Council Unit Gambia, London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Harouna M Soumare
- Medical Research Council Unit Gambia, London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Steven W Lindsay
- Department of Biosciences, Durham University, Durham, United Kingdom
| | - Bakary Conteh
- Medical Research Council Unit Gambia, London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Fatima Ceesay
- Medical Research Council Unit Gambia, London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - John Bradley
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Christian Kositz
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Balla Kandeh
- National Malaria Control Program, The Gambia, Banjul, Gambia
| | - Alexandra E Fehr
- Medical Anthropology Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Vrije Universiteit Amsterdam, Athena Institute, Amsterdam, Netherlands
| | - Claudia Nieto-Sanchez
- Medical Anthropology Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Joan Muela Ribera
- Medial Anthropology Research Center, Universitat Rovira i Virgili, Tarragona, Spain
| | - Koen Peeters Grietens
- Medical Anthropology Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Menno Roderick Smit
- Amsterdam Centre for Global Child Health, Emma Children's Hospital, Amsterdam University Medical Centres, Amsterdam, The Netherlands, Amsterdam, Netherlands
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Chris Drakeley
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Teun Bousema
- Radboud University Medical Centre, Nijmegen, Netherlands
| | - Jane Achan
- Medical Research Council Unit Gambia, London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Umberto D'Alessandro
- Medical Research Council Unit Gambia, London School of Hygiene and Tropical Medicine, Banjul, Gambia
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