Malaria mass and focal drug administration to advance malaria elimination in Mozambique: accelerating programmatic implementation and policy translation
The aim of the proposal is to support the Mozambican NMCP to develop a policy for Mass Drug Administration (MDA) and reactive focal MDA (rFMDA) for malaria and understand what it would take to include them in the national strategic guidelines.
After the inclusion of malaria elimination as a goal of the Global Technical Strategy (GTS) for Malaria 2016-2030 by the World Health Organization (WHO), the National Malaria Control Program (NMCP) of Mozambique has started developing a strategic plan to accelerate elimination efforts in the south, where transmission is lowest. To inform this strategy, between 2015 and 2018 FM and ISGlobal evaluated a malaria elimination package in Magude district, consisting of intensified vector control, and two rounds per year of population-wide MDA with dihydroartemisinin-piperaquine (DHAp) for two consecutive years. A 71% reduction in prevalence was observed and an estimated 75.6% of expected cases were averted. These interventions were followed by rFMDA, which was associated with a further reduction in prevalence of 41%, and 79.1% of the expected cases were averted. Although the WHO new policy recommendation on the use of MDA and rFMDA –expected in April 2019– has been adjourned due to the new WHO policy making process, the Malaria Policy Advisory Committee at WHO emphasized that current evidence indicates that the goal of MDA should be to reduce transmission to the point that case- and focus-based activities can be initiated. This is what has been demonstrated in Magude, and is aligned with current WHO recommendations on the use of time-limited MDA. In this context, the NMCP is willing to conduct a pilot programmatic implementation and eventualy adopt these interventions in their malaria strategic plan.
This study will be implemented in three phases:
1 - Develop an optimized delivery strategy and monitoring plan for the implementation of MDA and rFMDA in programmatic mode through consultation with relevant stakeholders to understand its implementation and financial needs, as well as through the creation of a data collection and visualization system to facilitate the monitoring and supervision of activities.
2 - Pilot the programmatic implementation of MDA and rFMDA to evaluate the feasibility and the operational performance of the optimized delivery strategy.
3 - Support the development of policy and guidelines for MDA and rFMDA by working directly with the Malaria Elimination Technical Working Group.