A supplement program for malaria elimination strategy in Thailand and Myanmar based on mass primaquine preventive treatment (Southeast Asia ICEMR)
The goal of this study is to thoroughly assess effectiveness, feasibility, sustainability, acceptability and community engagement of mass primaquine preventive treatment (MPPT) as a strategy for malaria elimination in Thailand and Myanmar.
The Ministries of Public Health in Thailand and Myanmar are considering integrating MPPT into their national malaria control programs, but are hesitating because of a lack of clear evidence for the effectiveness of this strategy for eliminating vivax malaria in tropical countries. Two integrated studies are proposed:
I. Observational Study (mixed methods approach):
Assess the acceptability and operational feasibility of implementing MPPT and enhanced vector-control interventions in malaria endemic villages as well as the readiness of the community and health providers for malaria elimination.
II. Implementation Study (impact and cost-effectiveness of MPPT on malaria transmission):
II.1 - To conduct a cluster-randomized control trial to evaluate effectiveness of MPPT augmented to national standard of care to inform malaria elimination effort.
II.2 - To conduct preparatory activities such as surveillance, community sensitization, and stakeholder engagement for potential scale-up.
I. In-depth interviews and focus-group discussions to collect information from 500 healthcare personnel and 1,500 adults in malaria endemic provinces.
II.1. A cross-over clustered-randomized controlled trial will be conducted in 6 clusters in Thailand and 4 clusters in Myanmar, with the total population of approximately 4,000.
- Arm 1 - MPPT (experimental): A dose of PQ will be administered daily for 14 days to all volunteers with a normal G6PD test result in Year 1. Volunteers in this group will be switched and not receive any treatment in Year 2.
- Arm 2 - Control group (no intervention): Volunteers will not receive PQ in Year 1 but will be switched and receive PQ for 14 days in Year 2.
- Reduction in malaria incidence: a) Clinical malaria incidence rates; b) Plasmodium prevalence rates [month 1 / month 5 / month 9, each year; and passive case detection]
- Cost estimates for MPPT implementation
-Baseline prevalence of G6PD deficiency in the study population
-Rates of primaquine-induced hemolysis in females
-Impact of MPPT on parasite genetic diversity and relapse rates
-Monthly morbidity data of reportable diseases from the surveillance system
II.2. The study will also include prepartion of the target communities for potential large-scale MPPT implementation.