Assessment of community-level effects of intermittent preventive treatment for malaria in schoolchildren in Jinja, Uganda (START-IPT trial): a cluster-randomised trial.
Assessment of community-level effects of intermittent preventive treatment for malaria in schoolchildren in Jinja, Uganda (START-IPT trial): a cluster-randomised trial.
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DOI：
10.1016/s2214-109x(18)30126-8
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发表时间：
2018-06
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影响因子：
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通讯作者：
Drakeley C
中科院分区：
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作者：
Staedke SG;Maiteki-Sebuguzi C;Rehman AM;Kigozi SP;Gonahasa S;Okiring J;Lindsay SW;Kamya MR;Chandler CIR;Dorsey G;Drakeley C
间歇性预防治疗是一种行之有效的疟疾控制干预措施。向学龄儿童提供因特网促进和培训可以在社区一级带来好处的证据有限。我们在乌干达金贾进行了一项整群随机对照试验，以评估小学生使用双氢青蒿素-哌喹（DP）进行IPT对社区疟疾传播指标的影响。我们包括84个群组，每个群组包括一所小学和100个最近的家庭。通过限制性随机化，将这些集群以1：1的比例随机分配接受IPT与DP或标准治疗（对照），以确保地理和学校类型的平衡。干预学校的儿童每月接受多达六轮的IPT（2014年6月至12月）。我们在基线和2015年1月至4月对随机选择的家庭进行了横断面社区调查，在此期间，我们测量了参与者的体温，并获得了手指采血涂片，用于通过显微镜测量寄生虫患病率。我们还做了昆虫学调查，每月1晚，从20个随机选择的IPT和20个控制集群的家庭。主要试验结果是最终社区调查中的寄生虫患病率。主要昆虫学调查结果是2014年7月至2015年4月的年度昆虫接种率（aEIR）。本试验在ClinicalTrials.gov注册，编号NCT 02009215。 在42所干预学校登记的23280名学生中，10079名（43%）年龄在5-20岁之间的学生入学并接受了至少一剂DP。 9286/10079例（92%）接受了至少一个完整疗程的DP（3剂）。 干预组的社区寄生虫感染率低于对照组（19% vs 23%，校正风险比0.85，95%CI 0.73 - 1.00，p= 0.05）。干预组的aEIR低于对照组，但差异不显著（每人10.1 vs 15.2次感染性叮咬，校正的发病率比0.80，95% CI 0.36 - 1.80，p= 0.59）。对患有DP的学龄儿童进行IPT可能对社区一级的疟疾指标产生积极影响，并且在操作上是可行的。需要更大的IPT覆盖范围的研究。英国医学研究理事会、英国国际发展部和惠康信托基金会。
Intermittent preventive treatment (IPT) is a well established malaria control intervention. Evidence that delivering IPT to schoolchildren could provide community-level benefits is limited. We did a cluster-randomised controlled trial to assess the effect of IPT of primary schoolchildren with dihydroartemisinin-piperaquine (DP) on indicators of malaria transmission in the community, in Jinja, Uganda. We included 84 clusters, each comprising one primary school and the 100 closest available households. The clusters were randomly assigned 1:1 to receive IPT with DP or standard care (control) by restricted randomisation to ensure balance by geography and school type. Children in intervention schools received IPT monthly for up to six rounds (June to December, 2014). We did cross-sectional community surveys in randomly selected households at baseline and in January to April, 2015, during which we measured participants' temperatures and obtained finger-prick blood smears for measurement of parasite prevalence by microscopy. We also did entomological surveys 1 night per month in households from 20 randomly selected IPT and 20 control clusters. The primary trial outcome was parasite prevalence in the final community survey. The primary entomological survey outcome was the annual entomological inoculation rate (aEIR) from July, 2014, to April, 2015. This trial is registered at ClinicalTrials.gov, number NCT02009215. Among 23 280 students registered in the 42 intervention schools, 10 079 (43%) aged 5–20 years were enrolled and received at least one dose of DP. 9286 (92%) of 10 079 received at least one full course of DP (three doses). Community-level parasite prevalence was lower in the intervention clusters than in the control clusters (19% vs 23%, adjusted risk ratio 0·85, 95% CI 0·73–1·00, p=0·05). The aEIR was lower in the intervention group than in the control group, but not significantly so (10·1 vs 15·2 infective bites per person, adjusted incidence rate ratio 0·80, 95% CI 0·36–1·80, p=0·59). IPT of schoolchildren with DP might have a positive effect on community-level malaria indicators and be operationally feasible. Studies with greater IPT coverage are needed. UK Medical Research Council, UK Department for International Development, and Wellcome Trust.