Estimating the most efficient allocation of interventions to achieve reductions in Plasmodium falciparum malaria burden and transmission in Africa: a modelling study
Estimating the most efficient allocation of interventions to achieve reductions in Plasmodium falciparum malaria burden and transmission in Africa: a modelling study
复制标题
DOI：
10.1016/s2214-109x(16)30073-0
复制
发表时间：
2016-07-01
影响因子：
34.3
通讯作者：
Ghani, Azra C.
中科院分区：
文献类型：
--
作者：
Walker, Patrick G. T.;Griffin, Jamie T.;Ghani, Azra C.
减轻疟疾负担是一项全球优先事项，但财政限制意味着必须合理分配现有资源，以使其效果最大化。我们的目标是开发一个模型，以估计最有效（即最低成本）的干预措施排序，以减少疟疾负担和传播。我们还旨在估计不同空间尺度的实施效率。方法我们将捕获非洲疟疾传播异质性的动态模型与关键疟疾干预措施的财务单位成本数据相结合。我们结合了疟疾流行模式、降雨季节性和蚊子组成的估计，绘制了非洲各地这些干预措施的最佳方案。使用非线性优化方法，我们研究了在国家、次国家一级行政（省）或精细尺度（5公里(2)像素）空间尺度上部署和评估控制措施时，这些最佳方案是如何变化的。研究结果：在特定情况下，最有效的一揽子措施取决于是否以减少或消除疾病为目标。长效驱虫蚊帐通常是实现这两个目标的最具成本效益的第一干预措施，其次是季节性疟疾化学预防或室内残留喷洒，具体取决于季节性和病媒物种。据估计，在非洲43.4%（95%可信区间40.0-49.0）的高危人群中，这些干预措施可将疟疾传播减少到每年每1000人中1例以下。每年增加三轮大规模给药估计会使这一比例增加到90.9% （95% CI 86.9-94.6）。进一步的优化可以通过针对省级的政策来实现，相对于采用全国范围的政策，估计可以节省32.1% （95% CI 29.6-34.5）的成本。然而，我们预测41个国家中只有26个（95% CI 22-29）可以通过这些方法将传播减少到这些水平。这些结果突出了根据不同地区的生态景观精心定制疟疾干预措施的成本效益。然而，如果要实现消灭疟疾，就必须采取新的干预措施。
Background Reducing the burden of malaria is a global priority, but financial constraints mean that available resources must be allocated rationally to maximise their effect. We aimed to develop a model to estimate the most efficient (ie, minimum cost) ordering of interventions to reduce malaria burden and transmission. We also aimed to estimate the efficiency of different spatial scales of implementation.Methods We combined a dynamic model capturing heterogeneity in malaria transmission across Africa with financial unit cost data for key malaria interventions. We combined estimates of patterns of malaria endemicity, seasonality in rainfall, and mosquito composition to map optimum packages of these interventions across Africa. Using non-linear optimisation methods, we examined how these optimum packages vary when control measures are deployed and assessed at national, subnational first administrative (provincial), or fine-scale (5 km(2) pixel) spatial scales.Findings The most efficient package in a given setting varies depending on whether disease reduction or elimination is the target. Long-lasting insecticide-treated nets are generally the most cost-effective first intervention to achieve either goal, with seasonal malaria chemoprevention or indoor residual spraying added second depending on seasonality and vector species. These interventions are estimated to reduce malaria transmission to less than one case per 1000 people per year in 43.4% (95% CI 40.0-49.0) of the population at risk in Africa. Adding three rounds of mass drug administration per year is estimated to increase this proportion to 90.9% (95% CI 86.9-94.6). Further optimisation can be achieved by targeting policies at the provincial level, achieving an estimated 32.1% (95% CI 29.6-34.5) cost saving relative to adopting country-wide policies. Nevertheless, we predict that only 26 (95% CI 22-29) of 41 countries could reduce transmission to these levels with these approaches.Interpretation These results highlight the cost-benefits of carefully tailoring malaria interventions to the ecological landscape of different areas. However, novel interventions are necessary if malaria eradication is to be achieved.