Focal mass drug administration (fMDA) to reduce Plasmodium vivax transmission, a pragmatic cluster randomized controlled trial in Peru

项目摘要/摘要 在大多数接近消灭的国家中，间日疟原虫(PV)所占比例相对增加 恶性疟原虫(Pf)。大规模药物管理(MDA)作为一种针对亚专利、无症状感染的方式， 建议用于消灭恶性疟原虫，但该建议不适用于间日疟原虫，因为有限 证据、工具和安全问题。我们研究的目的是评估长期影响，安全性， 以及用于减少光伏传输的焦点丙二醛(FMDA)的成本效益。为了测试我们的假设，FMDA，in 除了标准的积极干预外，将安全地减少传播，我们建议为期3年的开放标签 秘鲁洛雷托地区低流行环境下的CRCT。村庄或集群将随机进行控制或 FMDA。控制臂将接受标准干预(病媒控制、症状性病例管理和 无症状病例的活跃病例检测)。治疗臂将接受标准干预加上FMDA， 它将利用一种根治间日疟原虫的新药他苯喹和一种新的定量葡萄糖6 磷酸脱氢酶(G6PD)缺乏快速检测以支持他苯喹的安全给药。FMDA 将针对同意的和符合条件的高风险村民，定义为 最近的PV索引病例。FMDA将每年进行两轮，在疟疾低发期相隔两个月进行 赛季，超过3年。资格将每年重新评估，并在每一轮FMDA之前。特定的 目的是：1)确定FMDA在减少光伏传播的有效性，如在初级 感染流行率、血清阳性率和遗传多样性的发病率和次要后果， 2)评价FMDA的安全性和耐受性，3)测量FMDA的成本-效果。要最大化地

Project Summary/Abstract In most countries approaching elimination, Plasmodium vivax (Pv) represents an increasing proportion relative to P. falciparum (Pf). Mass drug administration (MDA), as a way target subpatent, asymptomatic infections, is recommended for P. falciparum elimination, but the recommendation does not extend to P. vivax given limited evidence, tools, and safety concerns. The objective of our study is to evaluate the long-term impact, safety, and cost-effectiveness of focal MDA (fMDA) for Pv transmission reduction. To test our hypothesis that fMDA, in addition to standard aggressive interventions, will safely reduce transmission, we propose a 3-year open-label CRCT in the low endemic setting of Loreto Region, Peru. Villages or clusters will be randomized to control or fMDA. The control arm will receive standard interventions (vector control, symptomatic case management, and active case detection of asymptomatic cases). The treatment arm will receive standard interventions plus fMDA, which will utilize a new drug for radical cure of P. vivax, tafenoquine, and a new quantitative glucose 6 phosphate dehydrogenase (G6PD) deficiency rapid test to support safe administration of tafenoquine. fMDA will be targeted to consenting and eligible high-risk villagers, defined as household members and neighbors of recent Pv index cases. fMDA will be conducted in 2 rounds per year, two months apart during the low malaria season, and over 3 years. Eligibility will be re-assessed each year, and prior to each fMDA round. Specific aims are to: 1) Determine the effectiveness of fMDA to reduce Pv transmission as measured in a primary outcome of incidence and secondary outcomes of infection prevalence, seroprevalence, and genetic diversity, 2) Evaluate the safety and tolerability of fMDA, and 3) Measure the cost-effectiveness of fMDA. To maximize