N Govella, Ifakara Health Institute, Integrating intervention targetable behaviours of malaria vectors to optimize interventions selection and impact

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Malaria continues to impose a huge burden upon human health despite widespread use of insecticide-treated nets (ITNs), improved diagnosis, and treatment. The global problem this study aims to address is the lack of understanding of the mosquito and human behaviours that limit the impact of existing malaria vector control interventions like ITNs, but which also create opportunities for new ones to achieve further gains. For example, human exposure persisting outdoors could be targeted with insecticide vapour emanators and vector mosquitoes that survive by feeding on livestock could be targeted with veterinary approaches. Like most other African countries, Tanzania has achieved great success in reducing malaria with widespread use of ITNs. However, many new cases and deaths still occur, with a wide range of regional variation, from 0 up to 27 people infected per 100 tested for malaria. It is highly likely that much of this geographic variability in malaria transmission arises from the exceptional variability of climatic conditions in Tanzania and knock-on effects on relevant behaviours of mosquitoes and humans.I therefore propose to identify, quantify and address the underlying behavioural causes of persisting malaria transmission in climatically distinct geographic strata, so that they can be optimally tackled with supplementary vector control measures. This problem has already been prioritized as an important question by the Government of Tanzania, acting through the National Malaria Control Programme (NMCP) with the aim of adjusting intervention choices according to the local context to maximize impact. Specifically, I will integrate intervention-targetable behaviours of mosquitoes (e.g. feeding early and outdoors when most people are still outside or feeding on non-human host) and humans (e.g. use or not use of ITNs, time spent outdoor in the evening) into existing nationally-representative longitudinal, community-based surveillance system that monitors vector densities and infection rates in 32 districts of Tanzania, to assess how these behaviours are shaped across wide distinct environmental conditions and provide insight on how interventions could be tailored to local conditions for maximum impact. This study will provide insights into which additional strategies are likely to be most effective on the basis of local vector ecology. This could be a game changer in the development of locally-tailored, highly effective mosquito control packages in Africa, which accelerate progress toward malaria elimination. It will also form the basis for improved policy and practice with respect to effective targeting of supplementary vector control measures.