Ecology of African Highland Malaria

描述（由申请人提供）：在过去十年中，经杀虫剂处理的蚊帐（ITN）和室内滞留喷洒（IRS）的大规模推广，以及青蒿素联合治疗的采用，使非洲高地的疟疾流行率和发病率大幅下降。然而，杀虫剂耐药性的上升和室外传播的增加极大地阻碍了ITN和IRS的有效性，因为目前基于室内的干预措施并不针对室外叮咬的蚊子。因此，大多数高地地区保持持续的低水平传播，而其他一些地区最近经历了疟疾发病率的回升。因此，迫切需要新的补充干预措施，以解决室外传播和拟除虫菊酯杀虫剂耐药性问题。这一竞争性续期申请的中心目标是确定epa批准的长效微生物杀幼虫剂在减少肯尼亚西部高地疟疾传播和临床疟疾发病率方面的功效和成本效益。三个具体目标是：1)研究调节幼虫栖息地生产力的机制；2)通过聚类随机研究确定长效微生物杀幼虫剂在减少疟疾传播和临床疟疾发病率方面的功效；3)与其他疟疾控制干预措施相比，确定长效微生物杀幼虫计划的成本效益，并评估其对非目标生物的影响。通过对可能具有成本效益的长效微生物杀幼虫剂的综合评价，该项目将提供急需的数据，以确定是否可以扩大长效微生物杀幼虫剂作为疟疾控制的补充工具，进一步降低非洲高地的疟疾发病率。疟疾室外传播控制是目前非洲疟疾控制中一个非常重要和紧迫的问题，因此，我们的研究结果将对非洲疟疾流行和流行地区的疟疾预防和控制具有广泛的意义。

DESCRIPTION (provided by applicant): In the past decade, massive scale-up of insecticide-treated nets (ITN) and indoor residual spraying (IRS), together with the introduction of artemisinin-combination treatments, have led to substantial reductions in malaria prevalence and incidence in African highlands. However, rising insecticide resistance and increased outdoor transmission have greatly hampered the effectiveness of ITN and IRS because the current indoor-based interventions do not target the outdoor-biting mosquitoes. Consequently, most highland sites maintain sustained low- level transmission while some others have recently experienced resurgence in malaria rates. Therefore, new supplemental interventions that can tackle outdoor transmission and pyrethroid insecticide resistance are urgently needed. The central objective of this competing renewal application is to determine the efficacy and cost-effectiveness of EPA-approved long-lasting microbial larvicides in reducing malaria transmission and clinical malaria incidence in western Kenya highlands. The three specific aims are: 1) to examine mechanisms regulating larval habitat productivity, 2) to determine the efficacy of long-lasting microbial larvicides on the reduction of malaria transmission and clinical malaria incidence using a cluster randomized study, and 3) to determine the cost-effectiveness of the long-lasting microbial larviciding program as compared to other malaria control interventions and evaluate its impact on non-target organisms. Through comprehensive evaluation of potentially cost-effective long-lasting microbial larvicides, this project will provide critically needed data on whether long-lasting microbial larvicides can be scaled up as a supplemental malaria control tool to further reduce malaria incidence in African highlands. Malaria outdoor transmission control is presently a highly significant and urgent issue in malaria control across Africa, and thus, our results will have broad implications on malaria prevention and control in endemic and epidemic regions of Africa.