Malaria Operations Research to Improve Malaria Control and Reduce Morbidity and Mortality in Western Kenya

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Project summary This application is for the fourth, 5-year CoAG between CDC’s Malaria Branch and the Liverpool School of Tropical Medicine (LSTM). Activities take place in western Kenya under the umbrella of the long-term collaboration between the Kenya Medical Research Institute (KEMRI), CDC, and LSTM and benefit from LSTM’s existing infrastructure in Kenya. The research strategy follows the 5 objectives of the NOFO. The first objective involves the expansion in 2020/21 of the epidemiological (1.1) and entomological surveillance (1.2) platform to track progress towards malaria transmission reduction targets following the introduction of population-wide interventions in 2021/22. To maintain low transmission status, this requires a shift from the existing periodic, district-level surveillance to systems where surveillance itself becomes an intervention and can detect individual geo-located cases near real-time for rapid notification and foci investigation. We will support the Kenyan Ministry of Health (MoH) with their goal to digitise the data collected on their paper-based health registers using software that makes them scannable (1.1.5). This will include registers that capture case-burden data used in out-patient departments (1.1.6) and by community health workers as part of integrated community case management (ICCM) (1.1.7), and antenatal clinic registers that capture malaria infection prevalence during first antenatal clinic visits. This is a novel method to track the asymptomatic parasite reservoir in populations (1.1.8). Combined, this allows, for the first time, sustainable, daily, near real-time surveillance to track progress towards malaria transmission reduction targets. We will also conduct continuous malaria indicator household surveys (cMIS) to track malaria prevalence and intervention coverage (1.1.9) and entomological monitoring (1.2), both using adaptive sampling frameworks that can respond to challenges related to rapid changes in malaria transmission. As part of the second objective, we will implement population-wide interventions targeting malaria transmission, starting in 2021/22. The optimal combination of novel or improved interventions will be developed in close collaboration with CDC in 2020/21. This is likely to include enhanced case- management using digitally supported quality improvement approaches of ICCM, enhanced vector control with larval source management and insecticide-treated piperonyl butoxide (PBO) nets, and mass drug administration with dihydroartemisinin-piperaquine and ivermectin targeting the asymptomatic parasite reservoir (2.1). The third objective involves assessing the safety effectiveness of currently deployed antimalarials for the prevention (3.2.1) and treatment (3.2 and 3.3) of malaria in the context of increasing antimalarial drug resistance. We will liaise with CDC’s laboratories in Atlanta for the molecular monitoring of drug resistance. The fourth objective aims to maximise the public health impact by supporting the creation of a knowledge centre at the KEMRI’s CGHR for evidence synthesis and information exchange to enhance the translation of global malaria control policies (4). Objective 5 involves the strengthening of research capacity of the partners in Kenya by the provision of internships (5.1) and MSc, PhD and post-doctoral studentships and research leadership mentoring (5.1).