Monitoring and evaluation tools to allow sustained elimination of malaria transmission

Full Title Monitoring and evaluation tools to allow sustained elimination of malaria transmission.  Short Title  Project Leader Gerry Killeen  Description As Tanzania makes progress in delivering malaria control measures to its citizens the challenge of monitoring and evaluating much lower levels of transmission is essential to both sustaining these gains and building upon them to achieve elimination of malaria in as much of the country as possible. For example, in urban Dar es Salaam and the islands of Zanzibar, local transmission clearly remains but occurs at such low levels that, even with huge surveys it is difficult to detect the impact of interventions or to gauge progress towards the eventual goal of elimination. Current techniques for measuring malaria transmission by entomologic and parasitologic means require huge sample sizes in such mesoendemic and hypoendemic settings, necessitating financial and human resource investments which are burdensome, and often prohibitively so, to programmatic implementation bodies. Our overall goal is to develop and characterize a new set of surveillance tools that enable sustained elimination of malaria transmission through constant monitoring, evaluation and adaptation of integrated control programmes, even in low transmission scenarios where malaria is approaching elimination. The proposed research will deliver substantially improved entomological and serological tools which allow affordable and informative characterization of malaria transmission at unprecedented levels of sensitivity and detail so that control programmes can achieve and maintain elimination of transmission. Furthermore, we will also develop and characterize new field sampling techniques which allow the insecticide resistance and avoidance behaviours to be quantitatively evaluated without the need to conduct human landing catches. To achieve this goal we will address three objectives: Objective 1: Demonstrate that a new exposure-free mosquito trap is a more sensitive and epidemiologically representative tool for entomological surveillance of malaria transmission than any existing method, including the gold standard human landing catch. Objective 2: Demonstrate that a new serological technique for detection of infection history is a much more sensitive, representative and sustainable tool for routine surveillance of malaria transmission and control than existing technologies which only detect infections that are active and patently detectable at the time of sampling. Objective 3: Demonstrate that a suite of new mosquito trap formats can safely, affordably and effectively monitor malaria vector behavioural phenotypes in the field, notably insecticide resistance and avoidance, without necessitating any human exposure. This study will entail a number of common procedures involving human subjects, such as answering of questionnaires and taking of finger-prick blood samples to be tested for malaria. These are well-standardized and widely accepted methods which carry negligible risk to participants. However, this proposal also relies on the human landing catch technique for estimating mosquito biting density, characterizing their feeding behaviour and measuring human exposure to infectious bites. All human subjects participating in such human landing catches will be exposed to greater hazard of malaria transmission so we will reduce their vulnerability and risk of infection and the worst consequences of infection by providing prophylaxis with Malarone® (Atovaquone- Proguanil Hydrochoride), as well as ready access to diagnosis (ICT Rapid Test®) and, if they neverthless become infected, treatment with CoArtem® (Artemether- Lumefantrine). We therefore justify the utilization of the human landing catch under these conditions on the basis that these participants are actually safer from malaria than they would normally be because their overall risk of becoming infected and the negative consequences of becoming infected are greatly reduced. The use of human landing catches will be limited to the first year of this three-year study, following which only exposure-free entomological methods. Where no adequate substitute for human landing is identified after one year, those surveys of transmission intensity or vector behaviour will be discontinued. If successful, this study will preclude the need for human landing catches in any subsequent investigation or surveillance activity, thus eliminating the need or justification for applying this procedure in the future. Furthermore, this study is expected to deliver substantial benefits in terms of substantially improved surveillance tools leading to reduced malaria risk for both the participants and the population as a whole.  Collaborators                     Source of funding  Start Date                                      End Date

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