Towards malaria elimination : innovative tools and interventions to accelerate interruption of malaria transmission in The Gambia
The malaria burden in The Gambia has decreased substantially over the last two decades. However, despite the high coverage of standard control interventions, malaria transmission has not been interrupted, especially in eastern Gambia, underlining the need for innovative tools and interventions to consolidate gains and further decrease malaria transmission and eventually achieve elimination. This doctoral project explores in the context of The Gambia some of the potential interventions to support malaria elimination efforts. It focuses on mass treatment strategies to accelerate transmission reduction and on the performance of highly sensitive antigen-based diagnostic tests for improved surveillance and mass testing and treatment. It also explores the local communities’ acceptance of research using CHMI models as these can be used to evaluate new treatments and vaccines. For the first objective, we determined the impact of mass drug administration of dihydroartemisinin-piperaquine and ivermectin on malaria transmission. The intervention decreased malaria prevalence and vector density; although it did not affect vector parity, a proxy of mosquito survival. The intervention was safe and well-tolerated and could potentially complement other malaria control tools. For the second objective, we implemented a clinical trial to assess the efficacy and safety of pyronaridine-artesunate (PA) at different dosages (full or incomplete treatment) in asymptomatic P. falciparum-infected individuals. Day 28 PCR-adjusted Adequate Parasitological Response was 100% for both the 3-day and 2-day regimens, and 96.8% (89/94) for the 1-day regimen This study suggests that PA could be used for community-based malaria control interventions, in conjunction with other tools. For the third objective, the field performance of a highly sensitive RDT (HS-RDT) in asymptomatic malaria-infected individuals with low-parasites density was assessed. HS-RDT sensitivity was low when compared to qPCR, possibly limiting its use for malaria surveillance and mass screening and treatment. For the last objective, a qualitative study on the communities’ perception and acceptability of controlled human malaria infection (CHMI) models was carried out. The study shows a positive view about CHMI, indicating that such studies are acceptable to Gambian communities.
Antwerp : University of Antwerp, Faculty of Medicine and Health Sciences , 2023
XXII, 128 p.
Supervisor: Van geertruyden, Jean-Pierre [Supervisor]
Supervisor: D’Alessandro, Umberto [Supervisor]
Supervisor: Erhart, Annette [Supervisor]
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Creation 21.12.2023
Last edited 22.12.2023
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