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Open Access Study protocol

The impact of hotspot-targeted interventions on malaria transmission: study protocol for a cluster-randomized controlled trial

Teun Bousema12*, Jennifer Stevenson3, Amrish Baidjoe2, Gillian Stresman1, Jamie T Griffin4, Immo Kleinschmidt5, Edmond J Remarque6, John Vulule7, Nabie Bayoh7, Kayla Laserson78, Meghna Desai78, Robert Sauerwein2, Chris Drakeley1 and Jonathan Cox3

Author Affiliations

1 Department of Immunology & Infection; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK

2 Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands

3 Department of Disease Control; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK

4 MRC Centre for Outbreak Analysis & Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London, UK

5 MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK

6 Department of Parasitology, Biomedical Primate Research Centre, Rijswijk, The Netherlands

7 Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya

8 Centers for Disease Control and Prevention, Division of Parasitic Diseases and Malaria, Atlanta, GA, USA

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Trials 2013, 14:36  doi:10.1186/1745-6215-14-36

Published: 2 February 2013

Abstract

Background

Malaria transmission is highly heterogeneous in most settings, resulting in the formation of recognizable malaria hotspots. Targeting these hotspots might represent a highly efficacious way of controlling or eliminating malaria if the hotspots fuel malaria transmission to the wider community.

Methods/design

Hotspots of malaria will be determined based on spatial patterns in age-adjusted prevalence and density of antibodies against malaria antigens apical membrane antigen-1 and merozoite surface protein-1. The community effect of interventions targeted at these hotspots will be determined. The intervention will comprise larviciding, focal screening and treatment of the human population, distribution of long-lasting insecticide-treated nets and indoor residual spraying. The impact of the intervention will be determined inside and up to 500 m outside the targeted hotspots by PCR-based parasite prevalence in cross-sectional surveys, malaria morbidity by passive case detection in selected facilities and entomological monitoring of larval and adult Anopheles populations.

Discussion

This study aims to provide direct evidence for a community effect of hotspot-targeted interventions. The trial is powered to detect large effects on malaria transmission in the context of ongoing malaria interventions. Follow-up studies will be needed to determine the effect of individual components of the interventions and the cost-effectiveness of a hotspot-targeted approach, where savings made by reducing the number of compounds that need to receive interventions should outweigh the costs of hotspot-detection.

Trial registration

NCT01575613. The protocol was registered online on 20 March 2012; the first community was randomized on 26 March 2012.

Keywords:
Anopheles; elimination; epidemiology; eradication; falciparum; heterogeneity; immunology; malaria; molecular; transmission