Baidjoe, Amrish,Bayoh, Nabie,Bousema, Teun,Cox, Jonathan,Desai, Meghna,Drakeley, Chris,Griffin, Jamie T.,Kleinschmidt, Immo,Laserson, Kayla,Remarque, Edmond J.,Sauerwein, Robert,Stevenson, Jennifer,Stresman, Gillian,Vulule, John
Imperial College London, Radboud University Nijmegen, University of London, Biomed Primate Res Ctr, Centers for Disease Control & Prevention - USA, Ctr Dis Control & Prevent, Kenya Govt Med Res Ctr, London School of Hygiene & Tropical Medicine
"Baidjoe, Amrish: Radboud University Nijmegen","Cox, Jonathan: University of London","Drakeley, Chris: University of London","Griffin, Jamie T.: Imperial College London","Kleinschmidt, Immo: University of London","Sauerwein, Robert: Radboud University Nijmegen","Stevenson, Jennifer: University of London","Stresman, Gillian: University of London",
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.
ANOPHELES,ELIMINATION,EPIDEMIOLOGY,ERADICATION,falciparum,HETEROGENEITY,IMMUNOLOGY,MALARIA,MOLECULAR,TRANSMISSION,ANOPHELES-GAMBIAE,"BED NETS",CHILD-MORTALITY,DAR-ES-SALAAM,"DRIED BLOOD SPOTS",LIGHT-TRAP,PAPUA-NEW-GUINEA,PLASMODIUM-FALCIPARUM,TANZANIA,"WE