背景:流行国家的大多数疟原虫感染是无症状的,并且是向蚊子传播的来源。我们旨在研究是否可以通过积极筛查方法改善感染的早期检测和治疗来减少恶性疟原虫的传播和疟疾负担。
方法:在Sapone这项为期18个月的集群随机研究中,布基纳法索,家庭被纳入并随机分配(1:1:1)到三组中的一组:第一组(对照组)只接受标准护理,第2组接受每周活动,在家里,由社区卫生工作者进行发烧筛查,无论症状如何,发烧的参与者接受了快速诊断测试(RDT)和治疗,如果RDT阳性,和第3组接受每周积极的发热筛查(如第2组)加上每月RDT,无论症状如何,如果RDT阳性,则进行治疗。合资格住户至少有三名合资格住户,每个年龄组(<5岁,5-15年,和>15年)。主要结果是在研究结束的横断面调查中通过定量PCR(qPCR)进行的寄生虫患病率。次要结果包括所有三个季末横断面调查中的寄生虫和配子细胞患病率和密度,感染的发生率,以及感染传播给蚊子的可能性。该试验已在ClinicalTrials.gov(NCT03705624)注册并已完成。
结果:在两个阶段中,共有来自181个家庭的906个人被登记,并参与了这项研究。在2018年8月9日至17日之间招募了412名个人,并参加了1期,在2019年1月10日至31日之间招募了494名个人,在2期。在研究结束的横断面调查(于2020年1月13日至21日进行)中,通过qPCR检测,第3组的恶性疟原虫患病率显着降低(29·26%;270个中的79个),但不在第2组中(45·66%;265个中的121个),与第1组相比(48·72%;133/273;风险比0·65[95%CI0·52-0·81];p=0·0001)。在所有调查中,第3组的总寄生虫和配子细胞患病率和密度也显着降低。最大的差异出现在旱季结束时,与第1组相比,第3组的配子细胞患病率为78·4%,预测传播潜力为98·2%。
结论:在旱季使用时,每月积极的RDT测试和治疗可将寄生虫携带和恶性疟原虫的感染库减少到2%以下。这种见解可能会为控制和消除疟疾的方法提供信息。
背景:比尔和梅琳达·盖茨基金会,欧洲研究理事会,荷兰科学研究组织。
BACKGROUND: The majority of Plasmodium spp infections in endemic countries are asymptomatic and a source of onward transmission to mosquitoes. We aimed to examine whether Plasmodium falciparum transmission and malaria burden could be reduced by improving early detection and treatment of infections with active screening approaches.
METHODS: In this 18-month cluster randomised
study in Sapone, Burkina Faso, households were enrolled and randomly assigned (1:1:1) to one of three groups: group 1 (control) received standard of care only, group 2 received active weekly, at home,
fever screening by a community health worker regardless of symptoms, participants with a
fever received a rapid diagnostic test (RDT) and treatment if RDT positive, and group 3 received active weekly
fever screening (as in group 2) plus a monthly RDT regardless of symptoms, and treatment if RDT positive. Eligible households had a minimum of three eligible residents, one in each age group (<5 years, 5-15 years, and >15 years). The primary outcome was parasite prevalence by quantitative PCR (qPCR) in the end-of-study cross-sectional survey. Secondary outcomes included parasite and gametocyte prevalence and density in all three end-of-season cross-sectional surveys, incidence of infection, and the transmissibility of infections to mosquitoes. This
trial was registered at ClinicalTrials.gov (NCT03705624) and is completed.
RESULTS: A total of 906 individuals from 181 households were enrolled during two phases, and participated in the study. 412 individuals were enrolled between Aug 9 and 17, 2018, and participated in phase 1 and 494 individuals were enrolled between Jan 10 and 31, 2019, in phase 2. In the end-of-study cross-sectional survey (conducted between Jan 13 and 21, 2020), Pfalciparum prevalence by qPCR was significantly lower in group 3 (29·26%; 79 of 270), but not in group 2 (45·66%; 121 of 265), when compared with group 1 (48·72%; 133 of 273; risk ratio 0·65 [95% CI 0·52-0·81]; p=0·0001). Total parasite and gametocyte prevalence and density were also significantly lower in group 3 in all surveys. The largest differences were seen at the end of the dry season, with gametocyte prevalence 78·4% and predicted transmission potential 98·2% lower in group 3 than in group 1.
CONCLUSIONS: Active monthly RDT testing and treatment can reduce parasite carriage and the infectious reservoir of P falciparum to less than 2% when used during the dry season. This insight might inform approaches for malaria control and elimination.
BACKGROUND: Bill & Melinda Gates Foundation, European Research Council, and The Netherlands Organization for Scientific Research.