Topics

Estimating the Malaria Prevention Impact of New Nets: Observational Analyses to Evaluate the Evidence Generated During Piloted New Net Distributions in Burkina Faso

2019-11-11 17:49:15 | BioPortfolio

Summary

The use of insecticide-treated bed nets (ITN) has contributed to the substantial reduction in malaria cases and deaths. This progress is threatened by increasing resistance commonly used insecticides in mosquito populations. Newly developed, next-generation ITNs using two insecticides or an insecticide synergist and an insecticide are effective against resistant mosquitoes, but large-scale uptake of these nets has been slow due to higher costs and lack of enough evidence to support broad policy recommendations.

This observational study will occur alongside a pilot distribution of next-generation ITNs and collect data over three years on their entomological and epidemiological impact as well as anthropological factors that influence their uptake and use. Data collection will occur in three districts: one receiving dual-active ingredient ITNs, Interceptor® G2 (BASF), one receiving a standard pyrethroid long-lasting insecticidal net (LLIN), Interceptor® (BASF), and one receiving PermaNet®3.0 (Vestergaard) an LLIN containing an insecticide and an insecticide synergist. Data will be collected on malaria vector bionomics, disease epidemiology, and human behaviors in order to help better demonstrate the public health value of next-generation ITNs and to support donors, policymakers, and National Malaria Control Programs in their ITN decision-making and planning processes.

Description

The World Health Organization's (WHO) 2018 World Malaria Report estimates that in 2017, 219 million cases of malaria occurred worldwide resulting in 435,000 deaths, 93% of which occurred in Africa. While this represents a remarkable improvement in comparison with 2000, with malaria deaths having fallen by 40% in Africa, the downward trends in incidence and mortality stalled between 2015 and 2017. This recent failure to maintain the hard-won progress, let alone accelerate progress towards elimination, over the past three years has caused WHO to describe the global fight against malaria as being at a cross roads, calling for increased funding and highlighting the need to develop, optimize, and implement new tools to combat malaria.

Universal coverage of populations at risk with malaria vector control interventions—primarily insecticide treated nets (ITNs) and indoor residual spraying (IRS)—in malaria-endemic countries is a global and national priority because of its fundamental importance for malaria control and elimination. Unfortunately, the effectiveness of these tools is threatened by the emergence and spread of pyrethroid resistance in key mosquito populations, which is now reported in more than 85% of all malaria endemic countries and poses significant risk to the future impact of these tools. Emerging evidence suggests, however, that increasing mosquito mortality—and thereby continuing to reduce malaria transmission—is possible in areas with pyrethroid resistance by introducing new insecticide formulations for IRS and ITNs. For example, Protopopoff et al. showed in Tanzania that the distribution of LLINs with piperonyl butoxide (PBO) plus pyrethroid reduced malaria prevalence by 13% compared to standard pyrethroid-only LLIN distribution (42% vs. 29%; p=0.0011), and Tiono et al., working in Burkina Faso, showed that the distribution of a dual active-ingredient ITN reduced clinical malaria incidence by 22% (Incidence Rate Ratio = 0.88; p=0.04) and potentially infective mosquito bites by 51% (entomological inoculation rate ratio = 0.49; p<0.0001) compared to the distribution of a standard pyrethroid-only LLIN.

While there is evidence that standard LLINs can continue to provide effective personal protection to regular net users in regions with resistant vector populations, new classes of ITNs developed to perform against pyrethroid-resistant mosquitoes have been developed, with early trials and modelling suggesting that they may provide superior protective efficacy against malaria in areas with pyrethroid-resistant vectors. Access to these new resistance-breaking ITNs is restricted by need for efficacy data for continuing policy recommendations, high prices, lack of evidence of cost effectiveness compared to pyrethroid-only LLINs, and consequent poor demand in an uncertain market. Interceptor® G2 (IG2) (BASF), a new type of ITN consisting of two active ingredients including a mixture of a pyrethroid (alpha-cypermethrin) and a pyrrole (chlorfenapyr) insecticide, recently achieved WHO prequalification listing demonstrating that it performs to the thresholds required of pyrethroid-only LLINs and has no known specific side effects. While the IG2 ITN has been subsequently registered and approved for use in Burkina Faso based on this WHO listing the Roll Back Malaria Vector Control Advisory Group guidance indicates that dual active ingredient ITNs will require further epidemiological evidence before policy recommendations are made for their use in preference to pyrethroid-only LLINs in certain settings.

The Global Fund and Unitaid have developed a market shaping program for IG2 and other ITNs with novel insecticide formulations. Evidence on the efficacy of IG2s will be generated by the project through two randomized control trials taking place in Benin and Tanzania. In addition, through this program, these next-generation ITNs will be made available to countries for incorporation into their national distribution programs as pilot distributions with the aim of determining real-world effectiveness and cost-effectiveness in different contexts. In addition to the pilot distribution of IG2s taking place in Burkina Faso, three other countries will be piloting IG2s as part of the New Nets project: Mali, Mozambique, and Rwanda. This research will utilize these pilot distributions to understand the cost-effectiveness of the new ITNs in the chosen settings. The NMCP in Burkina Faso, in discussion with the Global Fund, chose to incorporate IG2 ITNs into the upcoming 2019 mass distribution campaign. This study covers gathering information to determine the public health impact of the IG2 ITNs in Burkina Faso, in comparison to sites that will receive standard pyrethroid-only LLINs or PBO LLINs during the mass campaign. The aim of this research is to better understand the effectiveness and cost effectiveness of IG2 ITNs in Burkina Faso and to collect data on community uptake of the ITNs. During the upcoming pilot implementation, entomological, epidemiological, and anthropological data will be collected in up to three study districts, one that will receive IG2 ITNs, one comparator district that will receive standard LLINs, and one additional comparator district that will receive PBO LLINs. Data will be analyzed, and results disseminated to support the NMCP, donors, policymakers, and other national and regional stakeholders in their ITN decision-making and planning processes.

As part of the New Nets Project initiative to catalyze the market introduction of next-generation ITNs, Burkina Faso will be piloting the deployment of next-generation ITNs in selected districts where enhanced surveillance activities will be used to support observational impact analyses. This study aims to provide National Malaria Control Programs (NMCP), international donors and other key stake holders with evidence on the impact next-generation ITNs on malaria burden. The decision on which type of ITNs to be distributed and where to distribute them were all made by the national control program with the support of international donors. These ITNs have gone through the country's appropriate registration process prior to their purchase and delivery in-country. This observational study is opportunistic in the sense that it is taking advantage of the decision of the national program to distribute the different ITNs (standard and next-generation) in different districts to evaluate their impact on malaria burden.

In these districts, epidemiological, entomological, and anthropological data will be collected with the primary goal of evaluating the effectiveness and cost-effectiveness of deploying next-generation ITNs. Each component specifically aims to:

- Epidemiological component - measure the epidemiological impact of the new IG2 ITNs, standard LLINs, and PBO LLINs in real deployment scenarios through observational studies. These studies will compare trends in (1) malaria case incidence rates passively reported to the national health system (passive case detection, PCD) and (2) malaria infection prevalence, measured through Rapid Diagnostic Tests (RDTs), in children 6 to 59 months of age from annual cross-sectional surveys during peak transmission periods.

- Entomological component - evaluate the impact of IG2 ITNs on vector populations and biting rates, compared to standard and PBO LLINs, through national mosquito surveillance data that will measure trends in species- specific (1) adult vector densities (2) indoor and outdoor human landing rates (3) estimated entomological inoculation rates and (4) insecticide resistance patterns.

- Anthropological component - map the social determinants of impact for IG2 LLINs and determine transmission risk defined as the intersection between time at risk of mosquito blood feeding and human activities not under protection of an ITN, through gathering evidence on LLIN uptake and usage. The collection of reliable data on such patterns, both indoors and outdoors, becomes thus an essential component of the evaluation of the ITN pilots for both modeling and contextual analysis of impact.

- Costing and cost-effectiveness component - estimate the cost and cost-effectiveness of IG2 ITNs in southwest Burkina Faso through data on the price of the product, delivery and deployment costs, and product effectiveness based on case incidence rates measured during the epidemiological component of this study. Additionally, mean costs per case averted that might occur in other contexts will be modeled and incorporated into the cost-effectiveness evaluations.

Study Design

Conditions

Malaria

Intervention

Standard long-lasting insecticidal net, Chlorfenapyr insecticide treated net, Piperonyl butoxide long-lasting insecticidal net

Location

Centre National de Recherche et de Formation sur le Paludisme
Ouagadougou
Burkina Faso
01 BP 2208

Status

Recruiting

Source

PATH

Results (where available)

View Results

Links

Published on BioPortfolio: 2019-11-11T17:49:15-0500

Clinical Trials [792 Associated Clinical Trials listed on BioPortfolio]

Efficacy of Three Novel Bi-treated Long Lasting Insecticidal Nets

The massive scale-up of Long Lasting Insecticidal Nets (LLIN) has led to a major reduction in malaria burden (up to 50%) in many sub-Saharan African countries. This progress is threatened ...

Efficacy of Two Dual Active Ingredient Long Lasting Insecticidal Nets for Control of Malaria Transmitted by Pyrethroid Resistant Vectors in Benin

The massive scale-up of Long Lasting Insecticidal Nets (LLIN) has led to a major reduction in malaria burden (up to 50%) in many sub-Saharan African countries. This progress is threatened ...

Effect of a Combined Use of Mosquito Repellent and Insecticide Treated Net on Malaria in Ethiopia

The combined use of a mosquito repellent and long lasting insecticidal nets (LLINs) by household members would result in a 40% reduction in malaria prevalence compared with households that...

Effectiveness Study of New Generation Bednets in the Context of Conventional Insecticide Resistance in the Democratic Republic of the Congo

Despite the mass distribution of LLINs (long-lasting insecticidal nets) as a Malaria control strategy, populations are still continuously exposed to a high frequency of malarial inoculatio...

Insecticide Resistance Management in Burkina Faso and Côte d'Ivoire

This study evaluates the benefit to use 1) insecticidal paints, 2) larvicides, 3) Ivermectin for both human and domestic animals and 4) strengthened Information, Education and Communicatio...

PubMed Articles [16679 Associated PubMed Articles listed on BioPortfolio]

Effect of insecticide-treated bed nets on visceral leishmaniasis incidence in Bangladesh. A retrospective cohort analysis.

Visceral leishmaniasis (VL) is a parasitic disease, transmitted by the sand fly species Phlebotomus argentipes in the Indian sub-continent. Effective vector control is highly desirable to reduce vecto...

Effect of Bacillus thuringiensis var. israelensis Sugar Patches on Insecticide Resistant Anopheles gambiae s.l. Adults.

Large distribution of long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) contributed to a significant decrease in malarial mortality. Unfortunately, large insecticide resistance...

Piperonyl Butoxide Enhances the Insecticidal Toxicity of Nanoformulation of Imidacloprid on (Diptera: Culicidae) Mosquito.

The use of conventional pesticides becomes a complicated issue as more species of insect pests become resistant to them. Nanopesticides suit new approaches in pest control. Herein, we tested the toxic...

A comprehensive testing cascade to identify resistance breaking repurposed insecticides for next-generation vector control tools: screening a panel of chemistries against a malaria vector.

With insecticide resistance in malaria vectors spreading in geographical range and intensity, there is a need for compounds with novel modes of action to maintain the successes achieved to date by lon...

Hughes Stovin: Sustained remission and regression of pulmonary aneurysms with anti-tumor necrosis factor treatment.

We report the first case of Hughes Stovin Syndrome successfully treated with long-lasting tumor necrosis factor α (TNF-α) blocker (infliximab) treatment. Because of the failure of the standard thera...

Medical and Biotech [MESH] Definitions

An insecticide synergist, especially for pyrethroids and ROTENONE.

Light weight meshwork fabric made of cotton, silk, polyester (nylon), or other material impregnated with insecticide, having openings too small to allow entry of mosquitoes or other insects, thereby offering protection against insect bite and insect-borne diseases.

An N-substituted amphetamine analog. It is a widely abused drug classified as a hallucinogen and causes marked, long-lasting changes in brain serotonergic systems. It is commonly referred to as MDMA or ecstasy.

Teleost hormones. A family of small peptides isolated from urophyses of bony fishes. They have many different physiological effects, including long-lasting hypotensive activity and have been proposed as antihypertensives. There are at least four different compounds: urotensin I, urotensin II, urotensin III, and urotensin IV.

A group of conditions due to overexposure to or overexertion in excess environmental temperature. It includes heat cramps, which are non-emergent and treated by salt replacement; HEAT EXHAUSTION, which is more serious, treated with fluid and salt replacement; and HEAT STROKE, a condition most commonly affecting extremes of age, especially the elderly, accompanied by convulsions, delusions, or coma and treated with cooling the body and replacement of fluids and salts. (From Segen, Dictionary of Modern Medicine, 1992)

More From BioPortfolio on "Estimating the Malaria Prevention Impact of New Nets: Observational Analyses to Evaluate the Evidence Generated During Piloted New Net Distributions in Burkina Faso"

Quick Search

Relevant Topics

Infectious-diseases
Antiretroviral Therapy Clostridium Difficile Ebola HIV & AIDS Infectious Diseases Influenza Malaria Measles Sepsis Swine Flu Tropical Medicine Tuberculosis Infectious diseases are caused by pathogenic...

Malaria
Malaria is a serious tropical disease spread by mosquitoes. If malaria is not diagnosed and treated promptly, it can be fatal. What causes malaria? Malaria is caused by a type of parasite known as Plasmodium. There are many different types of Plasmod...

Public Health
Alternative Medicine Cleft Palate Complementary & Alternative Medicine Congenital Diseases Dentistry Ear Nose & Throat Food Safety Geriatrics Healthcare Hearing Medical Devices MRSA Muscular Dyst...


Searches Linking to this Trial