Universitat Rovira i Virgili

Mass drug administration of ivermectin and dihydroartemisinin-piperaquine as an additional intervention for malaria elimination

  • Fitxa Tècnica:

    Insitucions finançadores:

    Medical Research Council United Kingdom (MRC, UK)

    Department for International Development, United Kingdom (DFID, UK)

    Wellcome Trust (UK)

    Investigador del MARC:

    Prof. Joan Muela Ribera

  • Investigador Principal:

    Prof. Umberto D'Alessandro MRCG (PI)
  • Equip Investigador:

    Dr. Jane Achan, MRCG, Dr. Muna Affara, MRCG, Dr. Davis Nwakanma, MRCG, Prof. Chris Drakeley, LSHTM, Prof. John Bradley, LSHTM, Prof. Teun Bousema, Radboud University Medical Centre, Dr. Hannah Slater, Imperial College London, Mr. Balla Kandeh, NMCP Gambia, Prof. Koen Peeters Grietens, Institute of Tropical Medicine and Hygiene, Antwerp, Prof. Rob Baltussen, Radboud University Medical Centre, Dr. Guido Bastiaens, Radboud University Medical Centre, Prof. Steven Lindsay, Durham University.

Massiv proposes a novel approach to decrease and/or interrupt residual malaria transmission through mass drug administration (MDA) with ivermectin (IVM) combined with dihydroartemisinin-piperaquine (DP), tested through a community-based, cluster-randomized trial.

This trial aims at establishing whether MDA with IVM and DP can reduce or interrupt malaria transmission in medium to low transmission settings by reducing vector survival and the human reservoir of infection. It will have an intervention and control arm [16 medium-sized (200-600 people) villages per arm]. Villages at least 3-4km apart will be selected. We will create around each intervention village a buffer zone of about 2km, i.e. the modified "fried egg" design. MDA with IVM and DP will be implemented in the intervention villages and all human settlements in the buffer zone, with the aim of minimizing spill-over effects. Control clusters will receive standard malaria control interventions as implemented by the National Malaria Control Program. The intervention consists of the administration to the entire population of (1) a full course of DP per manufacturer's guidelines once daily for 3 days and according to body weight, together with (2) IVM, given at 300-400μg/kg/day over 3 days (to the nearest 6mg tablet).

In the anthropological component of the trial-to be developed in the intervention arm- a mixed methods design triangulating ethnographic qualitative methods (including in-depth interviews and participant observation) and quantitative survey research will be carried out to determine sociocultural factors influencing intervention's effectiveness, including local acceptability, coverage and adherence to MDA. In a first phase, prior to the initial MDA campaign, potential bottlenecks for the intervention will be assessed and recommendations will be made to improve the implementation. This will help fine-tuning the intervention to local realities in addition to engaging stakeholders to facilitate participation. Subsequently, community members and stakeholders will be involved in the process of developing the MDA strategy to increase sustainability of the intervention. A comprehensive stakeholder assessment will be carried out at the beginning of the project, aiming to identify formal and informal groups and organizations active in the communities.

Institucions Participants

Medical Anthropology Research Center (MARC-URV): Medical Anthropology

Medical Research Council Unit The Gambia (MRCG): Epidemiology

London School of Hygiene and Tropical Medicine (LSHTM): Statistics and Serology

Institute of Tropical Medicine, Antwerp (ITMA): Anthropology

National Malaria Control Programme (NMCP), Gambia: Collaborator

Universitat Rovira i Virgili (URV) Tarragona: Anthropology

Radboud University Medical Centre, Nijmegen (RUMC): Malaria biology and Health Economics

Durham University (DU): Entomology

Imperial College London (ICL): Modelling