Evidence map›Paper›PMID 34193475›Full record

Trial reportBMJ global health2021

Effectiveness and safety of reactive focal mass drug administration (rfMDA) using dihydroartemisinin-piperaquine to reduce malaria transmission in the very low-endemic setting of Eswatini: a pragmatic cluster randomised controlled trial.

Sibonakaliso Vilakati, Nontokozo Mngadi, Jade Benjamin-Chung, Nomcebo Dlamini, Mi-Suk Kang Dufour, Brooke Whittemore, Khayelihle Bhangu, Lisa M Prach, Kimberly Baltzell, Nomcebo Nhlabathi and 12 more

Registry-linked trialOpen access · goldAbstract readRandomized Controlled TrialPragmatic Clinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ global health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02315690 (Evaluating the Effectiveness and Feasibility of Reactive Focal Mass Drug Administration vs. Reactive Case Detection as a Community Level Intervention in Response to a Passively Identified Index Malaria Case in Swaziland), which is not on this map. Cited by 12 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
12citing papers in PubMed, 4 pooled it
2.7field-weighted citation impact, top 10% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02315690 phase3completednot on this map

Evaluating the Effectiveness and Feasibility of Reactive Focal Mass Drug Administration vs. Reactive Case Detection as a Community Level Intervention in Response to a Passively Identified Index Malaria Case in Swaziland

TypeinterventionalSponsorUniversity of California, San FranciscoRan2015 to 2017Enrolled4,000ConditionsMalariaArmsdihydroartemisinin-piperaquine (DHAp), reactive case detection
3 · Its place in the literature

Who cites it

12 citing papers in PubMed, 4 syntheses or guidelines pooled it, 14 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

22 authors at 6 institutions in 3 countries.

Sibonakaliso Vilakati *National Malaria Program, Ministry of Health, Manzini, Eswatini.
Nontokozo Mngadi *Clinton Health Access Initiative, Mbabane, Swaziland.
Jade Benjamin-Chung *Epidemiology & Biostatistics, University of California, Berkeley, California, USA.
Nomcebo DlaminiNational Malaria Program, Ministry of Health, Manzini, Eswatini.
Mi-Suk Kang DufourEpidemiology & Biostatistics, University of California, Berkeley, California, USA.
Brooke WhittemorePediatrics, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Khayelihle BhanguNational Malaria Program, Ministry of Health, Manzini, Eswatini.
Lisa M PrachMalaria Elimination Initiative, University of California, San Francisco, California, USA.
Kimberly BaltzellFamily Health Care Nursing, University of California, San Francisco, California, USA.
Nomcebo NhlabathiNational Malaria Program, Ministry of Health, Manzini, Eswatini.
Calisile MalambeNational Malaria Program, Ministry of Health, Manzini, Eswatini.
Bongani DlaminiClinton Health Access Initiative, Mbabane, Swaziland.
Danica HelbMedicine, University of California, San Francisco, California, USA.
Bryan GreenhouseMedicine, University of California, San Francisco, California, USA.
Gugu MaphalalaNational Clinical Laboratory Services, Mbabane, Swaziland.
Deepa PindoliaClinton Health Access Initiative, Mbabane, Swaziland.
Muhindo KalungeroMedicine, Good Shepherd Hospital, Siteki, Swaziland.
Getahun TesfaPaediatrics, Raleigh Fitkin Memorial Hospital, Manzini, Swaziland.
Roly GoslingMalaria Elimination Initiative, University of California, San Francisco, California, USA.
Nyasatu NtshalintshaliClinton Health Access Initiative, Mbabane, Swaziland.
Simon KuneneNational Malaria Program, Ministry of Health, Manzini, Eswatini.
Michelle S HsiangMalaria Elimination Initiative, University of California, San Francisco, California, USA Michelle.Hsiang@ucsf.edu.
University of California, San Francisco · USMinistry of Health · SZClinton Health Access Initiative · USGood Shepherd College · NZThe University of Texas Southwestern Medical Center · USUniversity of California, Berkeley · US

Funding

Mentoring translational scientists in international infectious disease researchK24AI144048 · NIAID · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Bryan R Greenhouse · 2019 to 2026
$1.6M
NIAID NIH HHS K24 AI144048
6 · The paper itself

Abstract

introductionTo reduce malaria transmission in very low-endemic settings, screening and treatment near index cases (reactive case detection (RACD)), is widely practised, but the rapid diagnostic tests (RDTs) used miss low-density infections. Reactive focal mass drug administration (rfMDA) may be safe and more effective.

methodsWe conducted a pragmatic cluster randomised controlled trial in Eswatini, a very low-endemic setting. 77 clusters were randomised to rfMDA using dihydroartemisin-piperaquine (DP) or RACD involving RDTs and artemether-lumefantrine. Interventions were delivered by the local programme. An intention-to-treat analysis was used to compare cluster-level cumulative confirmed malaria incidence among clusters with cases. Secondary outcomes included safety and adherence.

resultsFrom September 2015 to August 2017, 222 index cases from 47 clusters triggered 46 RACD events and 64 rfMDA events. RACD and rfMDA were delivered to 1455 and 1776 individuals, respectively. Index case coverage was 69.5% and 62.4% for RACD and rfMDA, respectively. Adherence to DP was 98.7%. No serious adverse events occurred. For rfMDA versus RACD, cumulative incidences (per 1000 person-years) of all malaria were 2.11 (95% CI 1.73 to 2.59) and 1.97 (95% CI 1.57 to 2.47), respectively; and of locally acquired malaria, they were 1.29 (95% CI 1.00 to 1.67) and 0.97 (95% CI 0.71 to 1.34), respectively. Adjusting for imbalance in baseline incidence, incidence rate ratio for rfMDA versus RACD was 0.95 (95% CI 0.55 to 1.65) for all malaria and 0.82 (95% CI 0.40 to 1.71) for locally acquired malaria. Similar results were obtained in a per-protocol analysis that excluded clusters with <80% index case coverage.

conclusionIn a very low-endemic, real-world setting, rfMDA using DP was safe, but did not lower incidence compared with RACD, potentially due to insufficient coverage and/or power. To assess impact of interventions in very low-endemic settings, improved coverage, complementary interventions and adaptive ring trial designs may be needed. TRIAL REGISTRATION NUMBER: NCT02315690.

Indexed as

AntimalarialsMalariaArtemetherArtemether, Lumefantrine Drug CombinationArtemisininsEswatiniHumansMass Drug AdministrationPiperazinesQuinolinesAntimalarialsArtemetherArtemether, Lumefantrine Drug CombinationArtemisininsartenimolpiperaquinePiperazinesQuinolinesmalariapublic health

Identifiers

PMID34193475
PMCPMC8246301
OpenAlexW3173666532

What OpenQuestion holds

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LicenceCC BY
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.