Assess the micro-epidemiology of resistant falciparum malaria in SE Asia and to perform and evaluate an intervention with targeted chemo-elimination through a modified mass drug administration approach (Thailand)

Objectives

This a multinational clinical and laboratory project to evaluate targeted chemo-elimination (TCE) as a strategy to eliminate artemisinin resistant P. falciparum. In areas where artemisinin resistant falciparum malaria has been identified we will measure the impact of repeated TCE on the incidence of malaria, the size and the genetic structure of the malaria parasite population and on the transmission of malaria, and the progression of artemisinin resistance. We will develop and refine the epidemiological methods of assessment and assess the acceptability, safety, effectiveness, costs and feasibility of TCE and thereby provide tools for scale-up if it is proved effective.

1. Assess the safety and acceptability of targeted malaria elimination to eliminate the sub-microscopic reservoir of P. falciparum in an area of artemisinin resistance.

2. Assess the feasibility of mass drug administration (MDA) with dihydroartemisinin-piperaquine (DHP) + primaquine (P), using 3 rounds of treatment with 28 day intervals and a cluster randomised design. 

3. Assess the impact of MDA with DHP+P on the sub-microscopic reservoir. 

4. Study the re-emergence of P. falciparum if and when it occurs and explore to what extent the sub-microscopic reservoir contribute to transmission.