Last Updated: 19/02/2021
Targeting high risk populations with enhanced reactive case detection in Southern Lao Peoples Democratic Republic (COMBAT)
Objectives
Primary Objective:
To evaluate the effectiveness of reactive case detection (RACD) using highly-sensitive rapid diagnostic tests (HS-RDTs), targeting both village and forest working populations, compared to control for reducing the health center catchment-level incidence and prevalence of P. falciparum and P. vivax within two provinces in Lao PDR.
Secondary Objectives:
1. To determine the operational feasibility, cost-effectiveness, and acceptability of targeting high-risk populations with community-based reactive case detection strategies aimed at reducing P. falciparum and P. vivax transmission among village and forest working populations.
2. To determine the operational feasibility and safety of conducting G6PD testing and PQ administration and follow-up at the community level.
3. To determine factors associated with G6PD testing after referral to district or provincial-level facilities for persons with P. vivax positive RDT results, and subsequent adherence to Primaquine treatment.
4. To assess malaria vector species composition and bionomics in both village and forest settings.
In the Greater Mekong Subregion (GMS), the risk of malaria infection is often due not to village-based transmission but rather to occupational and behavioral risk factors leading to exposure in forest settings. Additionally, a substantial portion of infections are asymptomatic and/or submicroscopic, limiting the scope of current diagnostics and surveillance approaches. The proposed research will evaluate the effectiveness of RACD using HS-RDTs, targeting both village and forest working populations, compared to control for reducing the health center catchment-level incidence and prevalence of P. falciparum and P. vivax within two provinces in Lao PDR.
The primary outcome measures to assess effectiveness include P. falciparum and P. vivax confirmed case incidence over the study period; PCR-based P. falciparum and P. vivax prevalence at end line; and HS-RDT test positivity rate in village and forest worker RACD.
Secondary outcomes measures will examine the operational feasibility, safety, and acceptability of Village Malaria Workers (VMW)-led reactive approaches and glucose-6-phosphate dehydrogenase (G6PD) testing, referral to district or provincial-level facilities, safety and treatment adherence for P. vivax cases.
This study will employ a cluster randomized controlled trial design with two comparison arms:
(1) Control: standard of care – passive case management provided through community-based VMWs and existing health facilities; includes village-based RACD with conventional RDTs conducted by district surveillance teams.
(2) Enhanced community-based RACD: RACD conducted by community-based VMWs using both HS-RDTs and conventional RDTs within villages and among forest workers.
Diagnostics
Drug-based Strategies
Impact of Interventions
Targeting Foci
Vulnerable Populations
Jun 2020 — Jan 2021
