@article{fdi:010075324,
  title = {{E}ffect of generalised access to early diagnosis and treatment and targeted mass drug administration on {P}lasmodium falciparum malaria in {E}astern {M}yanmar : an observational study of a regional elimination programme},
  author = {{L}andier, {J}ordi and {P}arker, {D}.{M}. and {A}ung {M}yint {T}hu and {K}hin {M}aung {L}win and {D}elmas, {G}. and {N}osten, {F}.{H}. and {M}alaria {E}limination {T}ask {F}orce {G}roup},
  editor = {},
  language = {{ENG}},
  abstract = {{BACKGROUND}: {P}otentially untreatable {P}lasmodium falciparum malaria threatens the {G}reater {M}ekong subregion. {A} previous series of pilot projects in {M}yanmar, {L}aos, {C}ambodia, and {V}ietnam suggested that mass drug administration was safe, and when added to provision of early diagnosis and treatment, could reduce the reservoir of {P} falciparum and interrupts transmission. {W}e examined the effects of a scaled-up programme of this strategy in four townships of eastern {M}yanmar on the incidence of {P} falciparum malaria. {METHODS}: {T}he programme was implemented in the four townships of {M}yawaddy, {K}awkareik, {H}laingbwe, and {H}papun in {K}ayin state, {M}yanmar. {I}ncreased access to early diagnosis and treatment of malaria was provided to all villages through community-based malaria posts equipped with rapid diagnostic tests, and treatment with artemether-lumefantrine plus single low-dose primaquine. {V}illages were identified as malarial hotspots (operationally defined as >40% malaria, of which 20% was {P} falciparum) with surveys using ultrasensitive quantitative {PCR} either randomly or targeted at villages where the incidence of clinical cases of {P} falciparum malaria remained high (ie, >100 cases per 1000 individuals per year) despite a functioning malaria post. {D}uring each survey, a 2 m{L} sample of venous blood was obtained from randomly selected adults. {H}otspots received targeted mass drug administration with dihydroartemisinin-piperaquine plus single-dose primaquine once per month for 3 consecutive months in addition to the malaria posts. {T}he main outcome was the change in village incidence of clinical {P} falciparum malaria, quantified using a multivariate, generalised, additive multilevel model. {M}alaria prevalence was measured in the hotspots 12 months after mass drug administration. {FINDINGS}: {B}etween {M}ay 1, 2014, and {A}pril 30, 2017, 1222 malarial posts were opened, providing early diagnosis and treatment to an estimated 365 000 individuals. {I}ncidence of {P} falciparum malaria decreased by 60 to 98% in the four townships. 272 prevalence surveys were undertaken and 69 hotspot villages were identified. {B}y {A}pril 2017, 50 hotspots were treated with mass drug administration. {H}otspot villages had a three times higher incidence of {P} falciparum at malarial posts than neighbouring villages (adjusted incidence rate ratio [{IRR}] 2·7, 95% {CI} 1·8-4·4). {E}arly diagnosis and treatment was associated with a significant decrease in {P} falciparum incidence in hotspots ({IRR} 0·82, 95% {CI} 0·76-0·88 per quarter) and in other villages (0·75, 0·73-0·78 per quarter). {M}ass drug administration was associated with a five-times decrease in {P} falciparum incidence within hotspot villages ({IRR} 0·19, 95% {CI} 0·13-0·26). {B}y {A}pril, 2017, 965 villages (79%) of 1222 corresponding to 104 village tracts were free from {P} falciparum malaria for at least 6 months. {T}he prevalence of wild-type genotype for {K}13 molecular markers of artemisinin resistance was stable over the three years (39%; 249/631). {INTERPRETATION}: {P}roviding early diagnosis and effective treatment substantially decreased village-level incidence of artemisinin-resistant {P} falciparum malaria in hard-to-reach, politically sensitive regions of eastern {M}yanmar. {T}argeted mass drug administration significantly reduced malaria incidence in hotspots. {I}f these activities could proceed in all contiguous endemic areas in addition to standard control programmes already implemented, there is a possibility of subnational elimination of {P} falciparum.},
  keywords = {{PALUDISME} ; {DIAGNOSTIC} ; {TRAITEMENT} {MEDICAL} ; {PREVENTION} {SANITAIRE} ; {INCIDENCE} ; {PREVALENCE} ; {POLITIQUE} {DE} {SANTE} ; {POLITIQUE} {REGIONALE} ; {MYANMAR}},
  booktitle = {},
  journal = {{L}ancet},
  volume = {391},
  numero = {10133},
  pages = {1916--1926},
  ISSN = {0140-6736},
  year = {2018},
  DOI = {10.1016/{S}0140-6736(18)30792-{X}},
  URL = {https://www.documentation.ird.fr/hor/fdi:010075324},
}