title: The impact of hotspot-targeted interventions on malaria transmission: study protocol for a cluster-randomized controlled trial.
abstract: BACKGROUND
  Malaria transmission is highly heterogeneous in most settings, resulting in the formation of recognizable malaria hotspots. Targeting these hotspots might represent a highly efficacious way of controlling or eliminating malaria if the hotspots fuel malaria transmission to the wider community.
  
  
  METHODS
  Hotspots of malaria will be determined based on spatial patterns in age-adjusted prevalence and density of antibodies against malaria antigens apical membrane antigen-1 and merozoite surface protein-1. The community effect of interventions targeted at these hotspots will be determined. The intervention will comprise larviciding, focal screening and treatment of the human population, distribution of long-lasting insecticide-treated nets and indoor residual spraying. The impact of the intervention will be determined inside and up to 500 m outside the targeted hotspots by PCR-based parasite prevalence in cross-sectional surveys, malaria morbidity by passive case detection in selected facilities and entomological monitoring of larval and adult Anopheles populations.
  
  
  CONCLUSIONS
  This study aims to provide direct evidence for a community effect of hotspot-targeted interventions. The trial is powered to detect large effects on malaria transmission in the context of ongoing malaria interventions. Follow-up studies will be needed to determine the effect of individual components of the interventions and the cost-effectiveness of a hotspot-targeted approach, where savings made by reducing the number of compounds that need to receive interventions should outweigh the costs of hotspot-detection.
  
  
  BACKGROUND
  NCT01575613. The protocol was registered online on 20 March 2012; the first community was randomized on 26 March 2012.
authors: Department of Immunology & Infection; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK. teun.bousema@lshtm.ac.uk
authors: Teun
authors: T
authors: Bousema
authors: Jennifer
authors: J
authors: Stevenson
authors: Amrish
authors: A
authors: Baidjoe
authors: Gillian
authors: G
authors: Stresman
authors: Jamie T
authors: JT
authors: Griffin
authors: Immo
authors: I
authors: Kleinschmidt
authors: Edmond J
authors: EJ
authors: Remarque
authors: John
authors: J
authors: Vulule
authors: Nabie
authors: N
authors: Bayoh
authors: Kayla
authors: K
authors: Laserson
authors: Meghna
authors: M
authors: Desai
authors: Robert
authors: R
authors: Sauerwein
authors: Chris
authors: C
authors: Drakeley
authors: Jonathan
authors: J
authors: Cox
mesh_terms: D000818:Animals; D000852:Anopheles; D002985:Clinical Protocols; D003430:Cross-Sectional Studies; D003625:Data Collection; D006801:Humans; D007306:Insecticides / Q000494:pharmacology; D008288:Malaria / Q000517:prevention & control* / Q000635:transmission; D009032:Mosquito Control; D017063:Outcome Assessment, Health Care; D018401:Sample Size
chemical_list: D007306:Insecticides
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