title: Modelling the potential of focal screening and treatment as elimination strategy for Plasmodium falciparum malaria in the Peruvian Amazon Region.
abstract: BACKGROUND
  Focal screening and treatment (FSAT) of malaria infections has recently been introduced in Peru to overcome the inherent limitations of passive case detection (PCD) and further decrease the malaria burden. Here, we used a relatively straightforward mathematical model to assess the potential of FSAT as elimination strategy for Plasmodium falciparum malaria in the Peruvian Amazon Region.
  
  
  METHODS
  A baseline model was developed to simulate a scenario with seasonal malaria transmission and the effect of PCD and treatment of symptomatic infections on the P. falciparum malaria transmission in a low endemic area of the Peruvian Amazon. The model was then adjusted to simulate intervention scenarios for predicting the long term additional impact of FSAT on P. falciparum malaria prevalence and incidence. Model parameterization was done using data from a cohort study in a rural Amazonian community as well as published transmission parameters from previous studies in similar areas. The effect of FSAT timing and frequency, using either microscopy or a supposed field PCR, was assessed on both predicted incidence and prevalence rates.
  
  
  RESULTS
  The intervention model indicated that the addition of FSAT to PCD significantly reduced the predicted P. falciparum incidence and prevalence. The strongest reduction was observed when three consecutive FSAT were implemented at the beginning of the low transmission season, and if malaria diagnosis was done with PCR. Repeated interventions for consecutive years (10 years with microscopy or 5 years with PCR), would allow reaching near to zero incidence and prevalence rates.
  
  
  CONCLUSIONS
  The addition of FSAT interventions to PCD may enable to reach P. falciparum elimination levels in low endemic areas of the Amazon Region, yet the progression rates to those levels may vary substantially according to the operational criteria used for the intervention.
authors.affiliation: Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima 31, Peru. angelrosasa@gmail.com.|Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, 2000, Belgium. angelrosasa@gmail.com.|Research Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, 1200, Belgium. angelrosasa@gmail.com.
authors.forename: Angel
authors.initials: A
authors.lastname: Rosas-Aguirre
authors.affiliation: Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, 2000, Belgium. aerhart@itg.be.
authors.forename: Annette
authors.initials: A
authors.lastname: Erhart
authors.affiliation: Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima 31, Peru. elmer.llanos@upch.pe.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Llanos-Cuentas
authors.affiliation: Department of Medical Parasitology, New York University, New York, 10012, USA. oralee.branch@nyumc.org.
authors.forename: Oralee
authors.initials: O
authors.lastname: Branch
authors.affiliation: Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, 2000, Belgium. dberkvens@itg.be.
authors.forename: Dirk
authors.initials: D
authors.lastname: Berkvens
authors.affiliation: Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, 2000, Belgium. enjiabatih@itg.be.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Abatih
authors.affiliation: Research Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, 1200, Belgium. p.lambert@ulg.ac.be.|Institut des sciences humaines et sociales, Université de Liège, Liege, 4000, Belgium. p.lambert@ulg.ac.be.
authors.forename: Philippe
authors.initials: P
authors.lastname: Lambert
authors.affiliation: Institut des sciences humaines et sociales, Université de Liège, Liege, 4000, Belgium. gianluca.frasso@ulg.ac.be.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Frasso
authors.affiliation: Región de Salud Loreto, Iquitos, Loreto, 160, Peru. hmrodriguezf@hotmail.com.
authors.forename: Hugo
authors.initials: H
authors.lastname: Rodriguez
authors.affiliation: Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofia, Universidad Peruana Cayetano Heredia, Lima 31, Peru. dionigamboa@yahoo.com.
authors.forename: Dionicia
authors.initials: D
authors.lastname: Gamboa
authors.affiliation: Facultad de Medicina, Universidad Nacional Amazonia Peruana, Iquitos, Loreto, 160, Peru. sihuincha@hotmail.com.
authors.forename: Moisés
authors.initials: M
authors.lastname: Sihuincha
authors.affiliation: Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, 2000, Belgium. arosanas@itg.be.
authors.forename: Anna
authors.initials: A
authors.lastname: Rosanas-Urgell
authors.affiliation: Disease Control and Elimination, Medical Research Council Unit, Fajara, 220, The Gambia. udalessandro@mrc.gm.|London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK. udalessandro@mrc.gm.
authors.forename: Umberto
authors.initials: U
authors.lastname: D'Alessandro
authors.affiliation: Research Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, 1200, Belgium. niko.speybroeck@uclouvain.be.
authors.forename: Niko
authors.initials: N
authors.lastname: Speybroeck
mesh_terms: D000962:Antimalarials / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy / Q000453:epidemiology / Q000469:parasitology / Q000517:prevention & control*; D008297:Male; D008962:Models, Theoretical; D010568:Peru / Q000453:epidemiology; D010963:Plasmodium falciparum / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification / Q000502:physiology; D012424:Rural Population
chemical_list: D000962:Antimalarials