title: Short-term Impact of Mass Drug Administration With Dihydroartemisinin Plus Piperaquine on Malaria in Southern Province Zambia: A Cluster-Randomized Controlled Trial.
abstract: BACKGROUND
  Mass drug administration (MDA) using dihydroartemisinin plus piperaquine (DHAp) represents a potential strategy to clear Plasmodium falciparum infections and reduce the human parasite reservoir.
  
  
  METHODS
  A cluster-randomized controlled trial in Southern Province, Zambia, was used to assess the short-term impact of 2 rounds of community-wide MDA and household-level (focal) MDA with DHAp compared with no mass treatment. Study end points included parasite prevalence in children, infection incidence, and confirmed malaria case incidence.
  
  
  RESULTS
  All end points significantly decreased after intervention, irrespective of treatment group. Parasite prevalence from 7.71% at baseline to 0.54% after MDA in lower-transmission areas, resulting in an 87% reduction compared with control (adjusted odds ratio, 0.13; 95% confidence interval, .02-.92; P = .04). No difference between treatment groups was observed in areas of high transmission. The 5-month cumulative infection incidence was 70% lower (crude incidence rate ratio, 0.30; 95% confidence interval, .06-1.49; P = .14) and 58% lower (0.42; .18-.98; P = .046) after MDA compared with control in lower- and higher-transmission areas, respectively. No significant impact of focal MDA was observed for any end point.
  
  
  CONCLUSIONS
  Two rounds of MDA with DHAp rapidly reduced infection prevalence, infection incidence, and confirmed case incidence rates, especially in low-transmission areas.
  
  
  BACKGROUND
  NCT02329301.
authors.affiliation: Center for Applied Malaria Research and Evaluation, Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Eisele
authors.affiliation: Malaria Elimination Initiative, Global Health Group, University of California San Francisco.
authors.forename: Adam
authors.initials: A
authors.lastname: Bennett
authors.affiliation: PATH-Malaria Control and Elimination Partnership in Africa (MACEPA), National Malaria Control Centre, Chainama Hospital College Grounds.
authors.forename: Kafula
authors.initials: K
authors.lastname: Silumbe
authors.affiliation: Center for Applied Malaria Research and Evaluation, Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Finn
authors.affiliation: Institute for Medical Research and Training, University Teaching Hospital.
authors.forename: Victor
authors.initials: V
authors.lastname: Chalwe
authors.affiliation: National Malaria Control Centre, Zambia Ministry of Health, Chainama Hospital, Lusaka.
authors.forename: Mulakwa
authors.initials: M
authors.lastname: Kamuliwo
authors.affiliation: National Malaria Control Centre, Zambia Ministry of Health, Chainama Hospital, Lusaka.
authors.forename: Busiku
authors.initials: B
authors.lastname: Hamainza
authors.affiliation: National Malaria Control Centre, Zambia Ministry of Health, Chainama Hospital, Lusaka.
authors.forename: Hawela
authors.initials: H
authors.lastname: Moonga
authors.affiliation: Zambia Ministry of Health, Southern Provincial Health Office, Choma.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Kooma
authors.affiliation: National Malaria Control Centre, Zambia Ministry of Health, Chainama Hospital, Lusaka.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Chizema Kawesha
authors.affiliation: Center for Applied Malaria Research and Evaluation, Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
authors.forename: Joshua
authors.initials: J
authors.lastname: Yukich
authors.affiliation: Center for Applied Malaria Research and Evaluation, Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
authors.forename: Joseph
authors.initials: J
authors.lastname: Keating
authors.affiliation: Center for Applied Malaria Research and Evaluation, Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
authors.forename: Travis
authors.initials: T
authors.lastname: Porter
authors.affiliation: PATH-MACEPA, Seattle, Washington.
authors.forename: Ruben O
authors.initials: RO
authors.lastname: Conner
authors.affiliation: PATH-Malaria Control and Elimination Partnership in Africa (MACEPA), National Malaria Control Centre, Chainama Hospital College Grounds.
authors.forename: Duncan
authors.initials: D
authors.lastname: Earle
authors.affiliation: PATH-MACEPA, Seattle, Washington.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Steketee
authors.affiliation: PATH-Malaria Control and Elimination Partnership in Africa (MACEPA), National Malaria Control Centre, Chainama Hospital College Grounds.
authors.forename: John M
authors.initials: JM
authors.lastname: Miller
mesh_terms: D000962:Antimalarials / Q000008:administration & dosage*; D037621:Artemisinins / Q000008:administration & dosage*; D018890:Chemoprevention / Q000379:methods; D002675:Child, Preschool; D004358:Drug Therapy / Q000379:methods; D005191:Family Characteristics; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D015995:Prevalence; D011804:Quinolines / Q000008:administration & dosage*; D016896:Treatment Outcome; D015024:Zambia / Q000453:epidemiology; D010879:Piperazines
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D011804:Quinolines; C039060:artenimol; C034759:piperaquine; D010879:Piperazines
keywords: elimination; malaria; mass drug administration