Estimating the programmatic cost of targeted mass drug administration for malaria in Myanmar

Abstract Background Mass drug administration (MDA) has received growing interest to accelerate the elimination of multi-drug resistant malaria in the Greater Mekong Subregion. Targeted MDA, sometimes referred to as focal MDA, is the practice of delivering MDA to high incidence subpopulations only, rather than the entire population. The potential effectiveness of delivering targeted MDA was demonstrated in a recent intervention in Kayin State, Myanmar. Policymakers and funders need to know what resources are required if MDA, targeted or otherwise, is to be included in elimination packages beyond existing malaria interventions. This study aims to estimate the programmatic cost and the unit cost of targeted MDA in Kayin State, Myanmar. Methods We used financial data from a malaria elimination initiative, conducted in Kayin State, to estimate the programmatic costs of the targeted MDA component using a micro-costing approach. Three activities (community engagement, identification of villages for targeted MDA, and conducting mass treatment in target villages) were evaluated. We then estimated the programmatic costs of implementing targeted MDA to support P. falciparum malaria elimination in Kayin State. A costing tool was developed to aid future analyses. Results The cost of delivering targeted MDA within an integrated malaria elimination initiative in eastern Kayin State was approximately US$ 910,000. The cost per person reached, distributed among those in targeted and non-targeted villages, for the MDA component was US$ 2.5. Conclusion This cost analysis can assist policymakers in determining the resources required to clear malaria parasite reservoirs. The analysis demonstrated the value of using financial data from research activities to predict programmatic implementation costs of targeting MDA to different numbers of target villages.

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An ingredients-based approach to costing integrated malaria elimination strategies: an example from Myanmar

10.21203/rs.3.rs-60017/v1 ◽

2020 ◽

Author(s):

Shwe Sin Kyaw ◽

Gilles Delmas ◽

Tom L Drake ◽

Olivier Celhay ◽

Wirichada Pan-ngum ◽

...

Keyword(s):

Malaria Elimination ◽

Malaria Parasite ◽

Financial Data ◽

Drug Resistant ◽

Policy Makers ◽

Research Activities ◽

Implementation Costs ◽

The Cost ◽

Greater Mekong Subregion ◽

Malaria Interventions

Abstract Background Mass drug administration (MDA) has received growing interest to accelerate the elimination of multi-drug resistant malaria in the Greater Mekong Subregion. The potential effectiveness of delivering targeted MDA was demonstrated in a recent intervention in Kayin State, Myanmar. Policymakers and funders need to know what resources are required if MDA is to be included in elimination packages beyond existing malaria interventions. Methods We used financial data from a malaria elimination initiative, conducted in Kayin State, to estimate the programmatic costs of the MDA component using a micro-costing approach. Three activities (community engagement, identification of villages for MDA, and conducting mass treatment in target villages) were evaluated. We then estimate the programmatic costs of implementing targeted MDA to support P. falciparum malaria elimination in Kayin State. A costing tool was developed to aid future analyses.Results The cost of delivering MDA within an integrated malaria elimination initiative in Eastern Kayin State was approximately US$ 910 000. The cost per person reached for MDA was US$ 2·5. Conclusion This cost analysis can assist policy makers in determining the resources required to clear malaria parasite reservoirs. The analysis demonstrated the value of using financial data from research activities to predict programmatic implementation costs of MDA in different numbers of target villages.

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“Nine Dimensions”: A multidisciplinary approach for community engagement in a complex postwar border region as part of the targeted malaria elimination in Karen/Kayin State, Myanmar

Wellcome Open Research ◽

10.12688/wellcomeopenres.14698.1 ◽

2018 ◽

Vol 3 ◽

pp. 116

Author(s):

Decha Tangseefa ◽

Krishna Monthathip ◽

Naruemol Tuenpakdee ◽

Andrea König ◽

Ladda Kajeechiwa ◽

...

Keyword(s):

Drug Administration ◽

Mass Drug Administration ◽

Malaria Elimination ◽

Participant Observation ◽

Structured Interviews ◽

Team Members ◽

Cross Border ◽

Control Programmes ◽

Elimination Programme ◽

Post War

Background:In light of growing antimalarial drug resistance in Southeast Asia, control programmes have become increasingly focused on malaria elimination, composed of mass drug administration coupled with prompt diagnosis and treatment of symptomatic cases. The key to a successful elimination programme centres on high participation rates in targeted communities, often enhanced by community engagement (CE) efforts. Social science research was conducted to develop a conceptual framework used for CE activities in the Targeted Malaria Elimination programme, as a cross-border operation in Karen/Kayin State, Myanmar.Methods:Data was collected from three main sources: (1) participant observation and semi-structured interviews of CE team members; (2) participant observation and semi-structured interviews with villagers; and (3) records of CE workshops with CE workers conducted as part of the TME programme.Results:Interviews were conducted with 17 CE team members, with 10 participant observations and interviews conducted with villagers and a total of 3 workshops conducted over the course of this pilot programme in 4 villages (November 2013 to October 2014). Thematic analysis was used to construct the nine dimensions for CE in this complex, post-war region: i) history of the people; ii) space; iii) work; iv) knowledge about the world; v) intriguing obstacle (rumour); vi) relationship with the health care system; vii) migration; viii) logic of capitalism influencing openness; and ix) power relations.Conclusions:Conducting CE for the Targeted Malaria Elimination programme was immensely complicated in Karen/Kayin State because of three key realities: heterogeneous terrains, a post-war atmosphere and cross-border operations. These three key realities constituted the nine dimensions, which proved integral to health worker success in conducting CE. Summary of this approach can aid in infectious disease control programmes, such as those using mass drug administration, to engender high rates of community participation.

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Electrocardiographic Safety of Repeated Monthly Dihydroartemisinin-Piperaquine as a Candidate for Mass Drug Administration

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01153-18 ◽

2018 ◽

Vol 62 (12) ◽

Author(s):

Pere Millat-Martínez ◽

Rhoda Ila ◽

Moses Laman ◽

Leanne Robinson ◽

Harin Karunajeewa ◽

...

Keyword(s):

Drug Administration ◽

Mass Drug Administration ◽

Malaria Elimination ◽

Safety Data ◽

Repeated Administration ◽

Risk Difference ◽

Safety Endpoint ◽

The Difference ◽

Repeated Dosing ◽

Long Acting

ABSTRACT Mass drug administration (MDA) of sequential rounds of antimalarial drugs is being considered for use as a tool for malaria elimination. As an effective and long-acting antimalarial, dihydroartemisinin-piperaquine (DHA-PQP) appears to be suitable as a candidate for MDA. However, the absence of cardiac safety data following repeated administration hinders its use in the extended schedules proposed for MDA. We conducted an interventional study in Lihir Island, Papua New Guinea, using healthy individuals age 3 to 60 years who received a standard 3-day course of DHA-PQP on 3 consecutive months. Twelve-lead electrocardiography (ECG) readings were conducted predose and 4 h after the final dose of each month. The primary safety endpoint was QT interval correction (QTc using Fridericia’s correction [QTcF]) prolongation from baseline to 4 h postdosing. We compared the difference in prolongations between the third course postdose and the first course postdose. Of 84 enrolled participants, 69 (82%) participants completed all treatment courses and ECG measurements. The average increase in QTcF was 19.6 ms (standard deviation [SD], 17.8 ms) and 17.1 ms (SD, 17.1 ms) for the first-course and third-course postdosing ECGs risk difference, −2.4 (95% confidence interval [95% CI], −6.9 to 2.1; P = 0.285), respectively. We recorded a QTcF prolongation of >60 ms from baseline in 3 (4.3%) and 2 (2.9%) participants after the first course and third course (P = 1.00), respectively. No participants had QTcF intervals of >500 ms at any time point. Three consecutive monthly courses of DHA-PQP were as safe as a single course. The absence of cumulative cardiotoxicity with repeated dosing supports the use of monthly DHA-PQP as part of malaria elimination strategies.

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Mass drug administration can be a valuable addition to the malaria elimination toolbox

Malaria Journal ◽

10.1186/s12936-019-2906-8 ◽

2019 ◽

Vol 18 (1) ◽

Cited By ~ 5

Author(s):

Thomas P. Eisele

Keyword(s):

Drug Administration ◽

Mass Drug Administration ◽

Malaria Elimination ◽

Valuable Addition

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Optimising Strategies for Plasmodium falciparum Malaria Elimination in Cambodia: Primaquine, Mass Drug Administration and Artemisinin Resistance

PLoS ONE ◽

10.1371/journal.pone.0037166 ◽

2012 ◽

Vol 7 (5) ◽

pp. e37166 ◽

Cited By ~ 67

Author(s):

Richard J. Maude ◽

Duong Socheat ◽

Chea Nguon ◽

Preap Saroth ◽

Prak Dara ◽

...

Keyword(s):

Plasmodium Falciparum ◽

Falciparum Malaria ◽

Drug Administration ◽

Mass Drug Administration ◽

Malaria Elimination ◽

Artemisinin Resistance ◽

Plasmodium Falciparum Malaria

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The promise, problems and pitfalls of mass drug administration for malaria elimination: a qualitative study with scientists and policymakers

International Health ◽

10.1093/inthealth/ihy079 ◽

2018 ◽

Vol 11 (3) ◽

pp. 166-176 ◽

Cited By ~ 9

Author(s):

Nils Kaehler ◽

Bipin Adhikari ◽

Phaik Yeong Cheah ◽

Nicholas P J Day ◽

Daniel H Paris ◽

...

Keyword(s):

Drug Administration ◽

Mass Drug Administration ◽

Malaria Elimination ◽

Artemisinin Resistance ◽

Malaria Prevention ◽

Evidence Base ◽

World Health ◽

Pilot Studies ◽

Target Populations ◽

Health Organization

Abstract Background The emergence of artemisinin resistance in the Greater Mekong Subregion (GMS) has prompted urgent containment measures. One possible approach is mass drug administration (MDA). This article explores attitudes towards and perceptions of MDA for malaria elimination among policymakers and leading malariologists. Methods Thirty-two semistructured interviews (SSI) were conducted with policymakers (n=17) and principal investigators (n=15) selected based on their involvement in malaria prevention, control and elimination in the GMS. Interviews were audio recorded and transcribed for qualitative content (thematic) analysis using NVivo (QSR International, Doncaster, Victoria, Australia). Results Researchers and policymakers described reluctance and consequently delays to pilot MDA for malaria elimination. Most policymakers and some researchers reported concerns around the evidence base, citing a lack of data on its effectiveness and appropriate target populations. There were also worries about promoting resistance. Other issues included a previous lack of support from the World Health Organization, past MDAs, the remoteness of target populations and challenges explaining the rationale for MDA. Conclusions The complex rationale for MDA for malaria elimination, mistaking pilot studies for implementation, past experiences with MDA, difficulties in selecting appropriate sites and the WHO’s lack of clear backing undermined the support for MDA for malaria elimination.

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