Funded by the Bill and Melinda Gates Foundation, the TME project seeks to accelerate malaria elimination by providing mass drug administrations to communities with a relatively high P. falciparum prevalence that are covered by village health malaria workers and which have access to long lasting insecticide treated bed nets.
Gates funded TME project operates in four Greater Mekong Subregion countries: Myanmar, Cambodia, Lao PDR and Viet Nam. LOMWRU’s Dr Mayfong Mayxay is the principal investigator (PI) for the Lao PDR study, while Dr Koukeo Phommasone is the field site PI.
Savannakhet has the third highest malaria incidence of Laos’ 18 provinces. A survey conducted in 18 rural Savannakhet villages in 2015 using uPCR detected Plasmodium infections in 175 of 888 samples (20%). Most villages in Savannakhet are relatively accessible and malaria elimination is a high priority for the local government.
A pilot project to eliminate malaria was initiated in four villages in April 2016. The project showed that mass drug administration (MDA) in Savannakhet is feasible and well accepted, with more than 80% of the targeted villagers participating in three rounds of drug administrations.
The drug regimen consists of three monthly rounds (M0, M1 and M2) of three daily treatment doses of DHA/piperaquine (7 mg/kg dihydroartemisinin and 55 mg/kg piperaquine phosphate) combined with a single low dose primaquine (15mg or 0.25mg/kg). Frequency and timing of the MDA rounds relates to the modeled maximum effects on transmission reduction and the post-treatment prophylactic effect of piperaquine, which is around 30 days in sensitive strains.
All residents in the study villages are encouraged to take part in three rounds except for women in the first trimester of pregnancy and children under 6 months of age. A single low dose primaquine is sufficient to clear rapidly gametocytes which are not susceptible to schizontocidal drugs but does not clear hypnozoites and therefore does not prevent P. vivax relapses. During the MDAs, all drugs were administered under direct observation of study staff.