The Global Health Group's Malaria Elimination Initiative is leading multiple areas of research on malaria elimination: documenting national progress towards elimination, leading operational research to improve surveillance and response strategies for elimination, documenting innovative vector control methods, and researching the costs, benefits, and financing requirements and mechanisms for elimination and preventing reintroduction.
The Malaria Elimination Initiative has developed a malaria elimination country briefing for each of the 35 malaria-eliminating countries. The briefings are designed to be used by researchers, policy makers, donors, malaria programs and implementers, with the aim of providing information on a country's malaria history and elimination progress, and highlighting country specific successes and challenges. These briefings were generated in partnership with the national malaria programs and/or in-country partners of each of the malaria-eliminating countries.
In 2012, the Malaria Elimination Initiative partnered with the WHO to launch a Joint Case Study Series on Malaria Elimination. Comprehensive case studies were produced on Bhutan, Cape Verde, Malaysia, Mauritius, the Philippines, Reunion, Sri Lanka, Tunisia, Turkey, and Turkmenistan. The objective of this work is to build the evidence base to support intensification of malaria elimination as an important step in achieving international malaria targets. The Malaria Elimination Initiative is now analyzing the findings of these case studies to determine any commonalities or key findings across the different country settings.
The Malaria Elimination Initiative is testing new methods for quickly, cost-effectively and accurately detecting and preventing importation of malaria parasites in low-endemic settings. This policy-relevant research will help malaria-eliminating countries gain an accurate understanding of how much malaria infection exists, where it is located, which high-risk groups are contributing to sustained transmission, the origins of new cases, and strategies for preventing and controlling imported malaria. The Malaria Elimination's work on new surveillance strategies is being conducted with national malaria programs in Indonesia, Namibia, Swaziland, and Thailand.
The Malaria Elimination Initiative is initiating clinical trials to compare targeted parasite elimination (TPE, a form of focal mass drug administration) to reactive case detection (RACD, or screening and treatment) in settings of low malaria transmission. While RACD is useful in identifying asymptomatic infections and hotspots of transmission, it is logistically challenging and may miss low-density asymptomatic infections. TPE has the potential to be more feasible to implement and potentially more effective than RACD. These trials will take place in Swaziland and Namibia and are funded by the Bill & Melinda Gates Foundation and the Novartis Foundation.
The Malaria Elimination Initiative is conducting a clinical trial on the efficacy of the anti-malarial drug primaquine in malaria elimination settings. The study aims to provide evidence that adding a single low dose treatment of primaquine to artemisinin combination therapy (ACTs) can help reduce transmission of Plasmodium falciparum malaria and is currently underway at trial sites in Mali and Thailand. More information about Malaria Elimination Initiative's new primaquine trials can be found here.
The Malaria Elimination Initiative believes that bold new research and investment to identify and prioritize new and/or under-utilized effective vector control tools and approaches are urgently needed. The Malaria Elimination Initiative's research aims to gather and generate fresh evidence around vector control tools and strategies that go beyond nets and indoor insecticide spraying and have the potential to radically reduce malaria transmission by the Anopheles mosquito. This new evidence, combined with a thorough understanding of local vector bionomics and malaria epidemiology, will ultimately arm national malaria programs with a new awareness around innovative approaches that have potential to dramatically reduce malaria transmission and accelerate progress toward elimination.
Support for this research is funded by the Sean Parker Foundation.
On economics research, the Malaria Elimination Initiative is collecting and analyzing country-level data on the costs of current and past malaria elimination efforts, compiling new evidence on the comparative costs and benefits of eliminating malaria to create an evidence-based investment case for elimination, and developing new recommendations for countries and donors on sustainable, innovative financing mechanisms that can best support elimination.
The Malaria Elimination Initiative in collaboration with the Centers for Disease Control and Prevention, the Clinton Health Access Initiative, the University of Namibia, the National Malaria Control Program of Swaziland, and the University Cheikh Anta DIOP of Dakar in Senegal developed a pharmacovigilance tool to support the safe roll out of low dose primaquine for its gametocytocidal effect in the treatment of P. falciparum infections.
The Primaquine Roll Out Monitoring Pharmacovigilance Tool (PROMPT) assists programs to systematically collect evidence on the safety of primaquine by actively monitoring hematologic response. In addition to being a pharmacovigilance strengthening tool for programs, this tool will facilitate data sharing and aggregation between other interested partners for broader analysis of primaquine safety data. The pilot of PROMPT is currently planned for Senegal and Swaziland but with growing interest from programs in implementing PROMPT, future plans include supporting the tool's roll out beyond these two countries.
In order to target interventions at high risk populations, or hotpops, programs need to identify risk factors. In elimination settings, this is difficult to do with traditional approaches due to very low numbers of infections at any given time. The Malaria Elimination Risk Factor Analysis Tool (MERFAT) is a tool that will enable programs to gather information on cases and controls and identify which factors are associated with risk of infection. The tool is being developed in collaboration with the University of Namibia and the Ministry of Health and Social Services, and will pilot this tool in Namibia and Indonesia.
The Malaria Elimination Initiative and partners have developed a monitoring and evaluation (M&E) tool for case investigation and reactive case detection (RACD). The RACD M&E tool assesses the completeness and timeliness of active surveillance and response, and informs malaria programs on how and where efficiency gains can be made. The RACD M&E tool examines the key components of active surveillance activities, identifies and evaluates the strengths and gaps of the active surveillance program and assesses the costs of conducting RACD. The RACD M&E tool was conceived though supporting South Africa's active surveillance program in 2012, and upon further development of the RACD M&E tool, pilots were conducted in 2013 in Aceh, Indonesia and in Jiangsu, China working with local country partners. The RACD M&E tool will roll out in additional countries in southern Africa and the Asia Pacific.
The Malaria Elimination Initiative partnered with the World Health Organization, Clinton Health Access Initiative, Johns Hopkins University and Imperial College to develop a strategic decision-making and planning tool for countries considering malaria elimination.
This Elimination Scenario Planning tool, first piloted in Zanzibar in 2009, guides countries in conducting a thorough assessment of the technical, operational, and financial feasibility of elimination. The Malaria Elimination Initiative and the Clinton Health Access Initiative used the ESP tool to assess the feasibility of eliminating malaria in Senegal/Gambia, and Hispaniola. In 2015, the Malaria Elimination Initiative is supporting Rwanda in assessing the feasibility of achieving pre-elimination in the short-term.