Eliminating Plasmodium falciparum with artemisinin combination treatments (ACTs) in sub-Saharan Africa

Investigator: Roland Gosling, PhD, MS, MD
Sponsor: Novartis Fdn for Sustainable Development

Location(s): Namibia


In 2010 the Namibia Ministry of Health and Social Services launched a malaria elimination campaign to reduce the incidence to < 1/1,000 total population in every district by 2016 and to achieve national elimination by 2020. The Zambezi region, in the North of Namibia, bordering on Zambia, Angola and Botswana, is considered a high-risk area for transmission of malaria and has been a pilot site for Namibia’s active surveillance program for malaria elimination. The project includes two phases, first to understand the local epidemiology of malaria and build capacity for malaria surveillance and response in Zambezi region, and second to evaluate an innovative strategy for low-endemic settings called Targeted Parasite Elimination, or TPE.

As malaria incidence declines, it becomes geographically limited to “hot spots,” which can be identified through effective malaria surveillance. TPE is the community level administration of drugs to these “hot spots” as a way to address the remaining reservoir of malaria infection in people who are carrying the parasite but do not have symptomatic. The goal of TPE, along with other adjunctive measures such as indoor residual spraying with insecticide, is to to remove the parasites that maintain malaria transmission in the area and reduce contact between humans and mosquitoes. The partnership aims to determine the effectiveness of TPE vs. the recommend standard strategy of screening and treatment, as well the comparable operational feasibility, safety, and cost-effectiveness. If successful, the results will provide the evidence to inform strategy and policies in Namibia, other malaria elimination settings, and more generally, to other disease elimination efforts.