The impact of antimalarials and insecticide resistance on malaria transmission in Uganda
Eliminating malaria in high transmission settings where asymptomatic infections are prevalent will require improved interventions to treat malaria, control vectors, and also decrease transmission to mosquitoes. However, our understanding of what factors govern the efficiency of malaria transmission is incomplete, limiting our ability to accurately predict the impacts of transmission-reducing interventions. We hypothesize that parasite and mosquito factors are associated with the likelihood of malaria transmission to mosquitoes. To test this hypothesis, we will utilize our well-established clinical and entomology infrastructure in Tororo, Uganda to infect field-collected and colony anopheline mosquitoes with blood from P. falciparum-infected Ugandans using membrane feeding assays. We will then analyze the prevalence and intensity of malaria infection in mosquitoes in relation to measured parasite and vector characteristics. Among the characteristics we will investigate are gametocyte density, multiplicity of infection and sex ratio, parasite drug resistance and genotypes, and mosquito insecticide resistance and genotypes. Using Bayesian Markov Chain Monte Carlo techniques, we will fit models to our data, allowing explicit estimation of parameters related to infectiousness needed to reproduce the observed data, allowing us to test our hypotheses regarding variation in infectiousness, measure the magnitude of these effects, and identify putative sources of the variation, information that will be essential to inform policy decisions that will facilitate the control and eventual elimination of malaria. Specifically, our results will help us to prioritize control measures directed toward parasites (drugs) and mosquitoes (insecticides) in Uganda.