Broad One Health Endectocides-based Malaria Intervention in Africa

Broad One Health Endectocide-based Malaria Intervention in Africa – BOHEMIA is a consortium/ project funded by the UNITAID for the duration of 4 years (2019 – 2023) to evaluate IVERMECTIN mass drug administraiton (MDA) as the complimentary vector control strategy against residual malaria transmission in Africa.     

Residual malaria transmission make it difficult to eliminate malaria even with high coverage of Long lasting Insecticide Treated Nets (LLIN) and Inddoor Residual Spraying (IRS). This is driven by malaria vectors that bites human outside houses and nets, bite early morning/evening, feeding on livestock, and insecticide resistant. Therefore, new tools are needed to control residual malaria transmission in African countries including Tanzania. 

Endectocide is a class of antiparasitic drugs (e.g. eprinomectin, dorametin, moxidectin, abamectin and ivermectin) that are capable of killing endoparasites and ectoparasites in both humans and animals. Ivermectin MDA has potential advantages as complimentary malaria control tool to tackle residual malaria transmission including: treatment and prevention of Lymphatic filariasis, Onchocerciasis, Scabies and Soil Transmitted Helminths in humans; treatment and prevention of intestinal helminths and other ectoparasites including ticks, and tsetse flies in livestoks; targeting malaria vectors biting humans and livestocks outside houses; targeting insecticide resistant malaria vectors, target mosquitoes carrying malaria parasites; targeting malaria parasites in humans, wider safety profile in both humans and livestock, improving livestock health and productivity as well as the economic welbeing of household. These benefits of ivermectin MDA made it suitable suitable one health approach in controlling residual malaria transmission.

Project Objectives

BOHEMIA aims at assessing the effect of ivemectin MDA on malaria transmission in Africa. BOHEMIA will address the following broad objectives:

1) to dertermine the efficacy and safety of ivermectin MDA on reducing malaria prevention at acceptable safety profile,

2) to assess the social acceptability and feasibility of ivermectin MDA as malaria control tool,

3) to evaluate the indirect benefits to humans and direct benefits to animal health and productivity that improves economic well being,

4)to evaluate the environmental impact of ivermectin MDA on non-target fauna and soil,

5)to inform and involve stakeholders at local, regional, national and international level with the aim of contributing to policy changes.

BOHEMIA is organized around safety and efficacy protocol which is supported with 5 sub-studies, written as independent studies: Demography, Social Science, Entomology, Livectock Economics, and Environmental.

Methods

Study site: BOHEMIA is conducted in Kibiti and Rufiji Dictricts in Tanzania. A total of 17 wards (10 wards from Kibiti, and 7 wards from Rufiji) are prepared for BOHEMIA clinical trial away from those sites for  Tz – China clinical trial on Test Treat and Track Approach. Furthermore, these two clinical trials within IHI may not overlap because 3T is expected to close by October 2021, while BOHEMIA is anticipated to start during peak of malaria transmission in March 2022.

Study design: BOHEMIA will conduct cluster randomized controlled, open label, parallel treatment arms clinical trial, with malaria infection incidence and malaria clinical incidence as the primary outcomes. It is a one year (12 months) clinical trial with 3rounds of ivermectin or albendazole rounds, once per month for three month, and having 6months of follow. All other sub-sub-studies (demography, social science, entomology, livestock economics, and environmental) will be conducted with the clinical trial to generate evidence supporting epidemiological outcome.

Expected Outcomes

BOHEMIA will ultimately generate epidemiological evidence that will be supported by the entomological, social accetability, cost-effectiveness, safety and environmental data to facilitte policy recommendations or evidenced based decisitons by the respective national programs (NMCP, and NTDP) or ministries on the use ivermectin MDA to humans, or humans and livestock as complimentary malaria control strategy to enhance the exisiting interventions of LLIN and IRS to eliminate malaria in Africa.#