Table 1

A brief description of the various factors used in iMDA* impact assessment

Efficacy scenarios20% efficacy
(very conservative estimate based on minimally required criteria of the PPC†)
40% efficacy
(estimated based on BOHEMIA preliminary modelling)
Severity1%3%
Uptake levels Conservative
5% coverage of population at risk in 2023, with increase of 3% coverage per year.
Rapid
5% coverage of population at risk in 2023, with increase of 10% coverage per year.
National‡
Start at 5% in 2023 and double each year for first 3 years and then by 20% per year, with goal of reaching total national coverage in 7 years.
GTS§ scenarios 2016–2030 Accelerate 1 (incidence: −21%, mortality: −40%)
Increased coverage to 80% with a switch from quinine to injectable artesunate for management of severe disease and seasonal malaria chemoprevention.
Accelerate 2 (incidence: −59%, mortality: −74%)
Increased coverage to 90% with a switch from quinine to injectable artesunate for management of severe disease, seasonal malaria chemoprevention and rectal artesunate for pre-referral treatment at the community level.
Innovate (incidence: −74%, mortality: −81%)
Near-term innovation, including longer-lasting insecticidal nets and expansion of seasonal malaria chemoprevention.
Sustain (incidence: +28%, mortality: +11%)
Malaria interventions remain at the coverage levels of 2011–2013. Coverage comprises vector control and access to treatment.
No change (incidence: 0%, mortality: 0%)
Interventions remain constant over time at the 2018 levels. This scenario is used as a benchmark and is not a GTS strategy.
  • Note: This table shows the scenario setting for the full factorial experimental design, including four factors. The efficacy of iMDA is defined as the assumed reduction in malaria incidence among the at-risk population. Severity refers to the percentage of severe cases among all malaria cases. Uptake levels capture the timeline and coverage of iMDA over 64% of population at risk of malaria. The projected GTS global scenarios of malaria transmission 2016–2030 were developed by Griffin, et al 20 and indicated expected reduction percentages of incidence and mortality in 2030 as compared with 2015 levels.

  • *iMDA: ivermectin mass drug administration.

  • †PPC: WHO Preferred Product Characteristics.

  • ‡Specifically, the ‘National’ uptake coverage rate is 5% in 2023, 10% in 2024, 20% in 2025, 40% in 2026, 60% in 2027, 80% in 2028 and 100% in 2029, but this study only simulates for the 2023–2027 period.

  • §GTS: Global Technical Strategy for Malaria.

  • BOHEMIA, Broad One Health Endectocide-based Malaria Intervention in Africa.