评估马拉基特干预措施对圭亚那地盾疟疾传播的影响：一项数学模型研究

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas Pub Date : 2025-05-15 DOI:10.1016/j.lana.2025.101123

Yann Lambert , Raphaëlle Métras , Alice Sanna , Muriel Galindo , Hélène Hiwat , Paola Marchesini , Yassamine Lazrek , Lise Musset , Stephen Vreden , Martha Cecilia Suárez-Mutis , Oscar Mesones Lapouble , Antoine Adenis , Mathieu Nacher , Pierre-Yves Boëlle , Chiara Poletto , Maylis Douine

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引用次数: 0

摘要

背景：在流动人群和难以到达的人群中消除疟疾需要新的、有针对性的干预措施。在法属圭亚那，从事非法金矿开采的人口中疟疾的负担很高。在2018年4月至2020年3月期间，我们实施了Malakit，这是一项针对金矿工人的新干预措施，并依赖于疟疾自我诊断和自我治疗工具包的分发。在本研究中，我们评估了Malakit对疟疾传播的影响。方法将恶性疟原虫（Pf）和间日疟原虫（Pv）传播的数学模型与巴西和苏里南的监测数据以及横断面调查的流行率数据拟合，以估计干预前（2014-2018）和干预（2018-2020）期间治疗覆盖率和繁殖数量的变化。利用反事实情景分析，我们估计了干预对疟疾发病率的影响。与干预前相比，干预期间治疗覆盖率有所增加，对Pf型疟疾（从20.6% [95% CrI 17.0, 25.7]到81.7% [95% CrI 67.9, 96.4]）的影响强于Pv型疟疾（从22.3% [95% CrI 19.3, 25.7]到47.3% [95% CrI 42.6, 52.3]）。同时，Pf的平均繁殖数从0.96 （95% CrI 0.93, 1.00）下降到0.34 (95% CrI 0.22, 0.46)， Pv的平均繁殖数从1.13 （95% CrI 1.10, 1.16）下降到0.86 （95% CrI 0.82, 0.90）。我们估计，在2018年至2020年期间，Malakit分别帮助避免了1231例（95% CrI 589, 1870）和2406例（95% CrI 1191, 3621）由Pf和Pv引起的症状感染，相当于减少了44.2%的疟疾总发病率（95% CrI - 52.5, - 34.5）。马拉基特通过改善法属圭亚那非法采金工人获得治疗的机会，对疟疾传播产生了重大影响。马拉基特在过去15年的区域努力的基础上，为圭亚那盾区消除疟疾又迈出了一步。资助欧洲联盟、全球基金、巴西卫生部、卡宴医院、法属圭亚那卫生区域机构。

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Evaluating the impact of the Malakit intervention on malaria transmission in the Guiana Shield: a mathematical modelling study

Background

Malaria elimination in mobile and hard-to-reach populations calls for novel, tailored interventions. In French Guiana, the malaria burden is high among the population working in illegal gold mining. Between April 2018 and March 2020, we implemented Malakit, a new intervention targeting gold miners, and relying on the distribution of kits for the self-diagnosis and self-treatment of malaria. In this study, we evaluate the impact of Malakit on malaria transmission.

Methods

We fitted mathematical models of the transmission of Plasmodium falciparum (Pf) and Plasmodium vivax (Pv) to surveillance data from Brazil and Suriname and to prevalence data from cross-sectional surveys to estimate the change in treatment coverages and reproduction numbers between the pre-intervention (2014–2018) and intervention (2018–2020) periods. Using counterfactual scenario analysis, we estimated the impact of the intervention on malaria incidence.

Findings

Treatment coverage increased in the intervention compared to the pre-intervention period, the effect being stronger for Pf malaria (from 20.6% [95% CrI 17.0, 25.7] to 81.7% [95% CrI 67.9, 96.4]) than Pv malaria (from 22.3% [95% CrI 19.3, 25.7] to 47.3% [95% CrI 42.6, 52.3]). Concomitantly, the mean reproduction number decreased from 0.96 (95% CrI 0.93, 1.00) to 0.34 (95% CrI 0.22, 0.46), for Pf, and from 1.13 (95% CrI 1.10, 1.16) to 0.86 (95% CrI 0.82, 0.90) for Pv. We estimated that between 2018 and 2020 Malakit helped avert a total of 1231 (95% CrI 589, 1870) and 2406 (95% CrI 1191, 3621) symptomatic infections by Pf and Pv, respectively, corresponding to a 44.2% reduction of the overall malaria incidence (95% CrI −52.5, −34.5).

Interpretation

Malakit had a significant impact on malaria transmission by improving the access to treatment for the population working in illegal gold mining in French Guiana. Building on the regional efforts of the past fifteen years, Malakit contributed to another step towards malaria elimination in the Guiana Shield.

Funding

European Union, Global Fund, MoH of Brazil, Cayenne Hospital, Health Regional Agency of French Guiana.

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来源期刊

Lancet Regional Health-Americas Multiple-

CiteScore

8.00

自引率

0.00%

发文量

期刊介绍： The Lancet Regional Health – Americas, an open-access journal, contributes to The Lancet's global initiative by focusing on health-care quality and access in the Americas. It aims to advance clinical practice and health policy in the region, promoting better health outcomes. The journal publishes high-quality original research advocating change or shedding light on clinical practice and health policy. It welcomes submissions on various regional health topics, including infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, emergency care, health policy, and health equity.