Abstract Background Mass screening and treatment (MST) aims to reduce malaria risk in communities by identifying and treating infected persons without regard to illness. Methods A cluster-randomized trial evaluated malaria incidence with and without MST. Clusters were randomized to 3, 2, or no MST interventions: MST3, 6 clusters (156 households/670 individuals); MST2, 5 clusters (89 households/423 individuals); and MST0, 5 clusters (174 households/777 individuals). All clusters completed the study with 14 residents withdrawing. In a cohort of 324 schoolchildren (MST3, n = 124; MST2, n = 57; MST0, n = 143) negative by microscopy at enrollment, we evaluated the incidence density of malaria during 3 months of MST and 3 months following. The MST intervention involved community-wide expert malaria microscopic screening and standard therapy with dihydroartemisinin-piperaquine and primaquine for glucose-6 phosphate dehydrogenase–normal subjects. All blood examinations included polymerase chain reaction assays, which did not guide on-site treatment. Results The risk ratios for incidence density of microscopically patent malaria in MST3 or MST2 relative to that in MST0 clusters were 1.00 (95% confidence interval [CI], .53–1.91) and 1.22 (95% CI, .42–3.55), respectively. Similar results were obtained with molecular analysis and species-specific ( P. falciparum and P. vivax ) infections. Microscopically subpatent, untreated infections accounted for 72% of those infected. Conclusions Two or 3 rounds of MST within 3 months did not impact the force of anopheline mosquito-borne infection in these communities. The high rate of untreated microscopically subpatent infections likely explains the observed poor impact. Clinical Trials Registration NCT01878357. This cluster-randomized trial demonstrated a negligible impact of mass microscopic screening in guiding treatment as a means to reduce malaria transmission at a mesoendemic site in Indonesia. Retrospective polymerase chain reaction analysis revealed that the majority of infections were microscopically subpatent.
【저자키워드】 Indonesia, malaria control, Mass screening and treatment, Cluster-randomized trial,