Radical CUREfor MAlaria Among Highly Mobile and Hard-to-reach Populations in the Guyanese Shield
Status:
Not yet recruiting
Trial end date:
2025-12-12
Target enrollment:
Participant gender:
Summary
The investigators are proposing a new malaria control strategy to reach the group of
garimpeiros not reached by the usual actions of the health services. As it is a complex
strategy, several evaluation mechanisms have been designed. The main characteristics of the
research are:
- Access to the target population: our target population is represented by miners active
and mobile in the south of the Guiana Shield, between Amapá (Brazil), French Guiana
(France) and Suriname. To overcome the obstacles posed by the remoteness and
clandestinity of the communities of interest, our intervention will take place in the
logistical and support hubs (staging areas) of the miners, located in the border regions
between the above territories. Thus, it will take advantage of their periodic mobility
between these bases and the gold mining sites, and reach the target population where it
can be easily accessed.
- The intervention will be combined and will include a common core (malaria health
education activity) and two modules that will be offered to participants. Each
participant (meeting the inclusion criteria) will be able to choose between
participating to one or both modules.
- The common core of health education will focus on malaria: its causes, means of
prevention, the main differences between P. falciparum and P. vivax disease, the
importance of a complete treatment against any form of Plasmodium spp.
- Module A of the intervention will be treatment targeting asymptomatic individuals
at risk of carrying P. vivax. The aim of this module is to prevent relapses and
reduce the number of human hosts able to transmitthe parasite.
- Module B of the intervention will correspond to the provision, after appropriate
training, of a Malakit self-test and self-treatment kit. The aim of this module is
to provide access to quality diagnosis and treatment for episodes of symptoms
consistent with malaria that occur in situations of extreme remoteness from health
services.
- The purpose of this study is to evaluate a strategy that, if appropriate, can be
implemented by health authorities in countries with residual malaria transmission in
populations with characteristics similar to our study population. The investigators will
therefore use a pragmatic approach so that the conclusions drawn can be transposed as
easily as possible to real life, while at the same time putting great effort into the
safety of the intervention. Thus, the study field workers who will administer the
intervention will have a similar profile to health workers recruited by a large number
of malaria control programmes, particularly in remote areas. In addition, monitoring
will be simplified and monitoring data can be collected both through face-to-face visits
and remotely administered questionnaires.
- The investigators chose to design many of the components of the intervention and study
with a participatory approach.
- In order to generate the data necessary for health authorities to potentially take
ownership of the intervention in the future, the study will evaluate two aspects of the
intervention: effectiveness and implementation.
- First, the investigators want to evaluate the population-scale effectiveness ofthe
intervention to reduce malaria transmission with a quasi-experimental approach.
- Secondly, the investigators will analyse the implementation of theintervention, and
generate valuable knowledge for further implementation within local health
services.
This evaluation will be carried out through the components of the CUREMA study: the
intervention itself, pre/post-intervention cross-sectional surveys, a nested cohort, the
qualitative component and the modelling of epidemiological surveillance data.
• The implementation of these components will have an expected duration of approximately 27
months, the start of inclusions is scheduled for September 2022.