Large-scale Artemisinin-Piperaquine Mass Drug Administration with or Without Primaquine Dramatically Reduces Malaria in a Highly Endemic Region of Africa

Abstract

Background Mass drug administration (MDA), with or without low-dose primaquine (PMQ LD), is being considered for malaria elimination programs. The potential of PMQ LD to block malaria transmission by mosquitoes must be balanced against liabilities of its use. Methods Artemisinin-piperaquine (AP), with or without PMQ LD, was administered in 3 monthly rounds across Anjouan Island, Union of Comoros. Plasmodium falciparum malaria rates, mortality, parasitemias, adverse events, and PfK13 Kelch-propeller gene polymorphisms were evaluated. Results Coverage of 85 to 93% of the Anjouan population was achieved with AP plus PMQ LD (AP+PMQ LD) in 2 districts (population 97164) and with AP alone in 5 districts (224471). Between the months of April-September in both 2012 and 2013, average monthly malaria hospital rates per 100000 people fell from 310.8 to 2.06 in the AP+PMQ LD population (ratio 2.06/310.8 = 0.66%; 95% CI: 0.02%, 3.62%; P =.00007) and from 412.1 to 2.60 in the AP population (ratio 0.63%; 95% CI: 0.11%, 1.93%; P