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Meta-Analysis
. 2024 Mar 12;110(4_Suppl):44-53.
doi: 10.4269/ajtmh.23-0127. Print 2024 Apr 2.

Mass Testing and Treatment to Accelerate Malaria Elimination: A Systematic Review and Meta-Analysis

Beena Bhamani  1 , Elisabet Martí Coma-Cros  1 , Maria Tusell  1 , Vita Mithi  2   3   4 , Elisa Serra-Casas  1 , Nana Aba Williams  1 , Kim A Lindblade  5 , Koya C Allen  1
Affiliations
Meta-Analysis

Mass Testing and Treatment to Accelerate Malaria Elimination: A Systematic Review and Meta-Analysis

Beena Bhamani et al. Am J Trop Med Hyg. .

Abstract

In regions where malaria transmission persists, the implementation of approaches aimed at eliminating parasites from the population can effectively decrease both burden of disease and transmission of infection. Thus, mass strategies that target symptomatic and asymptomatic infections at the same time may help countries to reduce transmission. This systematic review assessed the potential benefits and harms of mass testing and treatment (MTaT) to reduce malaria transmission. Searches were conducted in March 2021 and updated in April 2022 and included cluster-randomized controlled trials (cRCTs) as well as nonrandomized studies (NRSs) using malaria infection incidence, clinical malaria incidence, or prevalence as outcomes. The risk of bias was assessed with Cochrane's risk of bias (RoB2) tool and Risk of Bias Tool in Nonrandomized Studies - of Interventions (ROBINS-I), and the certainty of evidence (CoE) was graded for each outcome. Of 4,462 citations identified, seven studies (four cRCTs and three NRSs) contributed outcome data. The analysis revealed that MTaT did not reduce the incidence (risk ratio [RR]: 0.95, 95% CI: 0.87-1.04; 1,181 participants; moderate CoE) or prevalence (RR: 0.83, 95% CI: 0.67-1.01; 7,522 participants; moderate CoE) of malaria infection but resulted in a small reduction in clinical malaria (RR: 0.82; 95% CI: 0.70-0.95; 334,944 participants; moderate CoE). Three studies contributing data on contextual factors concluded that MTaT is an acceptable, feasible, and cost-effective intervention. Mathematical modeling analyses (n = 10) suggested that MTaT effectiveness depends on the baseline transmission level, diagnostic test performance, number of rounds, and other co-interventions. Based on the limited evidence available, MTaT has little to no impact on reducing malaria transmission.

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Conflict of interest statement

Disclosures: This systematic review was originally undertaken as a part of the guideline development process for the Global Malaria Programme, WHO HQ, Geneva, Switzerland. The WHO Guideline Development Group provided expert advice in the formation of the review methodology and evidence for the decision process for interpretation and recommendations. The findings and conclusions in this report are those of the authors and do not necessarily represent the views, decisions, or policies of the institutions with which the authors are affiliated.

Figures

Figure 1.
Figure 1.
PRISMA flow diagram for systematic review of mass test and treat (MTaT) for reduction of human malaria. CF = contextual factors; ICTRP = International Clinical Trials Registry Platform; ISRCTN = International Standard Randomised Controlled Trial Number; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2.
Figure 2.
Effect of mass testing and treatment versus no mass testing and treatment on incidence of malaria infection at the community level (cluster-randomized controlled trials [cRCTs]). FE = fixed effects.
Figure 3.
Figure 3.
Effect of mass testing and treatment versus no mass testing and treatment on prevalence of infection at the community level (cluster-randomized controlled trials [cRCTs]). RE = random effects.
Figure 4.
Figure 4.
Effect of mass testing and treatment versus no mass testing and treatment on incidence of clinical malaria at the community level (cluster-randomized controlled trials [cRCTs]). FE = fixed effects.
See this image and copyright information in PMC

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