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Adjunctive Ivermectin Mass Drug Administration for Malaria Control (MATAMAL)

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ClinicalTrials.gov Identifier: NCT04844905
Recruitment Status : Not yet recruiting
First Posted : April 14, 2021
Last Update Posted : April 14, 2021
Sponsor:
Collaborators:
Medical Research Council Unit, The Gambia
Ministerio de Saude Publica, Guinee-Bissau
Bandim Health Project
Instituto Nacional de Estudos e Pesquisas, Guinee-Bissau
Information provided by (Responsible Party):
London School of Hygiene and Tropical Medicine

Brief Summary:
This is a cluster-randomized placebo-controlled clinical trial to evaluate the additive benefit of Ivermectin (IVM) (or Placebo) mass drug administration (MDA) to dihydroartemisinin-piperaquine (DP) MDA for malaria control in a moderate to low malaria-endemic setting as an adjunctive strategy to existing programmatic malaria control measures. The regime of DP and IVM will target both human reservoirs of Plasmodium falciparum and the Anopheles gambiae vector respectively, with the aim of interrupting transmission. The trial will be conducted on the Bijagos Archipelago, where islands (clusters) will be randomised to receive seasonal DP and IVM or DP and Placebo MDA. The primary outcome will be the prevalence of infection with Plasmodium falciparum in all age groups detected by nucleic acid amplification testing during the peak malaria transmission season after two years of intervention.

Condition or disease Intervention/treatment Phase
Malaria,Falciparum Neglected Tropical Diseases Strongyloidiasis Lymphatic Filariasis Scabies Hook Worm Soil Transmitted Helminths Drug: Ivermectin Drug: Placebo Drug: Dihydroartemisinin-piperaquine Phase 3

Detailed Description:

The objectives of this trial are

  1. To evaluate the impact of adjunctive IVM to DP MDA on malaria transmission in communities with high ITN coverage.
  2. To evaluate the impact of IVM MDA on An. gambiae population density and age-structure.
  3. To evaluate the impact of IVM MDA on the prevalence of co-endemic IVM-susceptible Neglected Tropical Diseases (lymphatic filariasis, soil transmitted helminths and scabies)
  4. To evaluate acceptability, feasibility and access to MDA as a strategy for malaria control and to identify the most acceptable way of achieving and sustaining high coverage MDA with IVM and DP.

This cluster-randomized placebo-controlled trial has two arms. A total of 24 clusters will be randomly assigned to receive DP + IVM MDA or DP+ Placebo MDA using computer-generated random numbers. To mitigate against contamination effects, the majority of clusters will be separate islands and will be separated by distances greater than 2km. On the two islands that are divided (each into two clusters), a buffer zone of 2km between each cluster will be ensured. The total population of the archipelago is 24,000. The investigators will ensure balance between trial arms with respect to population size, baseline Plasmodium falciparum prevalence and access to health care. All clusters will receive the standard programmatic malaria control interventions implemented by the National Malaria Control Programme which includes insecticide-treated nets (ITN), intermittent preventative treatment in pregnancy (IPTp), seasonal malarial chemoprophylaxis (SMC) for children aged 3-59 months and case diagnosis and treatment (CDT) with Artemether-lumefantrine.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 24000 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: Two arms with clusters randomized to DP+IVM or DP+Placebo with a 1:1 ratio
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Masking Description: An independent statistician will randomize the clusters to DP+IVM or DP+Placebo. The Placebo is identical in size, shape and colour and packaging. An independent pharmacist at Medical Research Council Unit The Gambia @ London School of Hygiene and Tropical Medicine will label the IVM and Placebo according to the statistician's designation and maintain the masking from all other investigators. Specifically generated masking codes will be generated and saved in three separate encrypted locations securely. Only the statistician and the pharmacist will have access to the encryption key.
Primary Purpose: Treatment
Official Title: Adjunctive Ivermectin Mass Drug Administration for Malaria Control on the Bijagos Archipelago of Guinea Bissau: A Cluster-randomized Placebo-controlled Trial
Estimated Study Start Date : May 2021
Estimated Primary Completion Date : March 2023
Estimated Study Completion Date : August 2023


Arm Intervention/treatment
Experimental: Ivermectin Mass Drug Administration
Ivermectin and Dihydroartemisinin-piperaquine MDA will be given to all eligible participants in each cluster (island) in addition to the standard national malaria control programme interventions.
Drug: Ivermectin
Ivermectin will be given as tablets of 3 or 6mg. It will be given at 300-400μg/kg/day for 3 days (to the nearest whole tablet) each month for 3 months. It will be taken on an empty stomach with water.

Drug: Dihydroartemisinin-piperaquine
Dihydroartemisinin-piperaquine will be given as tablets of 320/40mg (adult) and 160/20mg (child) piperaquine/dihydroartemisinin per tablet. Administration of a full course of dihydroartemisinin-piperaquine will be given in accordance with the manufacturer's guidelines once daily for 3 days each month for 3 months according to body weight. Dihydroartemisinin-piperaquine will be taken by mouth with water and without food.
Other Name: Eurartesim

Placebo Comparator: Placebo Mass Drug Administration
Placebo and Dihydroartemisinin-piperaquine MDA will be given to all eligible participants in each cluster (island) in addition to the standard national malaria control programme interventions.
Drug: Placebo
Placebo will be given as tablets of 3 or 6mg (identical to Ivermectin in colour, size, shape and packaging). It will be given at 300-400μg/kg/day for 3 days (to the nearest whole tablet) each month for 3 months. It will be taken by mouth with water and without food.

Drug: Dihydroartemisinin-piperaquine
Dihydroartemisinin-piperaquine will be given as tablets of 320/40mg (adult) and 160/20mg (child) piperaquine/dihydroartemisinin per tablet. Administration of a full course of dihydroartemisinin-piperaquine will be given in accordance with the manufacturer's guidelines once daily for 3 days each month for 3 months according to body weight. Dihydroartemisinin-piperaquine will be taken by mouth with water and without food.
Other Name: Eurartesim




Primary Outcome Measures :
  1. Prevalence of infection with Plasmodium falciparum [ Time Frame: 2 years ]
    Prevalence of infection with Plasmodium falciparum in all age groups estimated using a cross-sectional survey sample conducted during peak transmission season after 2 years of intervention


Secondary Outcome Measures :
  1. Vector parous rate [ Time Frame: 7-14 days post-MDA ]
    Vector parous rate will be determined by assessment of mosquitoes trapped 7-14 days following MDA. Vector parity will be used to determine Anopheles gambiae age structure to estimate vector survival between arms.

  2. Prevalence of infection with Plasmodium falciparum [ Time Frame: 1 year ]
    Prevalence of infection with Plasmodium falciparum in all age groups estimated using a cross-sectional survey sample conducted after the first year of intervention

  3. Incidence of clinical malaria (Passive Case Detection) [ Time Frame: For six months during the malaria transmission season ]
    Incidence of clinical malaria diagnosed at health facilities confirmed by malaria Rapid Diagnostic Test

  4. Incidence of clinical malaria (Active Case Detection) [ Time Frame: For six months during the malaria transmission season ]
    Incidence of clinical malaria confirmed by malaria Rapid Diagnostic Test in a cohort of 50 children per cluster aged 5-14 years

  5. Age-adjusted prevalence of recent exposure to Plasmodium falciparum [ Time Frame: Peak transmission season at 1 year and 2 years ]
    Mean Median Fluorescence Intensity of serological markers associated with recent exposure to Plasmodium falciparum in all age groups estimated using a cross-sectional survey sample during peak transmission season after each year of intervention

  6. Vector density [ Time Frame: For six months during the malaria transmission season ]
    Total number of trapped mosquitoes per cluster

  7. Vector species composition [ Time Frame: For six months during the malaria transmission season ]
    Species characterisation using nucleic acid amplification tests as a proportion of total mosquitoes caught in traps

  8. Prevalence of exposure to Anopheles exposure [ Time Frame: Peak transmission season at 1 year and 2 years ]
    Mean Median Fluorescence Intensity of serological markers associated with exposure to Anopheles salivary antigen in all age groups estimated using a cross-sectional survey sample

  9. Vector sporozoite rates [ Time Frame: For six months during the malaria transmission season ]
    Proportion of Plasmodium falciparum circumsporozoite antibody (CSP) positive mosquitoes caught in traps

  10. Prevalence of Ivermectin-susceptible Neglected Tropical Diseases (NTDs) [ Time Frame: 2 years ]
    Prevalence of IVM-susceptible NTDs (scabies, strongyloides, other soil-transmitted helminths and lymphatic filariasis) and head lice using clinical and serological parameters estimated using a cross-sectional survey sample during the dry season after two years of intervention.

  11. MDA coverage estimates [ Time Frame: During MDA in year 1 and year 2 ]
    Cluster level coverage estimates calculated from MDA distribution and denominator census

  12. Prevalence of resistance to artemisinin and partner drugs in humans [ Time Frame: Peak transmission season at 1 year and at 2 years ]
    Prevalence of resistance to artemisinin and partner drugs in humans using molecular markers of resistance in all age groups estimated using a cross-sectional survey sample



Information from the National Library of Medicine

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Ages Eligible for Study:   6 Months and older   (Child, Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  1. Age over six months to receive dihydroartemisinin-piperaquine
  2. Height over 90cm or weight over 15kg to receive ivermectin or placebo
  3. Willingness to adhere to trial procedures
  4. Individual written, informed consent from the participant or parent/guardian in the case of participants below the age of 18 years (and assent in young people between the ages of 12 and 17 years of age)

Exclusion Criteria:

  1. Known severe chronic illness (AIDS, Tuberculosis, chronic malnutrition)
  2. Known hypersensitivity to either dihydroartemisinin-piperaquine or ivermectin
  3. Pregnancy (any trimester) and breastfeeding (for ivermectin (or placebo)) and pregnancy (first trimester only) (for dihydroartemisinin-piperaquine)
  4. Travel to a Loa loa endemic country (eg Central African Republic) (for ivermectin (or placebo))
  5. Concomitant drugs that influence cardiac function or affect the corrected QT interval (for dihydroartemisinin-piperaquine)

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04844905


Contacts
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Contact: Anna R Last, MBChB PhD 0044(0)2072770 ext 2770 anna.last@lshtm.ac.uk
Contact: David CW Mabey david.mabey@lshtm.ac.uk

Locations
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Guinea-Bissau
Bijagos Archipelago (islands)
Bissau, Guinea-Bissau
Contact: Amabelia Rodrigues, PhD       a.rodrigues@bandim.org   
Contact: Harry Hutchins, MBChB       harry.hutchins@lshtm.ac.uk   
Principal Investigator: Amabelia Rodrigues, PhD         
Sponsors and Collaborators
London School of Hygiene and Tropical Medicine
Medical Research Council Unit, The Gambia
Ministerio de Saude Publica, Guinee-Bissau
Bandim Health Project
Instituto Nacional de Estudos e Pesquisas, Guinee-Bissau
Investigators
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Principal Investigator: Anna R Last, MBChB PhD London School of Hygiene and Tropical Medicine
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Responsible Party: London School of Hygiene and Tropical Medicine
ClinicalTrials.gov Identifier: NCT04844905    
Other Study ID Numbers: 19156
First Posted: April 14, 2021    Key Record Dates
Last Update Posted: April 14, 2021
Last Verified: April 2021
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description: There is a manuscript in preparation detailing the study protocol and statistical analysis plan. The participant information and and informed consent form may be requested from the trial research team. Results and a clinical study report will be made available within six months of completion of the trial. Analytic code will be made available under a Creative Commons license. Publication of results will be open-access and available in pre-print on MedRxiv (The Preprint Server for Health Sciences).
Supporting Materials: Study Protocol
Statistical Analysis Plan (SAP)
Informed Consent Form (ICF)
Clinical Study Report (CSR)
Analytic Code
Time Frame: The study protocol and Statistical Analysis Plan (SAP) will be made available on acceptance of the manuscript for publication. Participant information and Informed Consent Form (ICF) will be made available from recruitment. Results (including Clinical Study Report (CSR)) will be made available within six months of completion of the trial.
Access Criteria: Study Protocol and Statistical Analysis Plan (SAP) will be published in an Open Access peer-reviewed journal. The participant information and and informed consent form may be requested from the trial research team. Results and a clinical study report will be made available within six months of completion of the trial. Analytic code will be made available under a Creative Commons license. Publication of results will be Open-Access and available in pre-print on MedRxiv (The Preprint Server for Health Sciences).

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No
Keywords provided by London School of Hygiene and Tropical Medicine:
Vector Control
Mass Drug Administration
Integrated Disease Control
Malaria
Guinea Bissau
West Africa
Antimalarials
Ivermectin
Dihydroartemisinin
Piperaquine
Additional relevant MeSH terms:
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Malaria
Malaria, Falciparum
Filariasis
Scabies
Elephantiasis, Filarial
Strongyloidiasis
Elephantiasis
Protozoan Infections
Parasitic Diseases
Infections
Vector Borne Diseases
Spirurida Infections
Secernentea Infections
Nematode Infections
Helminthiasis
Lymphedema
Lymphatic Diseases
Mite Infestations
Ectoparasitic Infestations
Skin Diseases, Parasitic
Skin Diseases, Infectious
Skin Diseases
Rhabditida Infections
Ivermectin
Piperaquine
Artenimol
Antiparasitic Agents
Anti-Infective Agents
Antimalarials
Antiprotozoal Agents