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The contribution of active case detection to malaria elimination in Thailand

INTRODUCTION: Thailand’s malaria surveillance system complements passive case detection with active case detection (ACD), comprising proactive ACD (PACD) methods and reactive ACD (RACD) methods that target community members near index cases. However, it is unclear if these resource-intensive surveil...

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Autores principales: Kitchakarn, Suravadee, Naowarat, Sathapana, Sudathip, Prayuth, Simpson, Hope, Stelmach, Rachel, Suttiwong, Chalita, Puengkasem, Sombat, Chanti, Worawut, Gopinath, Deyer, Kanjanasuwan, Jerdsuda, Tipmontree, Rungrawee, Pinyajeerapat, Niparueradee, Sintasath, David, Bisanzio, Donal, Shah, Jui A
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10632818/
https://www.ncbi.nlm.nih.gov/pubmed/37940203
http://dx.doi.org/10.1136/bmjgh-2023-013026
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author Kitchakarn, Suravadee
Naowarat, Sathapana
Sudathip, Prayuth
Simpson, Hope
Stelmach, Rachel
Suttiwong, Chalita
Puengkasem, Sombat
Chanti, Worawut
Gopinath, Deyer
Kanjanasuwan, Jerdsuda
Tipmontree, Rungrawee
Pinyajeerapat, Niparueradee
Sintasath, David
Bisanzio, Donal
Shah, Jui A
author_facet Kitchakarn, Suravadee
Naowarat, Sathapana
Sudathip, Prayuth
Simpson, Hope
Stelmach, Rachel
Suttiwong, Chalita
Puengkasem, Sombat
Chanti, Worawut
Gopinath, Deyer
Kanjanasuwan, Jerdsuda
Tipmontree, Rungrawee
Pinyajeerapat, Niparueradee
Sintasath, David
Bisanzio, Donal
Shah, Jui A
author_sort Kitchakarn, Suravadee
collection PubMed
description INTRODUCTION: Thailand’s malaria surveillance system complements passive case detection with active case detection (ACD), comprising proactive ACD (PACD) methods and reactive ACD (RACD) methods that target community members near index cases. However, it is unclear if these resource-intensive surveillance strategies continue to provide useful yield. This study aimed to document the evolution of the ACD programme and to assess the potential to optimise PACD and RACD. METHODS: This study used routine data from all 6 292 302 patients tested for malaria from fiscal year 2015 (FY15) to FY21. To assess trends over time and geography, ACD yield was defined as the proportion of cases detected among total screenings. To investigate geographical variation in yield from FY17 to FY21, we used intercept-only generalised linear regression models (binomial distribution), allowing random intercepts at different geographical levels. A costing analysis gathered the incremental financial costs for one instance of ACD per focus. RESULTS: Test positivity for ACD was low (0.08%) and declined over time (from 0.14% to 0.03%), compared with 3.81% for passive case detection (5.62%–1.93%). Whereas PACD and RACD contributed nearly equal proportions of confirmed cases in FY15, by FY21 PACD represented just 32.37% of ACD cases, with 0.01% test positivity. Each geography showed different yields. We provide a calculator for PACD costs, which vary widely. RACD costs an expected US$226 per case investigation survey (US$1.62 per person tested) or US$461 per mass blood survey (US$1.10 per person tested). CONCLUSION: ACD yield, particularly for PACD, is waning alongside incidence, offering an opportunity to optimise. PACD may remain useful only in specific microcontexts with sharper targeting and implementation. RACD could be narrowed by defining demographic-based screening criteria rather than geographical based. Ultimately, ACD can continue to contribute to Thailand’s malaria elimination programme but with more deliberate targeting to balance operational costs.
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spelling pubmed-106328182023-11-10 The contribution of active case detection to malaria elimination in Thailand Kitchakarn, Suravadee Naowarat, Sathapana Sudathip, Prayuth Simpson, Hope Stelmach, Rachel Suttiwong, Chalita Puengkasem, Sombat Chanti, Worawut Gopinath, Deyer Kanjanasuwan, Jerdsuda Tipmontree, Rungrawee Pinyajeerapat, Niparueradee Sintasath, David Bisanzio, Donal Shah, Jui A BMJ Glob Health Original Research INTRODUCTION: Thailand’s malaria surveillance system complements passive case detection with active case detection (ACD), comprising proactive ACD (PACD) methods and reactive ACD (RACD) methods that target community members near index cases. However, it is unclear if these resource-intensive surveillance strategies continue to provide useful yield. This study aimed to document the evolution of the ACD programme and to assess the potential to optimise PACD and RACD. METHODS: This study used routine data from all 6 292 302 patients tested for malaria from fiscal year 2015 (FY15) to FY21. To assess trends over time and geography, ACD yield was defined as the proportion of cases detected among total screenings. To investigate geographical variation in yield from FY17 to FY21, we used intercept-only generalised linear regression models (binomial distribution), allowing random intercepts at different geographical levels. A costing analysis gathered the incremental financial costs for one instance of ACD per focus. RESULTS: Test positivity for ACD was low (0.08%) and declined over time (from 0.14% to 0.03%), compared with 3.81% for passive case detection (5.62%–1.93%). Whereas PACD and RACD contributed nearly equal proportions of confirmed cases in FY15, by FY21 PACD represented just 32.37% of ACD cases, with 0.01% test positivity. Each geography showed different yields. We provide a calculator for PACD costs, which vary widely. RACD costs an expected US$226 per case investigation survey (US$1.62 per person tested) or US$461 per mass blood survey (US$1.10 per person tested). CONCLUSION: ACD yield, particularly for PACD, is waning alongside incidence, offering an opportunity to optimise. PACD may remain useful only in specific microcontexts with sharper targeting and implementation. RACD could be narrowed by defining demographic-based screening criteria rather than geographical based. Ultimately, ACD can continue to contribute to Thailand’s malaria elimination programme but with more deliberate targeting to balance operational costs. BMJ Publishing Group 2023-11-08 /pmc/articles/PMC10632818/ /pubmed/37940203 http://dx.doi.org/10.1136/bmjgh-2023-013026 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Original Research
Kitchakarn, Suravadee
Naowarat, Sathapana
Sudathip, Prayuth
Simpson, Hope
Stelmach, Rachel
Suttiwong, Chalita
Puengkasem, Sombat
Chanti, Worawut
Gopinath, Deyer
Kanjanasuwan, Jerdsuda
Tipmontree, Rungrawee
Pinyajeerapat, Niparueradee
Sintasath, David
Bisanzio, Donal
Shah, Jui A
The contribution of active case detection to malaria elimination in Thailand
title The contribution of active case detection to malaria elimination in Thailand
title_full The contribution of active case detection to malaria elimination in Thailand
title_fullStr The contribution of active case detection to malaria elimination in Thailand
title_full_unstemmed The contribution of active case detection to malaria elimination in Thailand
title_short The contribution of active case detection to malaria elimination in Thailand
title_sort contribution of active case detection to malaria elimination in thailand
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10632818/
https://www.ncbi.nlm.nih.gov/pubmed/37940203
http://dx.doi.org/10.1136/bmjgh-2023-013026
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