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Fitting of transmission intensities to individual households in four HFCAs shows a prominent role for transmission by subpatent individuals.. (A) Distribution of fitted household transmission intensities by HFCA. EIR: entomological inoculation rate, the number of infectious bites per person per year. Shaded areas indicate 95% confidence intervals from 100 stochastic realizations. (B) Household transmission intensity varied spatially within an HFCA. Geometric mean transmission intensity observed over 100 stochastic realizations. (C) Asexual parasite prevalence and infectious potential of constructed populations by HFCA, age, and detectability of asexual parasites by current RDTs, improved RDTs, and PCR, normalized to population 1000, on June 15. Here the infectious potential was defined as the number of mosquitoes that would be infected if 1000 mosquitoes were to feed on a village of 1000 people. Results shown are means of 100 stochastic realizations.
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Depleting the infectious reservoir was highly dependent on coverage and somewhat dependent on infection-detection strategy (Fig 3A, Table 2).
Infection detection strategies differ in ability to reduce transmission.. (A) Success of infection detection strategies at depleting the infectious reservoir. Fraction of infectious reservoir eliminated was defined as the decrease in infectious potential integrated over 30 days post-campaign. Results shown are means of 100 stochastic realizations per coverage level. (B) Success of infection detection strategies at averting new infections. Results shown are means of 100 stochastic realizations per coverage level. HFCA populations were normalized to 1000.
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Depleting the infectious reservoir was highly dependent on coverage and somewhat dependent on infection-detection strategy (Fig 3A, Table 2). To evaluate the reduction in transmission after deploying drug campaigns, we estimated the expected number of new infections that would be seeded in humans due to vectors becoming infected in the first 30 days post-campaign (Fig 3B).
Infection detection strategies differ in ability to minimize overtreatment.. (A) Success of infection detection strategies at finding infected individuals while avoiding overtreatment of uninfected individuals. Results shown are means of 100 stochastic realizations per coverage level. Ticks indicate 20% steps in coverage. (B) Success of infection detection strategies at averting clinical cases while minimizing overtreatment at 80% coverage. Results shown are means and 95% confidence intervals of 100 stochastic realizations per coverage level. HFCA populations were normalized to 1000.
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Fig 4A shows receiver operating characteristic (ROC) curves of fraction of infected individuals treated (true positive rate) vs fraction of uninfected individuals treated (false positive rate) for each of the infection detection strategies. To compare rates of clinical case prevention and overtreatment across HFCAs, we normalized populations to 1000 people and fixed coverage at 80%, a high but achievable rate (Fig 4B).
MDA and sensitive serological diagnostics are the most effective detection strategies for malaria elimination.. (A) Probability that less than one new infection is seeded from vectors infected in the 30 days post-campaign. Results shown are means of 1000 stochastic realizations per coverage level. (B) Success of infection detection strategies at finding infected individuals while minimizing overtreatment. Results shown are means of 1000 stochastic realizations per coverage level. Ticks indicate 20% steps in coverage.
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MDA was the most effective strategy for elimination, leading to high probability of less than 1 onward infection at lower coverage levels than the other infection detection strategies (Fig 5).