Targeted Active Case Detection Among High Risk Populations in Southern Lao Peoples Democratic Republic

This study is the second phase of work in Champasak Province, Southern Lao PDR, building off
a formative phase of work that characterized the demographics, occupations, migratory
patterns, health-seeking behaviors, and social networks of mobile and migrant populations
(MMPs) in four target districts. This phase of the study now aims to determine the
effectiveness, cost-effectiveness, acceptability, and feasibility of proactive targeted
test-and-treat activities using high-sensitivity malaria rapid diagnostic tests (HS-RDTs) for
reducing Plasmodium falciparum malaria transmission in Champasak Province among (1) village
residents and (2) mobile and migrant populations (MMPs) and other high-risk populations
(HRPs).

The study will specifically assess the role of HS-RDTs, a diagnostic test that offers
potentially ~10-fold greater sensitivity than standard RDTs, in active case detection at both
the village-level and in forest-going HRPs for decreasing prevalence and incidence of P.
falciparum in target areas. The effectiveness of these interventions will be compared
independently and in combination against areas with no study interventions (standard of care)
over the course of implementation (planned for October 2017 - November 2018).

The two main study interventions are mass test and treat (MTAT) using HS-RDTs in
village-based populations, and peer navigator (PN) led focal test and treat (FTAT) using
HS-RDTs in forest based HRPs. Primary outcomes will include PCR-based P. falciparum
prevalence at endline. Following a baseline cross-sectional survey in November-December 2017,
the interventions will consist of 3 rounds of MTAT spaced throughout the year, with potential
to reduce to 2 based upon initial prevalence estimates, and ongoing FTAT by PNs among forest
and forest-fringe HRPs, with the primary evaluation to be conducted through an end-line
cross-sectional survey in November 2018.

Village Based MTAT

Inclusion Criteria

- All household members 18 months of age and older.

- Study participants include those in the 14 selected health center catchment areas
within the four target districts in Champasak Province, Southern Lao PDR; Moulapamook,
Panthampone, Sanamsaboun, and Soukhuma.

- Members of households who have provided informed consent will be included for blood
samples collection and treatment for identified malaria cases if meeting the
appropriate criteria.

Exclusion Criteria

- Household members less than 18 months of age will be excluded.

- Any individuals under the age of 18 months will be excluded from RDT testing and blood
collection.

Peer Naviagtor-Led FTAT

Inclusion Criteria

- All persons 15 years and older who have spent at least one night outside a formal
village in the past one month.

- Individuals must be 18 years and older and willing and able to provide consent to be
included in the peer navigator or study staff focus group discussions and key
informant interviews

- Study participants include those in the 14 selected health center catchment areas
within the four target districts in Champasak Province, Southern Lao PDR; Moulapamook,
Panthampone, Sanamsaboun, and Soukhuma

- High-risk populations in forested areas, rice field regions, plantations and any
informal settlements

- Individuals travelling into the HCCA who are willing and sufficiently able to
communicate with PNs to assess their eligibility

Exclusion criteria

- Individuals under the age of 18 will be excluded from peer navigator or study staff focus
group discussions and key informant interviews.