Focal Mass Drug Administration for the Prevention of Malaria in Pregnancy

The scientific objective of this pilot study is to demonstrate the feasibility, acceptability, and preliminary effectiveness of a focal mass drug administration program for household members of pregnant women to protect against Malaria in Pregnancy. The hypothesis is that eliminating the parasite reservoir within the household will provide a complementary layer of protection against Malaria in Pregnancy especially when access to care is limited and visits may be delayed or missed.

Aim 1: Determine the feasibility and acceptability of a Focal Mass Drug Administration program with dihydroartemisinin-piperaquine as a novel component of the Malaria in Pregnancy prevention package. The study team will conduct an open-label, randomized pilot study at a primary health center in rural western Uganda. The household members of women presenting to their first antenatal Clinic visit will be randomized 1:1:1: to (i) control (ii) one-time Focal Mass Drug Administration, or (iii) monthly Focal Mass Drug Administration. Using an established implementation framework, the study team will assess process measures such as the proportion of household members reached, willingness to take Dihydroartemisinin Piperaquine, adherence to the course of treatment, and frequency of adverse events.

Aim 2: Estimate the efficacy of Focal Mass Drug Administration to create a "safe zone" in the immediate home environment and ultimately prevent Malaria in Pregnancy. Using the study design outlined in Aim 1, The study team will follow participating pregnant women and associated households through delivery, including longitudinal assessments of P. falciparum infection. As a pilot study, the trial is deliberately not powered for statistical tests of significance, but The study team will measure the incidence of (i) clinical malaria, defined as the presence of typical symptoms (e.g., fever, lethargy) and a positive malaria rapid diagnostic test (Rapid Diagnostic Test), (ii) asymptomatic P. falciparum parasitemia and placental malaria by Polymerase Chain Reaction throughout pregnancy and (iii) the incidence of adverse birth outcomes (e.g., stillbirth, low birth weight). In addition, the study team will measure the prevalence of asymptomatic parasitemia in household members using Rapid Diagnostic Tests at three time points to estimate the effectiveness of Focal Mass Drug Administration at maintaining a parasite-free zone

• Percent of household members enrolled [Time frame: At enrollment visit (Day 1)]
• Refusal to receive fMDA [Time frame: Day 1 to study completion, generally 5 months]
• fMDA Adherence [Time frame: Day 1 to study completion, generally 5 months]
• P. falciparum parasitemia among household members [Time frame: Day 1 to study completion, generally 5 months]
• P. falciparum parasitemia among pregnant women [Time frame: Day 1 to study completion, generally 5 months]
• P. falciparum parasitemia in peripheral and placental blood at delivery [Time frame: At time of birth/delivery]
• Clinical malaria incidence among pregnant women [Time frame: Day 1 to study completion, generally 5 months]
• Maternal anemia [Time frame: Day 1 to study completion, generally 5 months]
• Adverse birth outcomes [Time frame: Day 1 to study completion, generally 5 months]
• Co-occurrence of malaria parasitemia in mother and household members [Time frame: Day 1 to study completion, generally 5 months]
• Number of adverse reactions to DP [Time frame: Day 1 to study completion, generally 5 months]