CUREMA project: a further step towards malaria elimination among hard-to-reach and mobile populations

• Published in: Malaria Journal
• Main Authors: Alice Sanna, Yann Lambert, Irene Jimeno Maroto, Muriel Suzanne Galindo, Lorraine Plessis, Teddy Bardon, Carlotta Carboni, Jane Bordalo, Helene Hiwat, Hedley Cairo, Lise Musset, Yassamine Lazrek, Stéphane Pelleau, Michael White, Martha Suárez Mutis, Stephen Vreden, Maylis Douine
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMC 2024
• Subjects: Malaria; Elimination; Research protocol; Public health intervention; Cross-border; Mobility; Arctic medicine. Tropical medicine; RC955-962; Infectious and parasitic diseases; RC109-216; Arctic; Pillar
• Online Access: https://doi.org/10.1186/s12936-024-05040-8; https://doaj.org/article/b576ddab88304c78b3258f99a5f37fb3

Abstract Background In most countries engaged on the last mile towards malaria elimination, residual transmission mainly persists among vulnerable populations represented by isolated and mobile (often cross-border) communities. These populations are sometimes involved in informal or even illegal activities. In regions with Plasmodium vivax transmission, the specific biology of this parasite poses additional difficulties related to the need for a radical treatment against hypnozoites to prevent relapses. Among hard-to-reach communities, case management, a pillar of elimination strategy, is deficient: acute malaria attacks often occur in remote areas, where there is limited access to care, and drugs acquired outside formal healthcare are often inadequately used for treatment, which typically does not include radical treatment against P. vivax. For these reasons, P. vivax circulation among these communities represents one of the main challenges for malaria elimination in many non-African countries. The objective of this article is to describe the protocol of the CUREMA study, which aims to meet the challenge of targeting malaria in hard-to-reach populations with a focus on P. vivax. Results CUREMA is a multi-centre, international public health intervention research project. The study population is represented by persons involved in artisanal and small-scale gold mining who are active and mobile in the Guiana Shield, deep inside the Amazon Forest. The CUREMA project includes a complex intervention composed of a package of actions: (1) health education activities; (2) targeted administration of treatment against P. vivax after screening against G6PD deficiency to asymptomatic persons considered at risk of silently carrying the parasite; (3) distribution of a self-testing and self-treatment kit (malakit) associated with user training for self-management of malaria symptoms occurring while in extreme isolation. These actions are offered by community health workers at settlements and neighbourhoods (often cross-border) ...