Investigating the impact of mass drug administration on Plasmodium falciparum population structure in the Bijagos Archipelago of Guinea-Bissau.

The World Health Organisation is committed to help reduce malaria deaths by 90% by 2030.

Although long-lasting insecticide treated bed nets (LLINs), rapid diagnostic tests (RDTs) and artemisinin-based medicines (ACT) are essential in reducing the death toll, they are insufficient.

A cluster randomised trial will assess the impact of mass drug administration (MDA) of an ACT (dihydroartemisinin-piperaquine, DP) and the mosquito-killing drug ivermectin (IVM) to tackle both human and mosquito reservoirs of malaria infection in Guinea-Bissau.

Nested within the trial, the proposed study aims to investigate (1) the origins, diversity, and drug resistance of P.falciparum, the malaria parasite, at the trial site before MDA is given, (2) the impact of MDA on parasite transmission and (3) characterisation and tracking of remaining parasites post-MDA.

Whole genome sequencing and genotyping - methods to read parasite genes - will be used to characterise and track parasites after MDA.

Antibodies to the parasite will also be investigated as a cost-effective alternative endpoint and sustainable surveillance tool.

The study hypothesis is that MDA will decrease P.falciparum transmission to very low levels leading to a decrease in the diversity and numbers of different types of P.falciparum parasites at the trial site.