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BOHEMIA: Broad One Health Endectocide-based Malaria Intervention in Africa-a phase III cluster-randomized, open-label, clinical trial to study the safety and efficacy of ivermectin mass drug administration to reduce malaria transmission in two African settings

Abstract:
Background
Residual malaria transmission is the result of adaptive mosquito behavior that allows malaria vectors to thrive and sustain transmission in the presence of good access to bed nets or insecticide residual spraying. These behaviors include crepuscular and outdoor feeding as well as intermittent feeding upon livestock. Ivermectin is a broadly used antiparasitic drug that kills mosquitoes feeding on a treated subject for a dose-dependent period. Mass drug administration with ivermectin has been proposed as a complementary strategy to reduce malaria transmission.
Methods
A cluster randomized, parallel arm, superiority trial conducted in two settings with distinct eco-epidemiological conditions in East and Southern Africa. There will be three groups: human intervention, consisting of a dose of ivermectin (400 mcg/kg) administered monthly for 3 months to all the eligible population in the cluster (>15 kg, non-pregnant and no medical contraindication); human and livestock intervention, consisting human treatment as above plus treatment of livestock in the area with a single dose of injectable ivermectin (200 mcg/kg) monthly for 3 months; and controls, consisting of a dose of albendazole (400 mg) monthly for 3 months. The main outcome measure will be malaria incidence in a cohort of children under five living in the core of each cluster followed prospectively with monthly RDTs
Discussion
The second site for the implementation of this protocol has changed from Tanzania to Kenya. This summary presents the Mozambique-specific protocol while the updated master protocol and the adapted Kenya-specific protocol undergo national approval in Kenya. BOHEMIA will be the first large-scale trial evaluating the impact of ivermectin-only mass drug administration to humans or humans and cattle on local malaria transmission
Trial registration
ClinicalTrials.govNCT04966702. Registered on July 19, 2021. Pan African Clinical Trials Registry PACTR202106695877303.
Publication status:
Published
Peer review status:
Peer reviewed

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Publisher copy:
10.1186/s13063-023-07098-2

Authors


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Role:
Author
ORCID:
0000-0001-9812-050X
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Role:
Author
ORCID:
0000-0003-4939-8411
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Role:
Author
ORCID:
0000-0003-0658-9330



Publisher:
BioMed Central
Journal:
Trials More from this journal
Volume:
24
Issue:
1
Article number:
128
Place of publication:
England
Publication date:
2023-02-21
Acceptance date:
2023-01-17
DOI:
EISSN:
1745-6215
Pmid:
36810194


Language:
English
Keywords:
Pubs id:
1330457
Local pid:
pubs:1330457
Deposit date:
2023-06-23

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