Mass test and treat (MTaT) for malaria prevalence in a moderate transmission setting, a quasi-experimental trial from rural Ghana

Abstract A principal challenge to reducing malaria transmission is the high prevalence of asymptomatic infections, whereby individuals without clinical symptoms continue to infect mosquitoes and sustain community-level transmission. Mass test and treat (MTaT), which involves screening populations and treating infected individuals, may reduce this hidden human reservoir, but evidence of its effectiveness in moderate transmission settings is limited. We conducted a two-year quasi-experimental study in 11 communities in the Pakro subdistrict of Ghana’s Eastern Region, an area with moderate malaria transmission. Seven communities received the MTaT intervention, while four served as controls. The intervention involved five rounds of MTaT delivered through community case management by trained community health volunteers. Community members were screened using rapid diagnostic tests, and those who tested positive were treated with artemether–lumefantrine. The primary outcome was malaria prevalence measured by rapid diagnostic tests, particularly among children aged 15 years or younger. An intention-to-treat analysis using mixed-effects Poisson regression models was applied. A total of 5,309 individuals participated, with 4,000 from intervention communities and 1,309 from control communities. MTaT coverage increased from 70.6% in March 2020 to 90.7% in March 2022. After adjusting for baseline malaria prevalence and insecticide-treated net use, overall malaria prevalence was 84% (aPR) of 0.16, 95% CI: 0.13–0.20, p < 0.001) lower in intervention communities than in controls. Among children aged 15 years or younger, prevalence was reduced by 89% (aPR = 0.11, 95% CI: 0.08–0.14; p < 0.001), while among individuals older than 15 years, prevalence was 74% (aPR = 0.26, 95% CI: 0.18–0.33; p < 0.001) lower in intervention communities. In conclusion, our findings suggest that implementation of MTaT over two years could contribute to reduction in malaria prevalence across all age groups in a moderate transmission setting. This approach could be considered as an effective strategy for reducing malaria burden and transmission in similar settings. Trial registration : NCT04301531, Date of Registration 03/04/2020. https://register.clinicaltrials.gov/prs/beta/records .