Haiti’s Commitment to Malaria Elimination: Progress in the Face of Challenges, 2010–2016

Lemoine, Jean Frantz; Boncy, Jacques; Filler, Scott; Kachur, S. Patrick; Fitter, David; Chang, Michelle

doi:10.4269/ajtmh.16-0902

Cited by 39 publications

(52 citation statements)

References 26 publications

(23 reference statements)

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“…These distinctive characteristics, along with the threat of emerging resistance to chloroquine [ 17 ] and renewed international attention towards shrinking the world malaria map [ 18 ], have led the Haitian and Dominican governments to commit to eliminating malaria by 2020 [ 19 ]. Over the last few years, several malaria prevention and diagnosis measures were adopted by Haiti’s Ministry of Public Health and Population, notably: adoption of rapid diagnostic tests (RDTs), drug-resistance monitoring, addition of primaquine to chloroquine as first-line therapy, establishment of an insectary and insecticide-resistance monitoring, implementation of surveillance sentinel sites, and strengthening of molecular and serological testing capacity at the national public health laboratory [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

“Wherever doctors cannot reach, the sunshine can”: overcoming potential barriers to malaria elimination interventions in Haiti

Druetz

Andrinopoulos

Boulos³

et al. 2018

Malar J

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BackgroundHaiti and the Dominican Republic, the only two Caribbean countries with endemic malaria transmission, are committed to eliminating malaria. With a Plasmodium falciparum prevalence under 1% and a highly focal transmission, the efforts towards elimination in Haiti will include several community-based interventions that must be tailored to the local sociocultural context to increase their uptake. However, little is known about local community perceptions regarding malaria and the planned elimination interventions. The aim of this study is to develop a robust understanding of how to tailor, implement and promote malaria elimination strategies in Haiti.MethodsA cross-sectional qualitative study was conducted December 2015–August 2016 in Grande-Anse and the North Department in Haiti. Data collection included key informant interviews (n = 51), in-depth interviews (n = 15) and focus group discussions (n = 14) with health workers, traditional healers, teachers, priests or pastors, informal community leaders, public officials, and community members. Following a grounded theory approach, transcripts were coded and analysed using content analysis. Coded text was sorted by the types of interventions under consideration by the malaria elimination programme.ResultsThe level of knowledge about malaria was low. Many participants noted community beliefs about malaria being caused by magical phenomena in addition to vector-borne transmission. Participants described malaria as a problem rooted in the environment, with vector control the most noted method of prevention. Though participants noted malaria a severe disease, it ranked lower than other health problems perceived as more acute. Access barriers to healthcare were described including a lack of bed nets. Some distrust about pills, tests, and foreigners in general was expressed, and in few cases linked to previous experience with malaria campaigns under dictatorial regimes.ConclusionsThere are several potential barriers and opportunities to implement community-based malaria elimination interventions in rural Haiti. Elimination efforts should include the collaboration of voodoo priests and other traditional healers, be coupled with solutions to wider community concerns or other health interventions, and learn from previous or similar programmes, such as the campaign to eliminate lymphatic filariasis. It is essential to engage with communities and gain their trust to successfully implement targeted aggressive elimination activities.Electronic supplementary materialThe online version of this article (10.1186/s12936-018-2553-5) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

“Wherever doctors cannot reach, the sunshine can”: overcoming potential barriers to malaria elimination interventions in Haiti

Druetz

Andrinopoulos

Boulos³

et al. 2018

Malar J

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“…Because this study demonstrated a substantial gain of additionally detected low-density infections, particularly in low transmission settings, us-qPCR could be crucial for surveillance in elimination settings. Molecular diagnosis is increasingly used to determine presence of infections to guide control efforts [26]. The use of us-qPCR, and thus greater con dence in diagnostic metrics, could reduce the number of samples to be screened before declaring a region malariafree.…”

Section: Discussionmentioning

confidence: 99%

Utility of ultra-sensitive qPCR to detect Plasmodium falciparum and Plasmodium vivax infections under different transmission intensities

Gruenberg

Moniz

Hofmann³

et al. 2020

Preprint

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Background The use of molecular diagnostics has revealed an unexpectedly large number of asymptomatic low-density malaria infections in many malaria endemic areas. This study compared the gains in parasite prevalence obtained by the use of ultra-sensitive (us)-qPCR as compared to standard qPCR in cross sectional surveys conducted in Thailand, Brazil and Papua New Guinea (PNG). The compared assays differed in the copy number of qPCR targets in the parasite genome. Methods Plasmodium falciparum ( Pf ) and Plasmodium vivax ( Pv ) parasites were quantified by qPCR amplifying the low-copy Pf_ and Pv _18S rRNA genes or the multi-copy targets Pf _varATS and Pv _mtCOX1. Cross-sectional surveys at the three study sites included 2252 participants of all ages and represented different transmission intensities. Results In the two low-transmission areas, P. falciparum positivity was 1.3% (10/773) (Thailand) and 0.8% (5/651) (Brazil) using standard Pf _18S rRNA qPCR. In these two countries, P. falciparum positivity by Pf_ varATS us-qPCR increased to 1.9% (15/773) and 1.7% (11/651). In PNG, an area with moderate transmission intensity, P. falciparum positivity significantly increased from 8.6% (71/828) by standard qPCR to 12.2% (101/828) by us-qPCR. The proportions of P. falciparum infections not detected by standard qPCR were 33%, 55% and 30% in Thailand, Brazil and PNG. Plasmodium vivax was the predominating species in Thailand and Brazil, with 3.9% (30/773) and 4.9% (32/651) positivity by Pv _18S rRNA qPCR. In PNG, P. vivax positivity was similar to P. falciparum , at 8.0% (66/828). Use of Pv _mtCOX1 us-qPCR led to a significant increase in positivity to 5.1% (39/773), 6.4% (42/651) and 11.5% (95/828) in Thailand, Brazil, and PNG. The proportions of P. vivax infections missed by standard qPCR were similar at all three sites, with 23%, 24% and 31% in Thailand, Brazil and PNG. Conclusion The proportional gains in the detection of P. falciparum and P. vivax infections by ultra-sensitive diagnostic assays were substantial at all three study sites. Thus, us-qPCR yields more precise prevalence estimates for both P. falciparum and P. vivax at all studied levels of endemicity and represents a significant diagnostic improvement. Improving sensitivity in P. vivax surveillance by us-qPCR is of particular benefit, because the additionally detected P. vivax infections signal the potential presence of hypnozoites and subsequent risk of relapse and further transmission.

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“…Light microscopy is dictated as the gold standard for malaria diagnosis by the Haitian Ministry of Health; however, after allowing the alternative use of rapid diagnostic tests (RDT) in recent years, they are more widely used [3,24,25].…”

Section: Study Sitesmentioning

confidence: 99%

“…In the Americas, Paraguay and Argentina achieved malaria elimination [1,2]. Apart from El Salvador, there remain 18 malaria-endemic countries and territories in the Americas, which includes only 2 in the Caribbean: the Dominican Republic and Haiti, on the sole island of Hispaniola on which malaria elimination is also considered feasible [3]. Plasmodium falciparum is the endemic species, transmission is mainly focal, and the annual incidence was < 1% in Haiti and reached < 0.1% in 2018 whereas < 1000 cases were reported for the Dominican Republic [1,4].…”

Section: Introductionmentioning

confidence: 99%

Performance of PURE-LAMP to Detect Declining Prevalence of Malaria in Haiti

Vincent

Existe

Komaki-Yasuda

et al. 2020

Preprint

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Background Malaria continues to cause burden in various parts of the world. Endemic countries are developing schemes to end this nuisance in accordance with the World Health Organization’s Global Technical Strategy for Malaria 2016–2030. Haiti, a Caribbean country, is among those aiming to eliminate malaria within a few years. Two surveys were conducted in Haiti in the summers of 2017 and 2018, respectively, during which we aimed to evaluate the performance of the simple and rapid PURE-LAMP (procedure for ultra-rapid extraction–loop-mediated isothermal amplification) method with dried blood spots as an alternative diagnostic method for malaria in the context of low to very low rates of transmission.Methods Febrile and asymptomatic subjects were recruited from three administrative divisions within Haiti. Their blood samples were tested by microscopy, rapid diagnostic tests (RDT), PURE-LAMP and nested PCR to detect Plasmodium infection. The positive rates for the two study periods as determined by the different methods were compared. Sensitivity, specificity, positive and negative predictive values and kappa statistics were estimated with the nested PCR results as the gold standard.Results Among 1074 samples analyzed, a positive rate of 8.3% was calculated based on the nested PCR results. Among symptomatic subjects, the rates in 2017 and 2018 were 14.6% and 1.4%, respectively. Three positives were detected among 172 asymptomatic participants in 2018 by PURE-LAMP and nested PCR, and all three were from the same locality. No asymptomatic subjects were recruited in 2017. The PURE-LAMP, RDT and microscopy had respective sensitivities of 100%, 85.4% and 49.4%. All of the testing methods had specificities over 99%.Conclusion The prevalence of malaria was found to have substantially decreased in 2018 in Haiti. A specific focus of infection appeared to require intervention with a sensitive malaria diagnostic method and treatment. This study confirmed the high performance of the PURE-LAMP method with dried blood spots and recommends its use in targeted mass screening and treatment activities in low endemic areas of malaria.

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Haiti’s Commitment to Malaria Elimination: Progress in the Face of Challenges, 2010–2016

Cited by 39 publications

References 26 publications

“Wherever doctors cannot reach, the sunshine can”: overcoming potential barriers to malaria elimination interventions in Haiti

“Wherever doctors cannot reach, the sunshine can”: overcoming potential barriers to malaria elimination interventions in Haiti

Utility of ultra-sensitive qPCR to detect Plasmodium falciparum and Plasmodium vivax infections under different transmission intensities

Performance of PURE-LAMP to Detect Declining Prevalence of Malaria in Haiti

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