Surveillance and response for high-risk populations: what can malaria elimination programmes learn from the experience of HIV?

Abstract

To eliminate malaria, malaria programmes need to develop new strategies for surveillance and response appropriate for the changing epidemiology that accompanies transmission decline, in which transmission is increasingly driven by population subgroups whose behaviours place them at increased exposure. Conventional tools of malaria surveillance and response are likely not sufficient in many elimination settings for accessing high-risk population subgroups, such as mobile and migrant populations (MMPs), given their greater likelihood of asymptomatic infections, illegal risk behaviours, limited access to public health facilities, and high mobility including extended periods travelling away from home. More adaptive, targeted strategies are needed to monitor transmission and intervention coverage effectively in these groups. Much can be learned from HIV programmes’ experience with “second generation surveillance”, including how to rapidly adapt surveillance and response strategies to changing transmission patterns, biological and behavioural surveys that utilize targeted sampling methods for specific behavioural subgroups, and methods for population size estimation. This paper reviews the strategies employed effectively for HIV programmes and offers considerations and recommendations for adapting them to the malaria elimination context.

Defining Malaria Risks Among Forest Workers in Aceh, Indonesia: A Formative Assessment

“…Their treatment-seeking behaviours provide insights for the Indonesian malaria programme, as the country prepares for malaria elimination in 2030. Globally, as national malaria programs seek to address suspected high-risk groups with which they have little previous familiarity, rapid, formative assessment studies such as this one are an increasingly relevant rst step to crafting effective elimination strategies [8,15], as they have been in the HIV context [17][18][19].…”

“…The IDI's and FG's followed semi-structured interview guides tailored to each respondent group, which explored work and mobility patterns in the forest as well as behavioural exposures related to malaria. In addition, interviewers detailed two potential methods for conducting screening and/or behavioural surveys of forest workers [15], including peer-referral (PR) and venue-based (VB) recruitment; participants were then asked to discuss the viability of each method.…”

Defining malaria risks among forest workers in Aceh, Indonesia: A formative assessment

“…Their treatment-seeking behaviours provide insights for the Indonesian malaria programme, as the country prepares for malaria elimination in 2030. Globally, as national malaria programs seek to address suspected high-risk groups with which they have little previous familiarity, rapid, formative assessment studies such as this one are an increasingly relevant rst step to crafting effective elimination strategies [8,15], as they have been in the HIV context [19][20][21].…”

“…The guides tailored to each respondent group, which explored work and mobility patterns in the forest as well as behavioural exposures related to malaria. In addition, interviewers detailed two potential methods for conducting screening and/or behavioural surveys of forest workers [15], including peer-referral (PR) and venue-based (VB) recruitment; participants were then asked to discuss the feasibility of each method.…”

Social network strategy as a promising intervention to better reach key populations for promoting HIV prevention: a systematic review and meta-analysis

“…However, these interventions alone are not sufficient because they neglect the importance of the construction and characteristics of the interpersonal social network that are closely associated with HIV transmission 8. Moreover, those high-risk populations are hard to reach by conventional sampling because they are relatively small, have privacy concerns or lack of a sampling frame 9. Social network strategy (SNS) is an intervention that works through the connections among at-risk people, and the network characteristics of those populations, such as network size, density and the length of time network members have known each other, have been found to be related to drug use and sexual risk behaviour, as well as HIV serostatus 10.…”