Table 1.

Policy implications of the Southern and Central Africa International Centers of Excellence for Malaria Research (ICEMR)

Transmission Setting	ICEMR Scientific Findings	Policy Implications
Low-transmission setting in Choma District, Zambia	Low sensitivity of RDTs for both active and passive surveillance Inability to detect hrp2 deletions in Plasmodium falciparum due to low parasitemia Most secondary cases are located in the index household Exophilic understudied vectors	Focal drug administration in index case household would achieve similar results to more costly reactive test-and-treat (Component D) Risk based reactive test-and-treat strategies, such as targeting households near streams and other high-risk environmental features could improve efficiency of RTAT Targeted IRS at index case households identified through passive case detection Expand entomological surveillance to identify and characterize underrecognized vectors Continued use of hrp2 RDTs Need for evaluation of outdoor vector control interventions More efficient and effective reactive case detection and focus investigations using a “1-3-7” focal intervention guided by a malaria mapping application Accurate and timely data reporting, analysis, and use at all levels
High-transmission setting in Nchelenge District, Zambia	Peak abundance of An. funestus in the dry season Documentation of persistent pyrethroid resistance in both major vectors Modest impact of IRS on malaria burden Modest impact of ITNs on malaria burden High case fatality among hospitalized children with severe malaria Excess malaria-attributable deaths due to stockouts of essential medical supplies	Increase IRS and ITN coverage throughout the district, in part through improved community mobilization and engagement Change timing of the IRS to end of the rainy season before An. funestus peaks Avoid pyrethroid-based insecticides for IRS and switch to PBO ITNs Continue to monitor insecticide resistance to more recently deployed insecticides Improve integrated community case management and make prereferral rectal or intramuscular artemisinin available at satellite health facilities Strengthen supply chains for antimalarial medications and blood products
Border transmission setting in Mutasa District, Zimbabwe	Pyrethroid resistance Reduction in malaria incidence after switch to primiphos-methyl IRS Persistent malaria burden, particularly along the border with Mozambique	Monitor insecticide resistance Avoid use of pyrethroids for IRS and switch to PBO ITNs Monitor cross-border malaria transmission Work with neighboring countries to harmonize and improve malaria control strategies and minimize imported malaria

IRS = indoor residual spraying; ITN = insecticide treated nets; PBO = piperonyl butoxide; RDT = rapid diagnostic tests; RTAT = reactive test-and-treat.