The US President's Malaria Initiative, Plasmodium falciparum transmission and mortality: A modelling study,PLOS Medicine

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The US President's Malaria Initiative, Plasmodium falciparum transmission and mortality: A modelling study
PLOS Medicine ( IF 10.5 ) Pub Date : 2017-11-21 , DOI: 10.1371/journal.pmed.1002448
Peter Winskill ₁ , Hannah C Slater ₁ , Jamie T Griffin ₂ , Azra C Ghani ₁ , Patrick G T Walker ₁

Affiliation

Background

Although significant progress has been made in reducing malaria transmission globally in recent years, a large number of people remain at risk and hence the gains made are fragile. Funding lags well behind amounts needed to protect all those at risk and ongoing contributions from major donors, such as the President’s Malaria Initiative (PMI), are vital to maintain progress and pursue further reductions in burden. We use a mathematical modelling approach to estimate the impact of PMI investments to date in reducing malaria burden and to explore the potential negative impact on malaria burden should a proposed 44% reduction in PMI funding occur.

Methods and findings

We combined an established mathematical model of Plasmodium falciparum transmission dynamics with epidemiological, intervention, and PMI-financing data to estimate the contribution PMI has made to malaria control via funding for long-lasting insecticide treated nets (LLINs), indoor residual spraying (IRS), and artemisinin combination therapies (ACTs). We estimate that PMI has prevented 185 million (95% CrI: 138 million, 230 million) malaria cases and saved 940,049 (95% CrI: 545,228, 1.4 million) lives since 2005. If funding is maintained, PMI-funded interventions are estimated to avert a further 162 million (95% CrI: 116 million, 194 million) cases, saving a further 692,589 (95% CrI: 392,694, 955,653) lives between 2017 and 2020. With an estimate of US$94 (95% CrI: US$51, US$166) per Disability Adjusted Life Year (DALY) averted, PMI-funded interventions are highly cost-effective. We also demonstrate the further impact of this investment by reducing caseloads on health systems. If a 44% reduction in PMI funding were to occur, we predict that this loss of direct aid could result in an additional 67 million (95% CrI: 49 million, 82 million) cases and 290,649 (95% CrI: 167,208, 395,263) deaths between 2017 and 2020. We have not modelled indirect impacts of PMI funding (such as health systems strengthening) in this analysis.

Conclusions

Our model estimates that PMI has played a significant role in reducing malaria cases and deaths since its inception. Reductions in funding to PMI could lead to large increases in the number of malaria cases and deaths, damaging global goals of malaria control and elimination.

中文翻译：

美国总统的疟疾倡议，恶性疟原虫的传播和死亡率：一项建模研究

背景

尽管近年来全球在减少疟疾传播方面取得了重大进展，但仍有大量人处于危险之中，因此取得的成果是脆弱的。资金远远落后于保护所有处于危险中的人所需的资金，而主要捐助者的持续捐款，如总统的疟疾倡议 (PMI)，对于保持进展和进一步减轻负担至关重要。我们使用数学建模方法来估计迄今为止 PMI 投资在减少疟疾负担方面的影响，并探讨如果 PMI 资金拟议减少 44% 时对疟疾负担的潜在负面影响。

方法和发现

我们结合建立的恶性疟原虫数学模型流行病学、干预和 PMI 融资数据的传播动态，以估计 PMI 通过资助长效杀虫剂处理的蚊帐 (LLIN)、室内滞留喷洒 (IRS) 和青蒿素联合疗法 (ACT) 对疟疾控制的贡献。我们估计，自 2005 年以来，PMI 已预防了 1.85 亿（95% CrI：1.38 亿、2.3 亿）疟疾病例并挽救了 940,049（95% CrI：545,228、140 万）生命。如果资金得以维持，PMI 资助的干预措施估计在 2017 年至 2020 年期间，避免了 1.62 亿（95% CrI：1.16 亿、1.94 亿）病例，进一步挽救了 692,589（95% CrI：392,694、955,653）人的生命。估计为 94 美元（95% CrI：51 美元） , 166 美元）每避免残疾调整生命年 (DALY)，PMI 资助的干预措施具有很高的成本效益。我们还通过减少卫生系统的病例数来展示这项投资的进一步影响。如果 PMI 资金减少 44%，我们预测这种直接援助的损失可能导致额外的 6700 万（95% CrI：4900 万、8200 万）病例和 290,649 例（95% CrI：167,208、395,263） 2017 年至 2020 年之间的死亡人数。在此分析中，我们没有模拟 PMI 资金的间接影响（例如加强卫生系统）。