Providing at-risk communities with uninterrupted access to early diagnosis and treatment is a key component in reducing malaria transmission and achieving elimination. As programmes approach malaria elimination targets it is critical that each case is tested and treated early, which may present a challenge when the burden of malaria is reduced. In this paper we investigate whether malaria testing rates decline over time and assess the impacts of integrating malaria and non-malaria services on testing rates in the malaria elimination task force (METF) programme in the Kayin state of Myanmar. A retrospective analysis was conducted using weekly collected data on testing rates from a network of more than 1200 malaria posts during the period from 2014 to 2020. To determine whether monthly testing rates changed over the years of programme operations, and whether integrating malaria and non-malaria services impacted these testing rates, we fitted negative binomial mixed-effects regression models to aggregate monthly data, accounting for malaria seasonal variation. In the first year of malaria post operation, testing rates declined, correlating with a decline in attendance by people from outside the malaria post catchment area, but then remained fairly constant (the Rate Ratio (RR) for 2nd versus 1st year open ranged from 0.68 to 0.84 across the four townships included in the analysis, the RR for 3rd to 6th year versus 1st year open were similar, ranging from 0.59–0.78). The implementation of a training programme, which was intended to expand the role of the malaria post workers, had minimal impact on testing rates up to 24 months after training was delivered (RR for integrated versus malaria-only services ranged from 1.00 to 1.07 across METF townships). Despite the decline in malaria incidence from 2014 to 2020, there has been no decline in the malaria testing rate in the METF programme after the establishment of the complete malaria post network in 2016. While the integration of malaria posts with other health services provides benefits to the population, our evaluation questions the necessity of integrated services in maintaining malaria testing rates in areas approaching elimination of malaria.

中文翻译：

---

缅甸东部消除疟疾检测率的纵向趋势：一项为期 7 年的观察性研究

为高危社区提供不间断的早期诊断和治疗是减少疟疾传播和实现消除疟疾的关键组成部分。随着计划接近消除疟疾的目标，对每个病例​​进行早期检测和治疗至关重要，这在减轻疟疾负担时可能会带来挑战。在本文中，我们调查了疟疾检测率是否会随着时间的推移而下降，并评估整合疟疾和非疟疾服务对缅甸克伦邦消除疟疾工作组 (METF) 计划中检测率的影响。使用每周收集的 2014 年至 2020 年期间从 1200 多个疟疾站网络收集的检测率数据进行了回顾性分析。以及整合疟疾和非疟疾服务是否会影响这些检测率，我们拟合了负二项式混合效应回归模型来汇总月度数据，说明疟疾的季节性变化。在实施疟疾后的第一年，检测率下降，这与来自疟疾后集水区以外的人的出勤率下降有关，但随后保持相当稳定（第二年与第一年开放的比率 (RR) 范围为 0.68分析中包括的四个乡镇的 RR 为 0.84，第 3 至第 6 年与第 1 年开放的 RR 相似，范围为 0.59-0.78）。实施旨在扩大疟疾邮政工作人员作用的培训计划，在提供培训后的 24 个月内对测试率的影响最小（在 METF 镇中，综合服务与仅疟疾服务的 RR 范围为 1.00 到 1.07）。尽管 2014 年至 2020 年疟疾发病率有所下降，但在 2016 年建立完整的疟疾邮政网络后，METF 计划中的疟疾检测率并没有下降。虽然疟疾邮政与其他卫生服务的整合为人口，我们的评估质疑综合服务在接近消除疟疾的地区维持疟疾检测率的必要性。