Improving PRegnancy Outcomes With Intermittent preVEntive Treatment in Africa

IPTp With Dihydroartemisinin-piperaquine and Azithromycin for Malaria, Sexually Transmitted and Reproductive Tract Infections in Pregnancy in High Sulphadoxine-pyrimethamine Resistance Areas in Kenya, Malawi and Tanzania

This study evaluates the efficacy and safety of monthly intermittent preventive treatment using dihydroartemisinin piperaquine (DP) alone or in combination with azithromycin (AZ) compared to sulphadoxine-pyrimethamine (SP) for the prevention of malaria in pregnant women in the second and third trimester.

Intermittent preventive treatment with sulphadoxine-pyrimethamine (IPTp-SP) is one of the pillars of malaria prevention in pregnancy in sub-Saharan Africa, in addition to prompt case management and use of long lasting insecticide treated bednets. However, mounting resistance to SP by Plasmodium falciparum increasing renders IPTP-SP ineffective.

Two exploratory trials in Uganda and Kenya demonstrated that IPTp with DP was superior to IPTp-SP for the prevention of malaria infection in pregnancy. However, neither study was adequately powered to look at adverse birth outcomes. This study is a confirmatory efficacy trial in Malawi, Tanzania and Kenya to determine the efficacy and safety of IPTp with DP alone or in combination with AZ.

This will be a 3-arm trial, superiority, partial blinded, placebo controlled, randomized trial comparing IPTp with SP, versus IPTp with DP alone, and IPTp with DP+AZ with the following hypotheses:

• IPTp with DP is superior to IPTp with SP in preventing adverse pregnancy outcomes.
• The combination of DP with AZ further reduces adverse pregnancy outcomes compared to IPTp with DP alone.

Inclusion Criteria:

• Pregnant women between 16-28 weeks' gestation
• Viable singleton pregnancy
• Resident of the study area
• Willing to adhere to scheduled and unscheduled study visit procedures
• Willing to deliver in a study clinic or hospital
• Provide written informed consent

Exclusion Criteria:

• Multiple pregnancies (i.e. twin/triplets)
• HIV-positive
• Known heart ailment
• Severe malformations or non-viable pregnancy if observed by ultrasound
• History of receiving IPTp-SP during this current pregnancy
• Unable to give consent
• Known allergy or contraindication to any of the study drugs