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| ID | Type | Description | Link |
|---|---|---|---|
| U19AI089674 | U.S. NIH Grant/Contract | View source |
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| Name | Class |
|---|---|
| National Institute of Allergy and Infectious Diseases (NIAID) | NIH |
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In Uganda, the National Malaria Control Division (NMCD) and implementing partners plan to deliver long-lasting insecticidal nets (LLINs) nationwide in 2020-21, through a mass distribution campaign supported by generous contributions from international donors. LLINs will be distributed free-of-charge to all Ugandan households, aiming to achieve universal coverage. The Against Malaria Foundation has agreed to provide LLINs treated with a pyrethroid insecticide plus pyriproxyfen (PPF) (Royal Guard, Disease Control Technology) and LLINs treated with a pyrethroid insecticide plus piperonyl butoxide (PBO) (PermaNet 3.0, Vestergaard), presenting an opportunity to rigorously evaluate and compare these two LLINs at scale across Uganda. In collaboration with the MOH, the investigators propose to embed a cluster-randomised trial to compare the impact of LLINs with PPF to LLINs with PBO into Uganda's 2020 LLIN distribution campaign. The primary objective of the study is: To evaluate the impact of LLINs treated with a pyrethroid insecticide plus pyriproxyfen (PPF LLINs), as compared to LLINs treated with a pyrethroid plus piperonyl butoxide (PBO LLINs), on malaria incidence in Uganda. The study will test the hypothesis that malaria incidence will be lower in intervention clusters (randomised to receive PPF LLINs) than in control clusters (randomised to receive PBO LLINs).
This rigorous, cluster-randomised trial will evaluate the impact of long-lasting insecticidal nets (LLINs) distributed in Uganda through the 2020-21 national universal coverage campaign. A cluster has been defined as the catchment area of a Malaria Reference Centre (MRC). A total of 64 clusters have been included in the study, covering 32 high malaria burden districts in Uganda where IRS is not being implemented. Clusters have been randomised in a 1:1 ratio in blocks of two by district to receive one of two types of LLINs: (1) pyriproxyfen (PPF) LLINs (Royal Guard) [n=32] and (2) piperonyl butoxide (PBO) LLINs (PermaNet 3.0) [n=32].
The intervention, including delivery of the LLINs and social and behaviour change communication (SBCC), will be led by the Ugandan National Malaria Control Division (NMCD) and other stakeholders. Currently, LLINs are scheduled to be delivered in the study areas from October 2020 to January 2021. The evaluation will include health facility surveillance at the MRCs to generate continuous estimates of malaria incidence for each MRC catchment area, cross-sectional community surveys at baseline (if additional resources are available), and at 12- and 24-months after LLIN distribution to gather information on net survivorship and use, and parasite prevalence in children 2-10 years of age, entomology surveys, and assessment of net durability and efficacy. The primary outcome of the trial will be malaria incidence as estimated using the health facility surveillance.
For each cluster the study will use a 'fried egg' approach for delivering the intervention ('egg white') and measuring our outcomes ('egg yolk'). The 'white' of the egg will include one sub-county per cluster, where the MRC is located. PPF LLINs and PBO LLINs will be distributed to the designated sub-county, as allocated in the randomisation. The 'yolk' of the egg will be the catchment area directly surrounding each MRC, where care-seeking at the MRC is expected to be high (i.e. if someone within the catchment area develops malaria, they are likely to seek care at the MRC). To determine the population of the MRC catchment areas, and to generate a sampling frame for the community surveys, the investigators will do the following: (1) define the catchment area of each MRC before the onset of the trial using data on village of residence from patients attending the MRCs, (2) map and enumerate all households within the MRC catchment areas before the 12-month community survey, and (3) conduct a census survey within each MRC catchment area to generate an accurate estimate of the study population in which study outcomes will be measured concurrently with the 12-month community survey.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Royal Guard | Experimental | alpha-cypermethrin + pyriproxyfen (PPF) |
|
| PermaNet 3.0 | Active Comparator | deltamethrin + piperonyl butoxide (PBO) |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| long lasting insecticidal nets with alpha-cypermethrin + pyriproxyfen (PPF LLIN, Royal Guard)) | Other | Next-generation bed net combining insecticides with different modes of action |
| Measure | Description | Time Frame |
|---|---|---|
| Malaria Incidence | Number of cases of laboratory-confirmed malaria diagnosed at the MRC among patients residing in the catchment areas per unit time/the population of the catchment areas | 24 months following LLIN distribution |
| Measure | Description | Time Frame |
|---|---|---|
| Prevalence of Parasitaemia | Proportion of children aged 2-10 years at the time of cross-sectional surveys with blood smears positive for parasites by microscopy | 12 months following LLIN distribution |
| Prevalence of Parasitaemia |
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A) Primary outcome: All patients who present to the outpatient departments of the MRCs
B) Community surveys for secondary outcomes:
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Sarah Staedke, MD, PhD | London School of Hygiene and Tropical Medicine | Principal Investigator |
| Moses Kamya, MBChB, MMed, PhD | Infectious Diseases Research Collaboration | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Infectious Diseases Research Collaboration | Kampala | Uganda |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 40009611 | Derived | Gonahasa S, Namuganga JF, Nassali MJ, Maiteki-Sebuguzi C, Nabende I, Epstein A, Snyman K, Nankabirwa JI, Opigo J, Donnelly MJ, Dorsey G, Kamya MR, Staedke SG. LLIN Evaluation in Uganda Project (LLINEUP2) - Effect of long-lasting insecticidal nets (LLINs) treated with pyrethroid plus pyriproxyfen vs LLINs treated with pyrethroid plus piperonyl butoxide in Uganda: A cluster-randomised trial. PLOS Glob Public Health. 2025 Feb 26;5(2):e0003558. doi: 10.1371/journal.pgph.0003558. eCollection 2025. |
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Only participants in the MRC target areas who participated in cross sectional surveys were considered enrolled while all other persons living in the target areas were not enrolled.
Households from each of the 64 clusters was randomly selected for participation in each of the community surveys. Within each cluster (MRC target area), households were randomly sampled from a list of households enumerated by the study team, until 50 households with children aged 2-10 years were sampled per cluster.
| ID | Title | Description |
|---|---|---|
| FG000 | Royal Guard | alpha-cypermethrin + pyriproxyfen (PPF) long lasting insecticidal nets with alpha-cypermethrin + pyriproxyfen (PPF LLIN, Royal Guard)): Next-generation bed net combining insecticides with different modes of action Social behaviour change communication: SBCC activities will use digital and other platforms, similar to those used for the COVID-19 response, including the following: (1) LLIN launch on television and radio; (2) regional advocacy meetings on Zoom; (3) mass media platforms (for advertisements, mini skits, DJ mentions, radio spots, interactive talks); (4) social media platforms; (5) VHTs; (6) operation hotlines and toll-free call centres; (7) community mobilisation (megaphones); and (8) use of appropriate information, education, and communication materials. Communication will include messages about COVID-19, malaria, and use, care, repair and repurposing of LLINs. |
| FG001 | PermaNet 3.0 | deltamethrin + piperonyl butoxide (PBO) long lasting insecticidal nets with deltamethrin + piperonyl butoxide (PBO LLIN, PermaNet 3.0)): Next-generation bed net combining an insecticide with a synergist Social behaviour change communication: SBCC activities will use digital and other platforms, similar to those used for the COVID-19 response, including the following: (1) LLIN launch on television and radio; (2) regional advocacy meetings on Zoom; (3) mass media platforms (for advertisements, mini skits, DJ mentions, radio spots, interactive talks); (4) social media platforms; (5) VHTs; (6) operation hotlines and toll-free call centres; (7) community mobilisation (megaphones); and (8) use of appropriate information, education, and communication materials. Communication will include messages about COVID-19, malaria, and use, care, repair and repurposing of LLINs. |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 12 Month Cross Sectional Survey |
| |||||||||||||
| 24 Month Cross Sectional Period |
|
Estimated number of persons living in 64 MRC target areas used in primary outcome; only persons enrolled in cross-sectional surveys were consented and enrolled and included within this estimated number
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| ID | Title | Description |
|---|---|---|
| BG000 | Royal Guard | alpha-cypermethrin + pyriproxyfen (PPF) long lasting insecticidal nets with alpha-cypermethrin + pyriproxyfen (PPF LLIN, Royal Guard)): Next-generation bed net combining insecticides with different modes of action Social behaviour change communication: SBCC activities will use digital and other platforms, similar to those used for the COVID-19 response, including the following: (1) LLIN launch on television and radio; (2) regional advocacy meetings on Zoom; (3) mass media platforms (for advertisements, mini skits, DJ mentions, radio spots, interactive talks); (4) social media platforms; (5) VHTs; (6) operation hotlines and toll-free call centres; (7) community mobilisation (megaphones); and (8) use of appropriate information, education, and communication materials. Communication will include messages about COVID-19, malaria, and use, care, repair and repurposing of LLINs. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Malaria Incidence | Number of cases of laboratory-confirmed malaria diagnosed at the MRC among patients residing in the catchment areas per unit time/the population of the catchment areas | estimated number of residents of all ages from MRC target areas; these estimates came from routine surveillance data that did not involve consent or enrollment | Posted | Number | episodes of malaria over 24 months | 24 months following LLIN distribution |
|
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All-Cause Mortality, Serious, and Other (Not Including Serious) Adverse Events were not monitored/assessed.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Royal Guard | alpha-cypermethrin + pyriproxyfen (PPF) long lasting insecticidal nets with alpha-cypermethrin + pyriproxyfen (PPF LLIN, Royal Guard)): Next-generation bed net combining insecticides with different modes of action Social behaviour change communication: SBCC activities will use digital and other platforms, similar to those used for the COVID-19 response, including the following: (1) LLIN launch on television and radio; (2) regional advocacy meetings on Zoom; (3) mass media platforms (for advertisements, mini skits, DJ mentions, radio spots, interactive talks); (4) social media platforms; (5) VHTs; (6) operation hotlines and toll-free call centres; (7) community mobilisation (megaphones); and (8) use of appropriate information, education, and communication materials. Communication will include messages about COVID-19, malaria, and use, care, repair and repurposing of LLINs. |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Grant Dorsey | UCSF | 628-206-4680 | grant.dorsey@ucsf.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot | Yes | No | No | Study Protocol | Oct 17, 2023 | Jun 24, 2024 | Prot_000.pdf |
| SAP | No | Yes | No | Statistical Analysis Plan | Jan 25, 2023 | Jun 24, 2024 | SAP_001.pdf |
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| ID | Term |
|---|---|
| D008288 | Malaria |
| ID | Term |
|---|---|
| D011528 | Protozoan Infections |
| D010272 | Parasitic Diseases |
| D007239 | Infections |
| D000096724 | Mosquito-Borne Diseases |
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| ID | Term |
|---|---|
| C017160 | cypermethrin |
| C055613 | pyriproxyfen |
| C017180 | decamethrin |
| D010882 | Piperonyl Butoxide |
| ID | Term |
|---|---|
| D052117 | Benzodioxoles |
| D004149 | Dioxoles |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |
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cluster-randomised trial
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| long lasting insecticidal nets with deltamethrin + piperonyl butoxide (PBO LLIN, PermaNet 3.0)) | Other | Next-generation bed net combining an insecticide with a synergist |
|
| Social behaviour change communication | Behavioral | SBCC activities will use digital and other platforms, similar to those used for the COVID-19 response, including the following: (1) LLIN launch on television and radio; (2) regional advocacy meetings on Zoom; (3) mass media platforms (for advertisements, mini skits, DJ mentions, radio spots, interactive talks); (4) social media platforms; (5) VHTs; (6) operation hotlines and toll-free call centres; (7) community mobilisation (megaphones); and (8) use of appropriate information, education, and communication materials. Communication will include messages about COVID-19, malaria, and use, care, repair and repurposing of LLINs. |
|
Proportion children aged 2-10 years at the time of cross-sectional surveys with blood smears positive for parasites by microscopy
| 24 months following LLIN distribution |
| Prevalence of Anaemia | Proportion of children aged 2-4 years with haemoglobin < 11 g/dL at the time of cross-sectional surveys | 12 months following LLIN distribution |
| Prevalence of Anaemia | Proportion of children aged 2-4 years with haemoglobin < 11 g/dL at the time of cross-sectional surveys | 24 months following LLIN distribution |
| Proportion of Households That Owned at Least One LLIN | Proportion of households with at least one LLIN at the time of cross-sectional surveys | 12 months following LLIN distribution |
| Proportion of Households That Owned at Least One LLIN | Proportion of households with at least one LLIN at the time of cross-sectional surveys | 24 months following LLIN distribution |
| Proportion of Households That Owned at Least One LLIN for Every Two Occupants | Proportion of households with at least one LLIN per every two occupants at the time of cross-sectional surveys | 12 months following LLIN distribution |
| Proportion of Households That Owned at Least One LLIN for Every Two Occupants | Proportion of households with at least one LLIN per every two occupants at the time of cross-sectional surveys | 24 months following LLIN distribution |
| Proportion of Household Residents Who Slept Under an LLIN the Previous Night | Proportion of households residents who report sleeping under LLIN the previous night at the time of cross-sectional surveys | 12 months following LLIN distribution |
| Proportion of Household Residents Who Slept Under an LLIN the Previous Night | Proportion of households residents who report sleeping under LLIN the previous night at the time of cross-sectional surveys | 24 months following LLIN distribution |
| NOT COMPLETED |
|
| BG001 | PermaNet 3.0 | deltamethrin + piperonyl butoxide (PBO) long lasting insecticidal nets with deltamethrin + piperonyl butoxide (PBO LLIN, PermaNet 3.0)): Next-generation bed net combining an insecticide with a synergist Social behaviour change communication: SBCC activities will use digital and other platforms, similar to those used for the COVID-19 response, including the following: (1) LLIN launch on television and radio; (2) regional advocacy meetings on Zoom; (3) mass media platforms (for advertisements, mini skits, DJ mentions, radio spots, interactive talks); (4) social media platforms; (5) VHTs; (6) operation hotlines and toll-free call centres; (7) community mobilisation (megaphones); and (8) use of appropriate information, education, and communication materials. Communication will include messages about COVID-19, malaria, and use, care, repair and repurposing of LLINs. |
| BG002 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Race (NIH/OMB) | Count of Participants | Participants |
|
| Incidence of malaria in residence of all ages from MRC target areas | Number | episodes of malaria over 3 months |
|
| OG001 | PermaNet 3.0 | deltamethrin + piperonyl butoxide (PBO) long lasting insecticidal nets with deltamethrin + piperonyl butoxide (PBO LLIN, PermaNet 3.0)): Next-generation bed net combining an insecticide with a synergist Social behaviour change communication: SBCC activities will use digital and other platforms, similar to those used for the COVID-19 response, including the following: (1) LLIN launch on television and radio; (2) regional advocacy meetings on Zoom; (3) mass media platforms (for advertisements, mini skits, DJ mentions, radio spots, interactive talks); (4) social media platforms; (5) VHTs; (6) operation hotlines and toll-free call centres; (7) community mobilisation (megaphones); and (8) use of appropriate information, education, and communication materials. Communication will include messages about COVID-19, malaria, and use, care, repair and repurposing of LLINs. |
|
|
| Secondary | Prevalence of Parasitaemia | Proportion of children aged 2-10 years at the time of cross-sectional surveys with blood smears positive for parasites by microscopy | children 2-10 years of age enrolled in cross-sectional surveys | Posted | Number | participants with parasitemia | 12 months following LLIN distribution |
|
|
|
| Secondary | Prevalence of Parasitaemia | Proportion children aged 2-10 years at the time of cross-sectional surveys with blood smears positive for parasites by microscopy | children 2-10 years of age enrolled in cross-sectional surveys | Posted | Number | participants with parasitemia | 24 months following LLIN distribution |
|
|
|
| Secondary | Prevalence of Anaemia | Proportion of children aged 2-4 years with haemoglobin < 11 g/dL at the time of cross-sectional surveys | children 2-4 years of age enrolled in cross-sectional surveys | Posted | Number | participants with hemoglobin <11g/dL | 12 months following LLIN distribution |
|
|
|
| Secondary | Prevalence of Anaemia | Proportion of children aged 2-4 years with haemoglobin < 11 g/dL at the time of cross-sectional surveys | children 2-4 years of age enrolled in cross-sectional surveys | Posted | Number | participants with hemoglobin <11g/dL | 24 months following LLIN distribution |
|
|
|
| Secondary | Proportion of Households That Owned at Least One LLIN | Proportion of households with at least one LLIN at the time of cross-sectional surveys | households enrolled in 12 month cross-sectional surveys | Posted | Number | households with at least 1 LLIN | 12 months following LLIN distribution | households | households |
|
|
|
| Secondary | Proportion of Households That Owned at Least One LLIN | Proportion of households with at least one LLIN at the time of cross-sectional surveys | households enrolled in 24 month cross-sectional surveys | Posted | Number | households with at least 1 LLIN | 24 months following LLIN distribution | households | households |
|
|
|
| Secondary | Proportion of Households That Owned at Least One LLIN for Every Two Occupants | Proportion of households with at least one LLIN per every two occupants at the time of cross-sectional surveys | households enrolled in 12 month cross-sectional surveys | Posted | Number | households with at least 1 LLIN/2persons | 12 months following LLIN distribution | households | households |
|
|
|
| Secondary | Proportion of Households That Owned at Least One LLIN for Every Two Occupants | Proportion of households with at least one LLIN per every two occupants at the time of cross-sectional surveys | households enrolled in 24 month cross-sectional surveys | Posted | Number | households with at least 1LLIN/2persons | 24 months following LLIN distribution | households | households |
|
|
|
| Secondary | Proportion of Household Residents Who Slept Under an LLIN the Previous Night | Proportion of households residents who report sleeping under LLIN the previous night at the time of cross-sectional surveys | household residents enrolled in 12 month cross-sectional surveys | Posted | Number | residents reported sleeping under LLIN | 12 months following LLIN distribution |
|
|
|
| Secondary | Proportion of Household Residents Who Slept Under an LLIN the Previous Night | Proportion of households residents who report sleeping under LLIN the previous night at the time of cross-sectional surveys | household residents enrolled in 24 month cross-sectional surveys | Posted | Number | residents reporting sleeping under LLIN | 24 months following LLIN distribution |
|
|
|
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| EG001 | PermaNet 3.0 | deltamethrin + piperonyl butoxide (PBO) long lasting insecticidal nets with deltamethrin + piperonyl butoxide (PBO LLIN, PermaNet 3.0)): Next-generation bed net combining an insecticide with a synergist Social behaviour change communication: SBCC activities will use digital and other platforms, similar to those used for the COVID-19 response, including the following: (1) LLIN launch on television and radio; (2) regional advocacy meetings on Zoom; (3) mass media platforms (for advertisements, mini skits, DJ mentions, radio spots, interactive talks); (4) social media platforms; (5) VHTs; (6) operation hotlines and toll-free call centres; (7) community mobilisation (megaphones); and (8) use of appropriate information, education, and communication materials. Communication will include messages about COVID-19, malaria, and use, care, repair and repurposing of LLINs. | 0 | 0 | 0 | 0 | 0 | 0 |
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| D000079426 |
| Vector Borne Diseases |
| D006574 |
| Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |