The purpose of the study is to assess the effectiveness, feasibility, and acceptability of targeted drug administration for seasonal migrant populations in Metema District, Amhara Region, Ethiopia

A cluster randomized controlled trial will be used to evaluate the effectiveness, feasibility, and acceptability of targeted antimalarial drug administration (TDA) for seasonal migrant farmworkers in the Delello farm sites in Metema district, Amhara Region. Individual farm sites will be randomized 1:1:1 to either of two intervention options or control, where all farmworkers at intervention sites will receive either two or three rounds of dihydro artemisinin piperaquine over the primary farming season.

All study farm-sites will receive enhanced case management conducted by mobile health teams throughout the study period.

Cross-sectional surveys will be conducted in all arms at baseline and 4 to 6 weeks following the third round of TDA to assess the effectiveness of the intervention for reducing parasite prevalence.

Inclusion Criteria:

• At the time of the study, be a seasonal farm worker at one of the selected farm sites in Metema district
• Available and willingness to participate in the study and provide consent (or parental/guardian consent and asset in the case of minors)

Exclusion Criteria:

• Severe illness (will be referred for care)
• Inability to provide informed consent
• Age 14-17 years old and not having a parent/guardian at the farm who can provide consent
• Age <14 years old

Additional exclusion criteria for the intervention group:

• Having received an antimalarial drug within the last 2 weeks

• Having any of the contraindications to receiving DP:

  • History of cardiac rhythm disturbances, bradycardia, or heart failure
  • Concomitant treatment with drugs that prolong the QT interval (fluconazole, fluoroquinolones, hydroxyzine, macrolides, ondansetron, etc.) or drugs containing any of the following: flecainide, metoprolol, imipramine, amitriptyline, clomipramine
  • Known allergic reactions to DP or other artemisinin derivatives
  • Pregnancy

For all data collected as part of the study, participants will be assigned a unique identification number. Individual identifiers (names, cell phone number) will be collected to support any follow up if needed. However, no personal identification information will be used in any reports arising out of this research.

Dried blood spots (DBS) will be collected from participants and shared with the Armauer Hansen Research Institute for sample analysis and storage. Stored biospecimens will be deidentified with no possibility of linking with study participants. Only a unique sample identification code will identify the samples. Results might be linked to the associated epidemiological data collected during the surveys from the participants, which will not include any identifiable information.