Optimal interruption of P. vivax malaria transmission using mass drug administration

Abstract

\textit{Plasmodium vivax} is the most geographically widespread malaria-causing parasite resulting in significant associated global morbidity and mortality. One of the factors driving this widespread phenomenon is the ability of the parasites to remain dormant in the liver. Known as hypnozoites, they reside in the liver following an initial exposure, before activating later to cause further infections, referred to as relapses. As around 79-96$\%$ of infections are attributed to relapses, we expect it will be highly impactful to apply treatment to target the hypnozoite reservoir to eliminate \textit{P. vivax}. Treatment with a radical cure to target the hypnozoite reservoir is a potential tool to control or eliminate \textit{P. vivax}. We have developed a multiscale mathematical model as a system of integro-differential equations that captures the complex dynamics of \textit{P. vivax} hypnozoites and the effect of hypnozoite relapse on disease transmission. Here, we use our model to study the anticipated effect of radical cure treatment administered via a mass drug administration (MDA) program. We implement multiple rounds of MDA with a fixed interval between rounds, starting from different steady-state disease prevalences. We then construct an optimisation model to obtain the optimal MDA interval. We also incorporate mosquito seasonality in our model to study its effect on the optimal treatment regime. We find that the effect of MDA interventions is temporary and depends on the pre-intervention disease prevalence (and choice of model parameters) as well as the number of MDA rounds under consideration. We find radical cure alone may not be enough to lead to \textit{P. vivax} elimination under our mathematical model (and choice of model parameters) since the prevalence of infection eventually returns to pre-MDA levels.