Ifakara Health Institute is part of a consortium of six partners from Tanzania, Mozambique, Spain, Switzerland, the UK and the USA, which is set to begin a phase II malaria trial to explore the use of ivermectin, an anti-parasitic drug, as a tool to reduce malaria transmission.

The trial, which is simply known as the BOHEMIA (Broad One Health Endectocide‑based Malaria Intervention in Africa) project, involves mass drug administration (MDA) of ivermectin to both humans and livestock. The study protocol for the trial was published in the Trials Journal on February 21, 2023.

Researchers Sigilbert Mrema, Mwaka Kakolwa, Issa Lyimo and Fredros Okumu – from Ifakara, are among the contributors to the publication. They will be working with colleagues from partner institutions; ISGlobal, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Mozambique; University Hospital Bern, Switzerland; University of Oxford, UK; and Virginia Tech, USA.

For the researchers, the primary aim of the trial is “to generate solid evidence to support the evaluation of ivermectin as a complementary vector control strategy for malaria prevention”, and will be the first large-scale trial evaluating the impact of MDA of ivermectin on local malaria transmission settings in Mozambique and Kenya.

The World Health Organization (WHO), through the Global Technical Strategy (GTS), has proposed goals for malaria by 2030 which include reducing malaria cases by 90% as compared with the 2015 numbers and elimination in at least 35 countries.

However, according to the researchers, one critical challenge to achieving the 2030 goals is residual transmission – which they define as the “persistence of malaria transmission following the implementation in time and space of a widely effective malaria programme”.

“Residual transmission is driven by mosquito behavioral adaptations that allow the transmission to continue even in presence of good coverage with core vector control tools such as long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS),” explained the researchers.

Against this backdrop, the main objective of the BOHEMIA project is to contribute to the global public health goals for malaria control by developing a complementary strategy for vector control.

As they aim to achieve this, the researchers also primarily seek to determine the safety (in humans) and efficacy of ivermectin MDA (to humans or humans and livestock simultaneously) for the prevention of malaria.