DOI: 10.5061/dryad.nr8d8
title: Data from: The impact of hotspot-targeted interventions on malaria transmission in Rachuonyo south district in the western Kenyan highlands: a cluster-randomized controlled trial

description: Background: Malaria transmission is highly heterogeneous, generating
 malaria hotspots that can fuel malaria transmission across a wider area.
 Targeting hotspots may represent an efficacious strategy for reducing
 malaria transmission. We determined the impact of interventions targeted
 to serologically defined malaria hotspots on malaria transmission both
 inside hotspots and in surrounding communities. Methods and Findings:
 Twenty-seven serologically defined malaria hotspots were detected in a
 survey conducted from 24 June to 31 July 2011 that included 17,503
 individuals from 3,213 compounds in a 100-km2 area in Rachuonyo South
 District, Kenya. In a cluster-randomized trial from 22 March to 15 April
 2012, we randomly allocated five clusters to hotspot-targeted
 interventions with larviciding, distribution of long-lasting
 insecticide-treated nets, indoor residual spraying, and focal mass drug
 administration (2,082 individuals in 432 compounds); five control clusters
 received malaria control following Kenyan national policy (2,468
 individuals in 512 compounds). Our primary outcome measure was parasite
 prevalence in evaluation zones up to 500 m outside hotspots, determined by
 nested PCR (nPCR) at baseline and 8 wk (16 June–6 July 2012) and 16 wk (21
 August–10 September 2012) post-intervention by technicians blinded to the
 intervention arm. Secondary outcome measures were parasite prevalence
 inside hotpots, parasite prevalence in the evaluation zone as a function
 of distance from the hotspot boundary, Anopheles mosquito density,
 mosquito breeding site productivity, malaria incidence by passive case
 detection, and the safety and acceptability of the interventions.
 Intervention coverage exceeded 87% for all interventions. Hotspot-targeted
 interventions did not result in a change in nPCR parasite prevalence
 outside hotspot boundaries (p ≥ 0.187). We observed an average reduction
 in nPCR parasite prevalence of 10.2% (95% CI −1.3 to 21.7%) inside
 hotspots 8 wk post-intervention that was statistically significant after
 adjustment for covariates (p = 0.024), but not 16 wk post-intervention (p
 = 0.265). We observed no statistically significant trend in the effect of
 the intervention on nPCR parasite prevalence in the evaluation zone in
 relation to distance from the hotspot boundary 8 wk (p = 0.27) or 16 wk
 post-intervention (p = 0.75). Thirty-six patients with clinical malaria
 confirmed by rapid diagnostic test could be located to intervention or
 control clusters, with no apparent difference between the study arms. In
 intervention clusters we caught an average of 1.14 female anophelines
 inside hotspots and 0.47 in evaluation zones; in control clusters we
 caught an average of 0.90 female anophelines inside hotspots and 0.50 in
 evaluation zones, with no apparent difference between study arms. Our
 trial was not powered to detect subtle effects of hotspot-targeted
 interventions nor designed to detect effects of interventions over
 multiple transmission seasons. Conclusions: Despite high coverage, the
 impact of interventions targeting malaria vectors and human infections on
 nPCR parasite prevalence was modest, transient, and restricted to the
 targeted hotspot areas. Our findings suggest that transmission may not
 primarily occur from hotspots to the surrounding areas and that areas with
 highly heterogeneous but widespread malaria transmission may currently
 benefit most from an untargeted community-wide approach. Hotspot-targeted
 approaches may have more validity in settings where human settlement is
 more nuclear. Trial registration: ClinicalTrials.gov NCT01575613.
description: intervention coverage
 dataset REDHOTcompound level data on
 participation in a focal screening approach (followed by focal mass drug
 administration), distribution of long lasting insecticide treated nets
 (LLINs) and Indoor Residual Spraying (IRS). The data can be linked to the
 intervention database using the compound and cluster
 identifiers.Entomology data
 REDHOTCDC light trap mosquito
 collections in 3 intervention and 3 control clusters. Number of female,
 male and total number of anopheles and culex mosquitoes is given per
 sampling round and compound. Up to 9 sampling rounds were completed per
 compound before (n=1) and after (n=8) the intervention.REDHOT entomology
 data.xlsREDHOT baseline survey
 2011Individual-level
 baseline data that were collected in preparation of a hotspot-targeted
 cluster randomized trial. Data include household and ecological
 characteristics, parasite prevalence by P. falciparum nPCR and antibody
 responses to P. falciparum antigens AMA-1 and MSP-1.baseline dataset
 REDHOT_anonymous.xlsIntervention data REDHOT
 cluster randomized trial (2012)Individual-level data
 from cross-sectional surveys prior to hotspot-targeted interventions and
 post-intervention. Data can be linked to intervention coverage data using
 compound and household identifiers. Data was collected in
 2012.intervention dataset
 REDHOT_anonymous_updated.xls