Residual bioefficacy of attractive targeted sugar bait stations targeting malaria vectors during seasonal deployment in Western Province of Zambia.

The primary vector control interventions in Zambia are long-lasting insecticidal nets and indoor residual spraying. Challenges with these interventions include insecticide resistance and the outdoor biting and resting behaviours of many Anopheles mosquitoes. Therefore, new vector control tools targeting additional mosquito behaviours are needed to interrupt transmission. Attractive targeted sugar bait (ATSB) stations, which exploit the sugar feeding behaviours of mosquitoes, may help in this role. This study evaluated the residual laboratory bioefficacy of Westham prototype ATSB® Sarabi v.1.2.1 Bait Station (Westham Ltd., Hod-Hasharon, Israel) in killing malaria vectors in Western Province, Zambia, during the first year of a large cluster randomized phase-III trial (Clinical Trials.gov Identifier: NCT04800055). This was a repeat cross-sectional study conducted within three districts, Nkeyema, Kaoma, and Luampa, in Western Province, Zambia. The study was conducted in 12 intervention clusters among the 70 trial clusters (35 interventions, 35 controls) between December 2021 and June 2022. Twelve undamaged bait stations installed on the outer walls of households were collected monthly (one per cluster per month) for bioassays utilizing adult female and male Anopheles gambiae sensu stricto (Kisumu strain) mosquitoes from a laboratory colony. A total of 84 field-deployed ATSB stations were collected, and 71 ultimately met the study inclusion criteria for remaining in good condition. Field-deployed stations that remained in good condition (intact, non-depleted of bait, and free of dirt as well as mold) retained high levels of bioefficacy (mean induced mortality of 95.3% in males, 71.3% in females, 83.9% combined total) over seven months in the field but did induce lower mortality rates than non-deployed ATSB stations (mean induced mortality of 96.4% in males, 87.0% in females, 91.4% combined total). There was relatively little variation in corrected mortality rates between monthly rounds for those ATSB stations that had been deployed to the field. While field-deployed ATSB stations induced lower mortality rates than non-deployed ATSB stations, these stations nonetheless retained relatively high and stable levels of bioefficacy across the 7-month malaria transmission season. While overall mean mosquito mortality rates exceeded 80%, mean mortality rates for females were 24 percentage points lower than among males and these differences merit attention and further evaluation in future studies. The duration of deployment was not associated with lower bioefficacy. Westham prototype ATSB stations can still retain bioefficacy even after deployment in the field for 7 months, provided they do not meet predetermined criteria for replacement.

Mwaanga G ，Ford J ，Yukich J ，Chanda B ，Ashton RA ，Chanda J ，Munsanje B ，Muntanga E ，Mulota M ，Simuyandi C ，Mulala B ，Simubali L ，Saili K ，Simulundu E ，Miller J ，Hamainza B ，Orange E ，Wagman J ，Mburu MM ，Harris AF ，Entwistle J ，Littrell M ... -  《MALARIA JOURNAL》

Efficacy of attractive targeted sugar bait stations against malaria in Western Province Zambia: epidemiological findings from a two-arm cluster randomized phase III trial.

Attractive targeted sugar bait (ATSB) stations containing bait (to attract) and ingestion toxicant (to kill) sugar-foraging mosquitoes are hypothesized to reduce malaria transmission by shortening the lifespan of Anopheles vectors. A two-arm cluster-randomized controlled trial (cRCT) was conducted in Western Province Zambia. Seventy clusters of 250-350 households were assigned (1:1) by restricted randomization to an intervention arm (ATSB) or control arm (no ATSB) in the context of standard of care vector control (insecticide-treated nets and/or indoor residual spraying). Two ATSB stations (Westham Sarabi, 0.11% dinotefuran w/w) were maintained on exterior walls of eligible household structures for a 7-month deployment period (December-June) during the high malaria transmission season. The primary outcome was clinical malaria incidence among two consecutive seasonal cohorts of children aged 1-14 years, followed-up monthly from January-June in 2022 and 2023. Secondary outcome was Plasmodium falciparum prevalence among individuals aged over six months. Analysis compared clinical malaria incidence and prevalence between arms among the intention-to-treat population. ATSB coverage, assessed by cross-sectional survey, was 98.3% in March-April 2022 and 89.5% in March-April 2023. 4494 children contributed any follow-up time to the cohort, with 2313 incident malaria cases in the intervention arm (1.28 per child per six-month transmission season), and 2449 in the control arm (1.38 per child-season). The incidence rate ratio between the two arms was 0.91 (95% CI 0.72-1.15, p = 0.42). 2536 individuals participated in cross-sectional surveys, with prevalence of P. falciparum 50.7% in the intervention arm and 53.5% in the control arm. The odds ratio between the two arms was 0.89 (95% CI 0.66-1.18, p = 0.42). Secondary covariable-adjusted and subgroup analyses did not substantially alter the findings. No serious adverse events associated with the intervention were reported. Two ATSB stations deployed per eligible structure for two consecutive transmission seasons did not result in a statistically significant reduction in clinical malaria incidence among children aged 1-14 years or in P. falciparum prevalence in rural western Zambia. Further studies are needed to assess the efficacy of ATSB stations in different settings and with different deployment strategies. The trial is registered with Clinicaltrials.gov (NCT04800055).

Ashton RA ，Saili K ，Chishya C ，Banda Yikona H ，Arnzen A ，Orange E ，Chitoshi C ，Chulu J ，Tobolo T ，Ndalama F ，Kyomuhangi I ，Ngulube W ，Moonga H ，Chirwa J ，Slutsker L ，Wagman J ，Chanda J ，Miller J ，Silumbe K ，Hamainza B ，Eisele TP ，Yukich J ，Littrell M ... -  《MALARIA JOURNAL》

Characteristics of the Western Province, Zambia, trial site for evaluation of attractive targeted sugar baits for malaria vector control.

Arnzen A ，Wagman J ，Chishya C ，Orange E ，Eisele TP ，Yukich J ，Ashton RA ，Chanda J ，Sakala J ，Chanda B ，Muyabe R ，Kaniki T ，Mwenya M ，Mwaanga G ，Eaton WT ，Mancuso B ，Mungo A ，Mburu MM ，Bubala N ，Hagwamuna A ，Simulundu E ，Saili K ，Miller JM ，Silumbe K ，Hamainza B ，Ngulube W ，Moonga H ，Chirwa J ，Burkot TR ，Slutsker L ，Littrell M ... -  《MALARIA JOURNAL》

Deployment of attractive targeted sugar baits in western Zambia: installation, monitoring, removal, and disposal procedures during a Phase III cluster randomized controlled trial.

Attractive Targeted Sugar Baits (ATSBs) offer a complementary vector control strategy to interventions targeting blood feeding or larval control by attacking the sugar feeding behaviour of adult mosquitoes using an attract-and-kill approach. Western Zambia was the first location to receive and deploy ATSB Sarabi version 1.2 stations in a Phase III cluster randomized controlled trial. This paper describes ATSB station installation, monitoring, removal, and disposal, quantifies ATSB station coverage, and reports major reasons for ATSB station replacement. ATSB stations were deployed during two annual transmission seasons, through scheduled installation and removal campaigns. During deployment, monitoring was conducted per protocol to maintain high coverage of the ATSB stations in good condition. Routine monitoring visits during the trial captured details on ATSB station damage necessitating replacement following pre-defined replacement criteria. Annual cross-sectional household surveys measured ATSB station coverage during peak malaria transmission. A total of 67,945 ATSB stations were installed in Year 1 (41,695 initially installed+ 26,250 installed during monitoring) and 69,494 ATSB stations were installed in Year 2 (41,982 initially installed+ 27,512 installed during monitoring) across 35 intervention clusters to maintain high coverage of two ATSB stations in good condition per eligible household structure. The primary reasons for ATSB station replacement due to damage were holes/tears and presence of mold. Cross-sectional household surveys documented high coverage of ATSB stations across Year 1 and Year 2 with 93.1% of eligible structures having ≥ 2 ATSB stations in any condition. ATSB station deployment and monitoring efforts were conducted in the context of a controlled cRCT to assess potential product efficacy. Damage to ATSB stations during deployment required replacement of a subset of stations. High coverage of eligible structures was maintained over the two-year study despite replacement requirements. Additional research is needed to better understand the impact of damage on ATSB station effectiveness under programmatic conditions, including thresholds of threats to physical integrity and biological deterioration on product efficacy. Optimizing ATSB stations to address causes of damage and conducting implementation research to inform optimal delivery and cost-effective deployment will be important to facilitate scale-up of ATSB interventions.

Orange E ，Kyomuhangi I ，Masuzyo M ，Mwenya M ，Mambo P ，Saili K ，Chishya C ，Chanda J ，Ashton RA ，Eisele TP ，Yukich J ，Miller J ，Silumbe K ，Hamainza B ，Wagman J ，Arnzen A ，Harris AF ，Entwistle J ，Slutsker L ，Burkot TR ，Littrell M ... -  《-》

Scalable camera traps for measuring the attractiveness of sugar baits for controlling malaria and dengue vectors.

Attractive targeted sugar baits (ATSBs) are promising new interventions that can complement existing vector control tools. However, reproducible and quantitative information on the level of attractiveness of ATSBs under field conditions is needed. Therefore, we customized camera traps for close-up imaging. We integrated them into a rugged ATSB monitoring station for day and nighttime recording of mosquitoes landing on the bait. The camera traps were evaluated in a semifield system and then in the field in rural Tanzania. In semifield experiments, camera traps were set up in large cages (2 m × 5 m × 2 m) to record mosquitoes landing on an attractive sugar bait (ASB), a blank ASB, or 20% sucrose (w/v). Next, 198 mosquitoes (33 males and 33 females of Anopheles arabiensis, An. funestus and Aedes aegypti) were released into each large cage and allowed to seek a sugar meal for 72 h with a camera recording images of the mosquitoes present on the ASB at 1-min intervals. In the field, 16 camera traps were set in 16 households, 7 with ASB attractant, 7 with ASB blank, and 2 with 20% sucrose (w/v). Human landing catch (HLC) was performed on the same nights as the camera trap recordings. Under semifield conditions, significantly more mosquitoes visited the ASBs than the blank baits, with An. funestus visiting more frequently than An. arabiensis. There were no significant differences between female and male An. arabiensis visits, but female An. funestus visited more than their conspecific males did. The duration of visits did not vary between the ASB and blank controls or between the mosquito species. Moreover, mosquitoes visited the ASB or sucrose equally, with An. arabiensis visiting the baits more than An. funestus. Compared with male mosquitoes, female mosquitoes visited the baits more often. There was no significant difference in visit duration between the species.  In the field study, a mean of 70 An. arabiensis were caught per person per night on HLC, while 1 individual was caught per night on ASBs. There were significantly more visits by mosquitoes to the ASB than to the ASB blanks or sucrose solution, with more An. arabiensis visiting the baits than An. funestus or Culex quinquefasciatus. Significantly more females than males visited the baits of all the species. Again, the duration of visits was similar among An. arabiensis, An. funestus and C. quinquefasciatus. Aedes aegypti very rarely visited ASBs in the semifield experiments, and none were observed on baits in the field. Using camera traps to record still images of mosquitoes on ASBs offers reliable, reproducible and quantitative information on their attractiveness in various environmental conditions. Thus, camera traps serve as effective tools for evaluating and improving ATSB technology.

Meza FC ，Tenywa FC ，Ashall S ，Okumu FO ，Moore SJ ，Tripet F ... -  《Parasites & Vectors》