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Table 1 This is an example of how the potential scenarios for a proof-of-concept study could be considered

From: Ivermectin to reduce malaria transmission II. Considerations regarding clinical development pathway

 

Residual transmission

Insecticide resistance

Transmission

Targeted for elimination

Artemisinin resistance

Burden of malaria

Testable

Elimination in the GMS

+++

+

+

+++

+++

+

Possibly

Elimination in selected areas of sub-Saharan Africa

++

+++

+++

+++

–

+++

Yes

Reduce disease burden in high-transmission areas

+

Any

+++

+

 

+++

Yes

Stem insecticide resistance in well-defined areas

Any

++++

Any

+

Any

+

Difficult

Elimination from hotspots in the endgame

++

+++

+++

+++

Any

+++ (local)

Doubtful

Stem of outbreaks

+

Any

++

Any

Any

+

Doubtful

  1. Testable refers to the potential implications of the transmission pattern on sample size and the feasibility of controlled clinical trials for each particular scenario
  2. GMS Greater Mekong Subregion