Fig. 3

Long-lasting systemic insecticides targeted at mobile, high-risk individuals can lead to elimination. Children under 5 and women of childbearing age are excluded from systemic insecticide eligibility unless otherwise indicated. a Model configuration includes two villages and a connected high-risk area to which some villagers regularly travel. Treatment for symptomatic malaria is available in villages but not in the high-risk area. MDA and traveling months occur during the end of the dry season. b Likelihood of elimination after MDA in both villages depends on MDA coverage and duration of systemic insecticide activity. c Targeting high-risk travellers in both villages as they depart for the high-risk area can be a successful elimination strategy, and minimal coverage required depends on duration of systemic insecticide activity. d Targeting high-risk travellers is more efficient at elimination than village-level MDA. e Long-lasting systemic insecticides should maintain activity for at least 30–40 days to be more effective than the anti-malarial DP at elimination in this context, but improved safety for children and pregnant women would shorten the required systemic insecticide duration. Shown: 60% coverage for both scenarios. f Distributing long-lasting systemic insecticides in MDA or to high-risk travellers can still result in likely elimination even if only residents of a single village receive the intervention, but requires higher coverage