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The effect of intermittent preventive treatment on anti-malarial drug resistance spread in areas with population movement

机译:间歇性预防治疗对人群流动地区抗疟疾药物耐药性的影响

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Background The use of intermittent preventive treatment in pregnant women (IPTp), children (IPTc) and infant (IPTi) is an increasingly popular preventive strategy aimed at reducing malaria risk in these vulnerable groups. Studies to understand how this preventive intervention can affect the spread of anti-malarial drug resistance are important especially when there is human movement between neighbouring low and high transmission areas. Because the same drug is sometimes utilized for IPTi and for symptomatic malaria treatment, distinguishing their individual roles on accelerating the spread of drug resistant malaria, with or without human movement, may be difficult to isolate experimentally or by analysing data. A theoretical framework, as presented here, is thus relevant as the role of IPTi on accelerating the spread of drug resistance can be isolated in individual populations and when the populations are interconnected and interact. Methods A previously published model is expanded to include human movement between neighbouring high and low transmission areas, with focus placed on the malaria parasites. Parasite fitness functions, determined by how many humans the parasites can infect, are used to investigate how fast resistance can spread within the neighbouring communities linked by movement, when the populations are at endemic equilibrium. Results Model simulations indicate that population movement results in resistance spreading fastest in high transmission areas, and the more complete the anti-malarial resistance the faster the resistant parasite will tend to spread through a population. Moreover, the demography of infection in low transmission areas tends to change to reflect the demography of high transmission areas. Additionally, when regions are strongly connected the rate of spread of partially resistant parasites (R1) relative to drug sensitive parasites (RS), and fully resistant parasites (R2) relative to partially resistant parasites (R1) tend to behave the same in both populations, as should be expected. Conclusions In fighting anti-malarial drug resistance, different drug resistance monitoring and management policies are needed when the area in question is an isolated high or low transmission area, or when it is close and interacting with a neighbouring high or low transmission area, with human movement between them.
机译:背景技术在孕妇(IPTp),儿童(IPTc)和婴儿(IPTi)中使用间歇性预防治疗是一种日益流行的预防策略,旨在降低这些脆弱人群的疟疾风险。进行研究以了解这种预防性干预措施如何影响抗疟药耐药性的传播非常重要,尤其是当相邻的低传播区和高传播区之间有人在活动时。由于有时将同一药物用于IPTi和对症性疟疾治疗,可能难以通过实验或分析数据来区分它们在促进耐药性疟疾传播(无论有无人类活动)方面的个体作用。因此,这里提出的理论框架是相关的,因为IPTi在加速耐药性传播中的作用可以在个别人群中以及人群相互联系和相互作用时隔离。方法将先前发布的模型扩展为包括相邻高低传播区域之间的人类运动,重点放在疟疾寄生虫上。由寄生虫可感染的人数决定的寄生虫适应度函数,用于研究当种群处于地方性平衡时,抵抗力如何在与运动相关联的相邻社区中快速传播。结果模型仿真表明,种群移动导致耐药性在高传播地区传播最快,而抗疟疾抗性越完整,抗性寄生虫将越容易在人群中传播。此外,低传播区域的感染人口统计学趋势会发生变化,以反映高传播区域的人口统计学。此外,当区域紧密相连时,部分耐药的寄生虫(R1)相对于药物敏感性寄生虫(RS)的扩散速率,以及完全耐药的寄生虫(R2)与部分耐药的寄生虫(R1)的扩散速率在两个人群中表现相同,这应该是预期的。结论在抗疟疾抗药性中,当相关区域是孤立的高或低传播区域时,或者当该区域与邻近的高或低传播区域并与人类相互作用时,需要采取不同的抗药性监测和管理策略。他们之间的运动。

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