Targeted Test and Treat at Point of Entry to Reduce Importation of Malaria Parasites: A Systematic Review

Abstract

As countries approach malaria elimination, imported cases of malaria make up a larger proportion of all cases and may drive malaria transmission. Targeted test and treat (TTaT) at points of entry (POEs) is a strategy that aims to reduce the number of imported infections in countries approaching elimination by testing and treating individuals at border crossings. No evidence has been systematically collected and evaluated to assess the impact and operational feasibility of this strategy. This systematic review gathered empirical evidence on the effectiveness of the intervention, contextual factors, and results of modeling studies that estimate its potential impact. Bibliographic searches were conducted in March 2021 and updated in April 2022, and a total of 1,569 articles were identified. All study designs were included, but none of them were intervention studies set up to measure the impact of TTaT at POEs. Seven nonrandomized observational studies were eligible for assessment of outcome data in terms of describing the extent of positive cases among people crossing borders. Also included in the review were three studies for assessment of acceptability and feasibility of the intervention and three for assessment of mathematical modeling. The positivity rates reported in the seven studies ranged between 0.0% and 70.0%, which may be attributable to the different settings and operational feasibility. Overall, there is limited evidence of the effect of TTaT at POEs on the prevalence of infection, and the certainty of the evidence was very low owing to critical risk of bias, serious inconsistency, and serious indirectness.