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MalariaNNPNCT03931473

Efficacy of Two Dual Active Ingredient Long Lasting Insecticidal Nets for Control of Malaria Transmitted by Pyrethroid Resistant Vectors in Benin

A study testing Bed nets in people with Malaria and Anemia, run by London School of Hygiene and Tropical Medicine at 1 site in Benin.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The massive scale-up of Long Lasting Insecticidal Nets (LLIN) has led to a major reduction in malaria burden (up to 50%) in many sub-Saharan African countries. This progress is threatened by the wide scale selection of insecticide resistant malaria vectors. Read more about this study

Who is it for?
Ages 6 months to 9 yearsHealthy volunteers can take part
Conditions the study is for
Malaria, Anemia
What is being tested?
Bed nets
Could I receive a placebo?
No, everyone receives an active treatment
How many people
1,800 participants
Where
1 siteBenin
Study dates
1 Jun 2020to 1 May 2023
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 6 months to 9 years
  • All sexes
  • Healthy volunteers accepted
  • Child

Who may be able to join

  • Children aged 6 months to 9 years
  • Resident in study villages
  • Written, informed consent from guardians

Who cannot join

  • Non-residents

Trial locations and contacts

1 site in 1 country.

Benin1 site
  • Manfred Accrombessi

    Cové

Other trials in Benin

About this study

The massive scale-up of Long Lasting Insecticidal Nets (LLIN) has led to a major reduction in malaria burden (up to 50%) in many sub-Saharan African countries. This progress is threatened by the wide scale selection of insecticide resistant malaria vectors. New types of LLIN combining a mixture of two insecticides have been developed to control resistant mosquitoes.

The efficacy of two bi-treated LLIN are compared to a standard LLIN in a three-arm, single blinded, cluster-randomized trial in Cove, Benin. The arms are; 1/ Royal Guard, a net combining pyriproxyfen (PPF), which is known to disrupt female reproduction and fertility of eggs, and the pyrethroid alpha-cypermethrin, 2/Interceptor G2, LLIN incorporating a mixture of two adulticides with different modes of action; chlorfenapyr and a pyrethroid (alpha-cypermethrin), and 3/ The control arm: Interceptor, a standard LLIN treated with alpha-cypermethrin.

The primary outcome of the trial will be malaria case incidence in children aged 6 months to 10 years.

Read the detailed description

Background: The massive scale-up of Long-Lasting Insecticidal Nets (LLIN) has led to a major reduction in malaria burden (up to 50%) in many sub-Saharan African (SSA) countries. This progress is threatened by the wide scale selection of insecticide resistant malaria vectors.

Study site: The study will be conducted in the districts of Cove, Zagnanado and Ouinhi, a collection of three districts found in the Zou department in Benin. This area consists of 100 villages with approximately 40,000 households and a population size of 191,000.

The aim of this research is to evaluate the efficacy of 2 novel dual active Ingredient (AI) LLINs in a community randomized controlled trial on epidemiology outcomes. The trial will take place over 2 years in an area where malaria vectors are resistant to pyrethroid insecticide in Benin, West Africa. Update- the trial is now continuing for a third year.

The primary objective is to assess the efficacy of next generation LLIN on malaria case incidence in children aged 6 months to 10 years, compared to standard LLINs. The secondary objectives are to evaluate the efficacy of the 2 bi-treated LLIN as compared to standard LLIN on a) malaria infection prevalence in children aged 6 months to 10 years; b) prevalence of moderate and severe anaemia in children under 5 years old and c) entomological inoculation rate (EIR) (as a proxy for malaria transmission). In addition, we will compare potential insecticide resistance selection, between the 3 trial arms and evaluate the impact of the new types of LLIN on other entomological outcomes (species composition, blood feeding, resting/feeding behaviour and sterility (oocyte [egg] development).

Study design: Three-arm superiority, single blinded, cluster-randomized trial with village as the unit of randomisation. The arms consist of; 1/ Royal Guard, a net combining pyriproxyfen (PPF), which is known to disrupt female reproduction and egg fertility, and the pyrethroid alpha-cypermethrin, 2/Interceptor G2, a mixture LLIN incorporating two adulticides with different modes of action; chlorfenapyr and a pyrethroid (alpha-cypermethrin), and 3/ The control arm: Standard LLIN Interceptor is an alpha-cypermethrin only LLIN.

The primary outcome of the trial will be incidence of malaria cases (confirmed by rapid diagnostic test (RDT)) in children aged 6 months to 10 years followed for 24 months. Update: the study is now continuing for a further year.

Secondary outcomes are cross-sectional community prevalence of malaria infection (confirmed by RDT) in the study population at 6- and 18-months post-intervention, prevalence of moderate and severe anaemia in children under 5 years old, entomological inoculation rates (EIR), vector density and insecticide resistance intensity. Update: there will also be a 30 month cross-sectional survey.

Sample size: To compare incidence of malaria cases between study arms, we will recruit a cohort of 25 children per cluster in 60 clusters for 24 months follow up to be able to detect a 30% relative reduction in malaria cases per child per year (rate ratio 0.7) between the intervention and the reference arms. The children will be visited twice a month during the transmission season (April to November) and once a month during the dry season. We will conduct malaria infection prevalence cross-sectional surveys, at 6 and 18 months after LLIN distribution. 40 households will be randomly selected from each of the 60 clusters (20 clusters per arm x 3 arms) and information on education, socio economic status, LLIN ownership and usage recorded during each survey. From these 40 households per cluster we will randomly select 70 individuals. The study will have 80% power to detect a relative 30% lower prevalence (prevalence ratio 0.70 in each intervention arm (Royal Guard or Interceptor G2) relative to standard LLIN. Entomological inoculation rate (EIR) will be measured bi-monthly for 2 years in 8 households per cluster in all the clusters. Update: Follow up for cohort children was suspended during the pandemic meaning the primary outcome only included 21 months of follow up- to counteract this, 30 children were selected in each cluster. The follow up is now continuing up to 36 months- post-distribution. Due to logistics, the entomological data collection took place in 4 houses in each cluster every 3 months.

Frequency and intensity resistance assay with An. gambiae, An. arabiensis and An.funestus will be performed using permethrin, alpha-cypermethrin, pyriproxyfen and chlorfenapyr in 6 clusters (2 clusters per arm). An. gambiae s.l. and An. funestus will be screened for mutations in insecticide target sites (Vgsc) and metabolic resistance following CYp6 genes a small group of P450s that are over expressed in insecticide resistant populations. Changes in frequency of these genes and target site mutation will be followed every year in the three arms.

Conditions
Malaria, Anemia
Being tested
Bed nets
Keywords
Long Lasting Insecticidal Net, Chlorfenapyr, Pyriproxyfen, Pyrethroid, Randomised Controlled Trial, Benin, Vector Control, Malaria
Medical subject headings
Malaria, Anemia

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Bed netsOther

    Next-generation bed nets combining insecticides with different modes of action or a standard pyrethroid bed net

Study groups in NCT03931473
Study groupRoleWhat they receive
Interceptor G2ExperimentalChlorfenapyr/alpha-cypermethrin
Receives: Other: Bed nets
Royal GuardExperimentalPyriproxyfen/alpha-cypermethrin
Receives: Other: Bed nets
InterceptorActive comparatorAlpha-cypermethrin
Receives: Other: Bed nets

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Malaria Case Incidence

    Malaria case incidence in children aged 6 months to 10 years measured through bi-monthly/monthly visits

    Measured: 2 years

Secondary outcomes (2)
  1. Malaria Infection prevalence

    Malaria infection prevalence measured in cross-sectional surveys 6 months and 18 months post- distribution

    Measured: 18 months

  2. Entomological Inoculation Rate

    EIR measured every quarter during entomological surveys

    Measured: 2 years

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted30 Apr 2019
  2. Study start1 Jun 2020
  3. Primary completion1 May 2023
  4. Study completion1 May 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
Triple blind
Who is masked
Participant, Care provider, Outcomes assessor
Enrolment
1,800 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03931473
Sponsor's protocol ID
NewNetsProject
Acronym
NNP
Status last verified
Oct 2024
First submitted
25 Apr 2019
Last updated
18 Oct 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Accrombessi M, Cook J, Ngufor C, Sovi A, Dangbenon E, Yovogan B, Akpovi H, Hounto A, Thickstun C, Padonou GG, Tokponnon F, Messenger LA, Kleinschmidt I, Rowland M, Akogbeto MC, Protopopoff N. Assessing the efficacy of two dual-active ingredients long-lasting insecticidal nets for the control of malaria transmitted by pyrethroid-resistant vectors in Benin: study protocol for a three-arm, single-blinded, parallel, cluster-randomized controlled trial. BMC Infect Dis. 2021 Feb 19;21(1):194. doi: 10.1186/s12879-021-05879-1.

    PubMed 33607958
  • Yovogan B, Sovi A, Padonou GG, Adoha CJ, Akinro B, Chitou S, Accrombessi M, Dangbenon E, Akpovi H, Messenger LA, Osse R, Hounto AO, Cook J, Kleinschmidt I, Ngufor C, Rowland M, Protopopoff N, Akogbeto MC. Pre-intervention characteristics of the mosquito species in Benin in preparation for a randomized controlled trial assessing the efficacy of dual active-ingredient long-lasting insecticidal nets for controlling insecticide-resistant malaria vectors. PLoS One. 2021 May 20;16(5):e0251742. doi: 10.1371/journal.pone.0251742. eCollection 2021.

    PubMed 34014982
  • Accrombessi M, Cook J, Dangbenon E, Yovogan B, Akpovi H, Sovi A, Adoha C, Assongba L, Sidick A, Akinro B, Osse R, Tokponnon F, Aikpon R, Ogouyemi-Hounto A, Padonou GG, Kleinschmidt I, Messenger LA, Rowland M, Ngufor C, Protopopoff N, Akogbeto MC. Efficacy of pyriproxyfen-pyrethroid long-lasting insecticidal nets (LLINs) and chlorfenapyr-pyrethroid LLINs compared with pyrethroid-only LLINs for malaria control in Benin: a cluster-randomised, superiority trial. Lancet. 2023 Feb 11;401(10375):435-446. doi: 10.1016/S0140-6736(22)02319-4. Epub 2023 Jan 24.

    PubMed 36706778
  • Sovi A, Yovogan B, Adoha CJ, Akinro B, Accrombessi M, Dangbenon E, Assongba L, Salako AS, Padonou GG, Messenger LA, Ngufor C, Cook J, Protopopoff N, Akogbeto MC. Efficacy of pyrethroid-pyriproxyfen and pyrethroid-chlorfenapyr nets on entomological indicators of malaria transmission: third year of a randomised controlled trial in Benin. Sci Rep. 2024 Jun 5;14(1):12958. doi: 10.1038/s41598-024-63883-2.

    PubMed 38839981
  • Ngufor C, Fagbohoun J, Fongnikin A, Ahoga J, Syme T, Ahogni I, Accrombessi M, Protopopoff N, Cook J, Dangbenon E, Sovi A, Baes M, Pigeon O, Todjinou D, Govoetchan R, Padonou GG, Akogbeto M. The attrition, physical and insecticidal durability of two dual active ingredient nets (Interceptor(R) G2 and Royal Guard(R)) in Benin, West Africa: results from a durability study embedded in a cluster randomised controlled trial. Parasit Vectors. 2024 Oct 7;17(1):420. doi: 10.1186/s13071-024-06504-1.

    PubMed 39375740
  • Accrombessi M, Cook J, Dangbenon E, Sovi A, Yovogan B, Assongba L, Adoha CJ, Akinro B, Affoukou C, Padonou GG, Kleinschmidt I, Messenger LA, Rowland M, Ngufor C, Akogbeto MC, Protopopoff N. Effectiveness of pyriproxyfen-pyrethroid and chlorfenapyr-pyrethroid long-lasting insecticidal nets (LLINs) compared with pyrethroid-only LLINs for malaria control in the third year post-distribution: a secondary analysis of a cluster-randomised controlled trial in Benin. Lancet Infect Dis. 2024 Jun;24(6):619-628. doi: 10.1016/S1473-3099(24)00002-1. Epub 2024 Feb 21.

    PubMed 38401551
  • Sovi A, Adoha CJ, Yovogan B, Cross CL, Dee DP, Konkon AK, Sidick A, Accrombessi M, Ahouandjinou MJ, Osse R, Dangbenon E, Towakinou L, Agbangla C, Padonou GG, Churcher TS, Ngufor C, Cook J, Protopopoff N, Akogbeto MC, Messenger LA. The effect of next-generation, dual-active-ingredient, long-lasting insecticidal net deployment on insecticide resistance in malaria vectors in Benin: results of a 3-year, three-arm, cluster-randomised, controlled trial. Lancet Planet Health. 2024 Nov;8(11):e894-e905. doi: 10.1016/S2542-5196(24)00232-8.

    PubMed 39515347

Questions about this trial

What is this clinical trial studying?

A study testing Bed nets in people with Malaria and Anemia, run by London School of Hygiene and Tropical Medicine at 1 site in Benin.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 18 Oct 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Benin. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Malaria Case Incidence (time frame: 2 years). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03931473, which also lists 7 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 18 Oct 2024.

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