Summary
Intermittent preventive treatment in infants (IPTi) for malaria is a program that distributes preventive antimalarial medication to infants that is delivered during routine immunization services. There is strong evidence showing the program is effective at preventing malaria among the treated population.
We believe this program is potentially promising; we currently think that it may be as or more cost-effective than other programs we expect to direct funding to in 2021, but this estimate is highly uncertain and depends upon, for example, the costs of the program, the likelihood of success, and the burden and seasonality of malaria in selected geographies.
In order to learn more about some of these uncertainties, in September 2021 we recommended a grant of $120,000 from an anonymous individual donor to PATH and Malaria Consortium to work together over four to six months to scope the feasibility of implementing IPTi at national scale in suitable areas in the Democratic Republic of the Congo (DRC) and Nigeria, assess the potential cost-effectiveness of delivering the program in those places, and build a notional plan for implementation.
If, based upon this work, we think that IPTi is likely to meet our cost-effectiveness bar in these countries after the scoping period, we may recommend funding to PATH and Malaria Consortium to implement the program at national scale.
Published: January 2022
Table of Contents
The intervention
IPTi is the provision of a malaria-preventive medication, generally sulfadoxine-pyrimethamine (SP), to infants, typically during their routine immunization visits in the first year of life.1
There is strong evidence showing that IPTi is effective in substantially reducing cases of malaria in the treated population: a Cochrane meta-analysis of 12 randomized controlled trials (RCTs)2 found that IPTi reduced cases of clinical malaria by 30%.3 See here for our review of this evidence.4
The World Health Organization (WHO) has recommended IPTi since 2010,5 but it has been implemented at a national scale in only one country.6 Some reasons we think that more widespread adoption of IPTi may have been hindered include:
- The WHO guidelines currently recommend that IPTi be conducted only where prevalence of markers of parasite resistance to SP is at or below 50%,7 which may make it more challenging for countries to take up IPTi if they no longer have routine monitoring of SP resistance or have levels of SP resistance above that threshold.8
- Until recently, existing drug formulations of SP were not suitable for infants and needed to be cut and crushed to appropriate dosages, which made administration of the drug more challenging.9 A dispersible tablet at the appropriate dosage for infants is now available.10
- The program requires strong coordination between national immunization and malaria programs.11
However, a previous UNICEF pilot implementation found that it was feasible to implement IPTi with high coverage levels12 in six countries in Africa (Benin, Ghana, Madagascar, Mali, Malawi, and Senegal).13 In addition, there has been increasing interest in accelerating the adoption of IPTi, as evidenced by IPTi's selection as one of the focus areas of the 2019 WHO technical consultation,14 as well as recent Unitaid15 and Bill and Melinda Gates Foundation (BMGF)16 investments in IPTi.
The organizations
Our process for identifying partners
Because we do not know of any organizations currently implementing IPTi at a substantial scale, our process for identifying partners was different from what we normally do at this stage of our research. We sent a request for information (RFI) to 18 organizations with demonstrated experience launching and scaling up malaria- or immunization-related programs in Africa. Our goal was to identify organizations that seemed well suited to designing and implementing an IPTi program at national scale.
In the RFI, we requested information related to organizational track record delivering similar interventions, as well as high-level thoughts on how each organization would approach assessing the feasibility and cost-effectiveness of bringing IPTi to national scale. We did not indicate any preference in terms of geographical focus.17
Seven organizations responded, and individual GiveWell researchers independently scored their expressions of interest. Based on those scores, we selected four organizations for further discussions. We had up to two rounds of discussions with each of these four organizations, in which we dug further into the organizations’ track records and proposed approaches to scoping and scaling up implementation of IPTi.
We ultimately selected two organizations — PATH and Malaria Consortium — to work together to conduct a study to assess the feasibility and cost-effectiveness of introducing IPTi into national policy in two countries.
Why PATH and Malaria Consortium?
After several conversations and a review of past performance, we believe that PATH and Malaria Consortium could have the organizational experience and positioning to successfully implement IPTi. It was our impression that both organizations demonstrated knowledge of scientific and practical considerations relevant to implementing malaria chemoprevention and vaccine strategies, thoughtful and transparent reasoning, and the ability to communicate effectively with us. Moreover, the two organizations have complementary strengths relevant to scaling up IPTi and have had experience working together successfully in the past.18
PATH
Based on conversations we’ve had with other organizations and experts in the malaria space, it is our impression that PATH has strong relationships with relevant stakeholders in the primary countries of interest, which we think would be important for the success of interventions implemented within government health systems.
PATH is one of the main implementation partners working on rolling out the RTS,S malaria vaccine in three African countries.19 This work has been successful so far in that it has achieved a high degree of coverage in a short period of time,20 and we think that PATH’s experience working at the intersection of immunization and malaria programs for scaling up RTS,S may be applicable to successfully implementing IPTi through immunization platforms.21
Malaria Consortium
Our impression is that Malaria Consortium is relatively strong in on-the-ground implementation and research design.22
In addition, we felt that they had a technical command of the details of IPTi.23
Moreover, Malaria Consortium is already piloting IPTi in six local government areas in Nigeria with BMGF funding,24
and it may be possible to leverage this work to support the scale-up of IPTi in Nigeria.
During our calls, Malaria Consortium appeared to be aligned with us around the importance of robust monitoring and evaluation (M&E) and cost-effectiveness as key considerations in planning for IPTi implementation.25
Planned activities
Geographies
Working with PATH and Malaria Consortium, we identified Nigeria and the Democratic Republic of the Congo (DRC) as promising settings in which to implement IPTi, for several reasons:26
- High malaria burden among infants27
- Low levels of parasitic resistance to SP, the drug used for IPTi28
- Large target populations, which could lead to higher cost-effectiveness if there are fixed costs to scaling up the program in each country29
- Malaria Consortium and PATH's apparently strong positioning in these two countries (see previous section)
However, we are highly uncertain about the feasibility of and costs associated with implementing IPTi in these countries.
Scoping feasibility and cost-effectiveness
PATH and Malaria Consortium are working together for four to six months, starting from September 2021, to scope the feasibility and likely cost-effectiveness of implementing IPTi at national scale in DRC and Nigeria, build a timeline, and plan program implementation. Specifically, the scoping work will include:
- Identifying stakeholders and assessing country interest in IPTi in conversation with those stakeholders30
- Defining subnational target areas through epidemiological analysis (i.e., which areas are suitable for IPTi based on the patterns of transmission and the burden of malaria)31
- Exploring existing delivery platforms that could be used for IPTi delivery (such as routine immunization platforms or community-based delivery with trained community health workers)32
- Understanding commodity procurement and distribution channels for IPTi drugs (i.e., whether there is a viable supply chain to bring IPTi to scale)33
- Assessing programmatic risks and developing risk mitigation strategies34
- Assessing the quality of routine surveillance and data systems in target areas, and proposing approaches for monitoring the uptake of IPTi were it to be introduced into national policy and practice35
- Building a timeline and plan for scale, including a costing model with an overall budget for implementation in each country36
The scoping phase will be followed by a full grant investigation to assess the promisingness of funding scale-up of IPTi in DRC and Nigeria.
It is possible that major uncertainties will remain about the feasibility and cost-effectiveness of IPTi implementation even after the scoping period.
Budget
The budget for the grant is $120,000, including the costs of labor, travel, data collection, local consultants, and meetings.37
Risks and reservations
Some uncertainties and reservations we have about recommending this scoping grant for IPTi include:
- Major uncertainties remaining after scoping. It is possible that major uncertainties will remain about the feasibility and cost-effectiveness of IPTi implementation even after the scoping period, and that we won’t have all the information we need to make a decision about funding IPTi at scale.
- Choice of partners. It is possible that other organizations would be better suited to do this work.
- For example, PATH is a new partner to us, and we may not be fully aligned on key uncertainties to answer during scoping, level of rigor for the monitoring and evaluation plan, and prioritization of cost-effectiveness. It’s possible that we won’t have the relevant information by the end of the scoping period to make a decision about funding IPTi at scale, or won’t be able to agree on a plan for scale-up. We think we can mitigate risks of misalignment with our partners by having regular check-ins with them throughout the scoping period.
- In addition, it’s possible that funding a joint project between PATH and Malaria Consortium will introduce more overhead costs of coordination than value from collaboration between the two organizations.
- Creating expectations of continued funding. During the scoping period, there may be a risk of setting unrealistic expectations by country governments of continued funding to scale up the program. If we then decide not to recommend another grant to implement IPTi at scale in these countries, it may have a negative impact on our or our implementing partners’ relationships with stakeholders in these countries.
- Strength of existing relationships in countries of interest. We have not independently verified the nature of PATH and Malaria Consortium’s presence in the proposed geographies and the strength of their relationships with those country governments. If we are wrong about the strength of their existing relationships in these countries, it is possible that they will gain less traction with assessing feasibility of IPTi implementation or with building a plan for scale-up.
- Waiting on more evidence generation vs. moving ahead now. Our understanding is that there will be additional evidence available on the potential impact and feasibility of IPTi in the next few years, including from recent Unitaid38 and BMGF39 investments in IPTi. While we think that there is benefit to learning more about and potentially bringing IPTi to scale as quickly as possible, waiting for the evidence from these investments to become available could better inform our understanding of the promisingness of IPTi.
- The interaction between RTS,S and IPTi. We are uncertain about how the rollout of the RTS,S malaria vaccine will affect the promisingness of IPTi. For example, IPTi may have a lower marginal impact if it is adopted in the same geographies where the vaccine is rolled out. On the other hand, it is possible that partnerships formed with immunization platforms and national malaria control programs for this IPTi grant could be leveraged for future implementation of RTS,S, in addition to or instead of IPTi.
Forecasts
For this grant, we are recording the following forecasts:
Confidence Prediction By time 85% We will receive country scoping reports and estimated budgets for the next stage of scale-up that, in combination with ongoing conversations with Malaria Consortium and PATH, will be sufficient for our cost-effectiveness analyses at the end of the scoping period. February 2022 50% Expected room for more funding for scaling this program that is at or above 10 times as cost-effective as cash transfers will be greater than $30 million. March 2022 50% We will recommend at least one other grant, worth more than $5 million, for IPTi programs. June 2022 Sources
- 1See our report on IPTi for more information on the intervention and our assessment of its promisingness.
- 2
- "We included randomized controlled trials (RCTs) that compared IPT to placebo or no intervention in infants (defined as young children aged between 1 to 12 months) in malaria-endemic areas." Esu, Oringanje, and Meremikwu 2021, "Selection criteria"
- “We included 12 trials that enrolled 19,098 infants; all were conducted in sub-Saharan Africa. Three trials were cluster-RCTs. IPTi with sulfadoxine-pyrimethamine (SP) was evaluated in 10 trials from 1999 to 2013 (n = 15,256). Trials evaluating ACTs included dihydroartemisinin-piperaquine (1 trial, 147 participants; year 2013), amodiaquine-artesunate (1 study, 684 participants; year 2008), and SP-artesunate (1 trial, 676 participants; year 2008).” Esu, Oringanje, and Meremikwu 2021, "Main results"
- 3 “Although the effect size varied over time and between drugs, overall IPTi impacts on the incidence of clinical malaria overall, with a 30% reduction (rate ratio 0.70, 0.62 to 0.80; 10 studies, 10,602 participants).” Esu, Oringanje, and Meremikwu 2021, "Main results"
- 4Note that the effect we have cited here is from a newer version of the meta-analysis that was published after our previous review of the evidence.
- 5“In 2010, WHO provided the following policy recommendation: ‘In areas of moderate-to-high malaria transmission where SP is still effective, provide intermittent preventive treatment with SP to infants (<12 months of age) (SP-IPTi) at the time of the second and third rounds of vaccination against diphtheria, tetanus and pertussis (DTP) and vaccination against measles.’” Malaria Policy Advisory Committee Meeting, Meeting Report: Technical Consultation to Review the Role of Drugs in Malaria Prevention for People Living in Endemic Settings, 2020, p. 10
More information on WHO’s IPTi guidelines can be found in the WHO IPTi Implementation Field Guide from 2011: here.
- 6“However, to date, only Sierra Leone has implemented IPTi at a national scale. The country adopted the intervention in 2016, piloting it in two then four districts before national roll-out in 2018.” Malaria Policy Advisory Committee Meeting, Meeting Report: Technical Consultation to Review the Role of Drugs in Malaria Prevention for People Living in Endemic Settings, 2020, p. 10
- 7
- "The 2015 Guidelines for the treatment of malaria recognized the potential of the routine immunization services within the Expanded Programme on Immunization (EPI) to deliver IPTi as part of the routine health system and defined resistance as 'not high' when the prevalence of the pfdhps540 mutation is ≤50%." Malaria Policy Advisory Committee Meeting, Meeting Report: Technical Consultation to Review the Role of Drugs in Malaria Prevention for People Living in Endemic Settings, 2020, p. 10
- "The cut-off of 50% prevalence of pfdhps540 mutants was originally recommended, as this was the highest prevalence at which IPTi-SP had been shown to have a protective effect." Malaria Policy Advisory Committee Meeting, Meeting Report: Technical Consultation to Review the Role of Drugs in Malaria Prevention for People Living in Endemic Settings, 2020, p. 11
- 8“The recommendation that IPTi should not be implemented in areas with high prevalence of molecular markers of SP resistance was seen as the primary barrier to its implementation for two reasons. First, the requirement for countries to measure molecular markers to determine the applicability of IPTi in their setting may be a barrier, as markers of SP resistance are no longer routinely monitored. Second, the prevalence of molecular markers of drug resistance may not correlate with the effectiveness of chemoprevention, as has been acknowledged with IPTp [intermittent preventive treatment of malaria in pregnancy]. However, caution is required in extrapolating findings from semi-immune pregnant women to nonimmune infants.” Malaria Policy Advisory Committee Meeting, Meeting Report: Technical Consultation to Review the Role of Drugs in Malaria Prevention for People Living in Endemic Settings, 2020, p. 11
- 9“Paediatric drug formulation: The pilot implementation studies found that, although it was possible to cut and crush SP tablets for administration to young infants, this was a cumbersome process. A paediatric formulation has been developed for SMC, which would make for much easier administration. The importance of ensuring adequate dosing and of understanding the pharmacokinetics in the target age group was recognized.” Malaria Policy Advisory Committee Meeting, Meeting Report: Technical Consultation to Review the Role of Drugs in Malaria Prevention for People Living in Endemic Settings, 2020, p. 12
- 10On 12 April 2021, WHO Prequalification Unit added a dispersible SP tablet to its list of prequalified medicinal products. See here.
“Date of prequalification: 12 April 2021
Basis of listing: Prequalified by WHO
Status: Active
INN: Pyrimethamine/Sulfadoxine
Therapeutic area: Malaria
Dosage form & strength: Tablet, Dispersible 12.5mg/250mg
Applicant: S Kant Healthcare Ltd, 3-A, Shiv Sagar Estate, Dr. Annie Besant Road, Worli, Mumbai, 400 018, India” - 11“At the central level, there is support to decrease the burden of malaria in infants, and implementation through routine immunization should ensure access for the target population. Integration of IPTi into immunization services, including outreach sessions, adds a preventive intervention and could increase coverage of both interventions in communities. However, careful coordination is required for training, supply and time management. As with IPTp, coordination is required between the established delivery platform, i.e., the routine immunization services, and the national malaria programme. The success of an IPTi programme will depend on strong leadership within the national and subnational EPI teams.” Malaria Policy Advisory Committee Meeting, Meeting Report: Technical Consultation to Review the Role of Drugs in Malaria Prevention for People Living in Endemic Settings, 2020, p. 11
- 12“Prior to the policy recommendation, pilot implementation by UNICEF in districts of six countries concluded that IPTi could be easily scaled up to near universal coverage, had an acceptable safety profile and was highly cost-effective (US$ 2.50/disability-adjusted life year [DALY] averted).” Malaria Policy Advisory Committee Meeting, Meeting Report: Technical Consultation to Review the Role of Drugs in Malaria Prevention for People Living in Endemic Settings, 2020, p. 10
- 13“In 2007, UNICEF launched an IPTi pilot implementation study in twenty districts across six malaria endemic countries in Africa (Benin, Ghana, Madagascar, Mali, Malawi and Senegal).” UNICEF, Operational Research on Intermittent Preventive Treatment of Malaria in Infants (IPTi), Pharmacovigilance Report, 2009, "Summary," p. 9
- 14
- “On 16–17 October 2019, the World Health Organization (WHO) convened a Technical Consultation to review the use of medicines for malaria prevention in endemic countries and to identify opportunities to increase their impact through review of the flexibility of the recommendations for their deployment. Experts reviewed the policies and use of chemoprevention as currently endorsed by WHO, including intermittent preventive treatment in pregnancy (IPTp), intermittent preventive treatment in infants (IPTi), seasonal malaria chemoprevention (SMC) and mass drug administration (MDA) for the reduction of disease burden in emergency situations.” Malaria Policy Advisory Committee Meeting, Meeting Report: Technical Consultation to Review the Role of Drugs in Malaria Prevention for People Living in Endemic Settings, 2020, p. 1
- “In October 2019, WHO held a Technical Consultation to Review the Role of Drugs in Malaria Prevention for People Living in Endemic Settings. Participants encouraged increased IPTi scale-up, and reiterated that IPTi should be pursued with a sense of urgency. There was agreement that a more flexible approach to IPTi implementation could engender adoption by countries. It was therefore recommended that adaptations of the current IPTi recommendations be tested through pilot implementation with robust evaluation to assess impact, operational feasibility and cost effectiveness.” Unitaid, "Call for proposals: intermittent preventive treatment in infants," 2019
- 15“With a US $35 million investment from Unitaid, the Intermittent Preventive Treatment in infants – Plus (IPTI+) project will develop scalable models of IPTi+, an innovation on the WHO-recommended IPTi, that expands the number of preventive doses of SP administered to children and extends coverage of IPTi through a child’s second year of life. Over the life of the project, the IPTi+ project will administer an estimated 2.5 million doses of SP for IPTi+ protecting over half a million children under two years of age from malaria and anemia.” Unitaid, "A new initiative will deliver enhanced malaria prevention to children under two across Africa through a WHO-recommended but under-implemented intervention," 2021
- 16“Purpose: To generate local evidence for the protective efficacy, cost effectiveness and programmatic feasibility of IPTi in Nigeria.” Bill and Melinda Gates Foundation, "Committed grants: Malaria Consortium"
- 17See GiveWell, Request for information: Scaling intermittent preventive treatment in infants (IPTi) for malaria, 2020 (redacted) for more details.
- 18“PATH and Malaria Consortium have collaborated before, notably on the VectorLink programme, is there anything you think we could partner on in the future?
"Our organisations have complementary strengths and geographic footprints. One particular way we could support each other is through sharing cross-country learnings for advocacy purposes – through the exchange of resources and evidence we can generate stronger advocacy case for use in the multiple policy pathways we are tapped into. Programmatically, both PATH and Malaria Consortium are strong in the field of surveillance and stratification – perhaps we could find a way to combine and have a larger impact in high burden countries.”
Power, "In conversation with Hana Bilak, malaria technical advisor at PATH," 2020
- 19“The RTS,S/AS01E malaria vaccine, developed by GSK for more than 30 years, and in partnership with PATH since 2001, is currently being piloted in regions of Ghana, Kenya, and Malawi under the Malaria Vaccine Implementation Programme (MVIP). Ministries of health are leading the implementation of the vaccine, which is being given to young children through the three countries’ routine immunisation programmes, with WHO providing technical and scientific leadership, playing a coordinating role, and working in collaboration with GSK, PATH, and a range of other partners.” PATH, Malaria Vaccine Initiative, "GSK, PATH, and Bharat Biotech sign product transfer agreement to help ensure long-term supply of RTS,S/AS01E malaria vaccine," 2021
- 20Rollout began in 2019. In 2020 coverage of the first dose of RTS,S ("RTS,S-1") reached 88%, 71%, and 69% in Malawi, Ghana, and Kenya, respectively. See WHO, Joint SAGE and MPAG Session on the RTS,S/AS01 Malaria Vaccine, slide 29.
- 21“The rollout of the new RTS,S malaria vaccine is showing promising signs so far, including quickly accelerating coverage rates and high rates of community acceptance. Since RTS,S is a vaccine and therefore fits more naturally within the EPI platform, its integration into the platform will not be identical to the potential integration of IPTi into EPI. However, there is substantial overlap between how the EPI and national malaria control programs (NMCPs) collaborated for the RTS,S vaccine rollout and how they could collaborate in rolling out IPTi.” GiveWell's non-verbatim summary of a conversation with PATH, May 28, 2021, p. 6
- 22For example, Malaria Consortium also supported implementation of ACCESS-SMC and is now running large-scale (20 million children), multi-country seasonal malaria chemoprevention (SMC) programming. GiveWell has supported Malaria Consortium’s SMC work in Nigeria since 2016.
- "At-scale roll out of SMC is essential to make a substantial impact in both public health and on the market for SMC products. ACCESS-SMC will provide 15 million SMC treatments in 2015 and 30 million SMC treatments in 2016, potentially averting 36,000 deaths.
"Malaria Consortium will support National Malaria Control and Elimination Programs to lead SMC implementation in Burkina Faso, Chad and Nigeria and CRS will support in Guinea, Mali, Niger and The Gambia." Malaria Consortium, ACCESS-SMC: Achieving Catalytic Expansion of Seasonal Malaria Chemoprevention in the Sahel - "In 2021, we aim to reach 20 million children across Burkina Faso, Chad, Mozambique, Nigeria, Togo and Uganda." Malaria Consortium, "Seasonal malaria chemoprevention"
- "At-scale roll out of SMC is essential to make a substantial impact in both public health and on the market for SMC products. ACCESS-SMC will provide 15 million SMC treatments in 2015 and 30 million SMC treatments in 2016, potentially averting 36,000 deaths.
- 23See, for example, this portion of our conversation with Malaria Consortium on March 12, 2021:
“Malaria Consortium believes that scaling up IPTi is one step toward the goal of eliminating malaria, especially in high-burden countries, and that this broader effort is currently receiving a lot of support from WHO's malaria program. However, some other malaria control interventions are becoming less cost-effective over time, jeopardizing progress on malaria elimination. Risks to commonly used malaria control interventions include:
- Rises in HRP2 gene deletions – genetic changes in malaria-causing parasites that make it more difficult for healthcare providers to diagnose (and, therefore, treat) malaria cases.
- Rising costs of long-lasting insecticide-treated nets (LLINs) – rising insecticide resistance that requires the use of more expensive next-generation nets.
- Decreasing coverage of indoor residual spraying (IRS) – fewer households are having their living spaces treated with insecticide.
- Anopheles stephensi – a species of mosquito endemic to Asia that has recently been discovered causing cases of malaria in Africa.”
GiveWell's non-verbatim summary of a conversation with Malaria Consortium, March 12, 2021, p. 9
- 24
- "Country: Nigeria. Donor: Bill & Melinda Gates Foundation. Length of project: November 2020 – October 2024." Malaria Consortium, Reducing Malaria Morbidity in Infants Through Intermittent Preventive Treatment in Nigeria, 2021, p. 1
- "This study will assess IPTi’s clinical effectiveness and operational feasibility in Nigeria. It aims to generate the necessary evidence to support the intervention’s uptake in the national health policy…. We plan to implement the intervention in six local government areas, reaching 10,800 children below the age of one." Malaria Consortium, Reducing Malaria Morbidity in Infants Through Intermittent Preventive Treatment in Nigeria, 2021, p. 2
- 25Below are some examples of Malaria Consortium's thinking around cost-effectiveness and evidence:
- “Malaria Consortium would be willing to adapt its proposal for the expansion of the Gates Foundation study to emphasize the operational research elements of the study, rather than the effectiveness assessment. However, Malaria Consortium also believes that it is important to embed a minimal amount of effectiveness monitoring in the study, as collecting that type of routine data will be valuable and will add to the evidence base for IPTi as it works toward scaling the program.” GiveWell's non-verbatim summary of a conversation with Malaria Consortium, May 24, 2021, pp. 2-3
- “While Malaria Consortium is excited that Cameroon is ready to move forward with IPTi, as an evidence-based organization, Malaria Consortium also believes that gathering evidence from these first two regions will be critical in securing funding to scale up the program, as well as to understand how to do so cost-effectively.” GiveWell's non-verbatim summary of a conversation with Malaria Consortium, May 24, 2021, p. 3
- "Malaria Consortium also believes it is important to implement IPTi at scale, because cost-effectiveness can only be optimized on a large scale, especially for an intervention like IPTi, which targets a relatively small population that is not being reached by other interventions.” GiveWell's non-verbatim summary of a conversation with Malaria Consortium, March 12, 2021, p. 9
- 26See our assessment of how promising various countries are likely to be here.
- 27See this spreadsheet, "Under-1 mortality rate from malaria (per 100,000 child years)" column.
- 28See this spreadsheet, "SP resistance" column.
- 29See this spreadsheet, "Population <5 yo (2020)" column.
- 30See the scoping proposal, Malaria Consortium and PATH, Accelerating the Scale-Up of Intermittent Preventive Treatment in Infants for Malaria: Proposed Approach for the Scoping Phase, 2021, Table 1, p. 3, "Country demand for IPTi" row.
- 31See Malaria Consortium and PATH, Accelerating the Scale-Up of Intermittent Preventive Treatment in Infants for Malaria: Proposed Approach for the Scoping Phase, 2021, Table 1, p. 4, "Appropriate epidemiological context for subnational targeting and relevant populations" row.
- 32See Malaria Consortium and PATH, Accelerating the Scale-Up of Intermittent Preventive Treatment in Infants for Malaria: Proposed Approach for the Scoping Phase, 2021, Table 1, pp. 5-6, "Existing delivery platforms" row.
- 33See Malaria Consortium and PATH, Accelerating the Scale-Up of Intermittent Preventive Treatment in Infants for Malaria: Proposed Approach for the Scoping Phase, 2021, Table 1, p. 6, "Functioning commodity procurement and distribution channels" row.
- 34"Identification of potential risk and mitigation strategies: The programmatic risks at each phase of scale in each country and potential mitigation strategies based on stakeholder consultations and in-country project implementation experience from both PATH and Malaria Consortium will be articulated. The categories of risks that will be identified will include security risks, lack of political will, lack of interest in IPTi implementation, issues with registration and procurement of drug, regulatory issues, biological risks including drug resistance, and other health emergencies that might impede implementation." Malaria Consortium and PATH, Accelerating the Scale-Up of Intermittent Preventive Treatment in Infants for Malaria: Proposed Approach for the Scoping Phase, 2021, Table 3, p. 13
- 35
- See Malaria Consortium and PATH, Accelerating the Scale-Up of Intermittent Preventive Treatment in Infants for Malaria: Proposed Approach for the Scoping Phase, 2021, Table 1, p. 7, "Assessment of the health information system and data quality for interoperability with other systems and readiness for scale-up" row.
- "The M&E plan will include the following components:
- Monitoring plan. The measurement framework will be aligned with the plan for scale and include indicators for (a) inputs, (b) processes, (c) outputs, (d) outcomes, and, where feasible, (e) impact.
- Evaluation plan for additional, embedded studies to support routine monitoring activities (see Table 2 potential indicators and approach). The evaluation plan will include studies that (a) estimate program impact, (b) estimate coverage and adherence to IPTi administration, (c) assess the quality and accuracy of the routine data collected, and (d) capture broader contextual lessons and benefits of the program. It will also include a process evaluation to understand how well the relationship with the government and other implementing partners is going and identify areas for improvement for greater efficiency and impact.
- Learning plan that includes key questions of interest to stakeholders and plans for discussion and dissemination of routine monitoring and evaluation results throughout the implementation period." Malaria Consortium and PATH, Accelerating the Scale-Up of Intermittent Preventive Treatment in Infants for Malaria: Proposed Approach for the Scoping Phase, 2021, p. 8
- 36
- "Costing model: We will develop a costing model design and inputs that capture fixed and variable costs of delivery of IPTi in targeted areas and delivery modalities within each country. The model will include costs specific to country implementation and costs associated with broader learning and evaluation. Costs will take into account both GiveWell project costs as well as government and other funded support for IPTi." Malaria Consortium and PATH, Accelerating the Scale-Up of Intermittent Preventive Treatment in Infants for Malaria: Proposed Approach for the Scoping Phase, 2021, Table 3, p. 13
- "Overall notional budget: Estimated cost of the proposed implementation work per country with the best guess timelines and budget that includes the 25th and 75th percentile timelines for each." Malaria Consortium and PATH, Accelerating the Scale-Up of Intermittent Preventive Treatment in Infants for Malaria: Proposed Approach for the Scoping Phase, 2021, Table 3, p. 13
- 37"We are requesting $120,000 in total costs for the scoping phase for both organizations. The proposed costs of the scoping phase are primarily driven by labor. Non-labor costs are budgeted for consultants, data collectors, local travel, and meeting costs to conduct stakeholder engagement, assessments, and reviews in DRC and Nigeria." Malaria Consortium and PATH, Accelerating the Scale-Up of Intermittent Preventive Treatment in Infants for Malaria: Proposed Approach for the Scoping Phase, 2021, “Budget for scoping phase,” p. 14.
- 38“With a US $35 million investment from Unitaid, the Intermittent Preventive Treatment in infants – Plus (IPTI+) project will develop scalable models of IPTi+, an innovation on the WHO-recommended IPTi, that expands the number of preventive doses of SP administered to children and extends coverage of IPTi through a child’s second year of life. Over the life of the project, the IPTi+ project will administer an estimated 2.5 million doses of SP for IPTi+ protecting over half a million children under two years of age from malaria and anemia.
“The project will collect evidence on impact, cost-effectiveness, and feasibility of IPTi+ across variable settings to inform scale-up in target countries and beyond. In addition to piloting implementation models in the four focus countries, the IPTi+ project will generate policy, economic, and suitability evidence on IPTi+ in three additional countries.” Unitaid, "A new initiative will deliver enhanced malaria prevention to children under two across Africa through a WHO-recommended but under-implemented intervention," 2021
- 39“Purpose: To generate local evidence for the protective efficacy, cost effectiveness and programmatic feasibility of IPTi in Nigeria.” Bill and Melinda Gates Foundation, "Committed grants: Malaria Consortium"