biostudies-literatureVilakati SBill &amp; Melinda Gates FoundationNIAID NIH HHSHorchow Family Funde005021https://www.ebi.ac.uk/biostudies/studies/S-EPMC8246301biostudies-literatureUnknown6(6)<h4>Introduction</h4>To reduce malaria transmission in very low-endemic settings, screening and treatment near index cases (reactive case detection (RACD)), is widely practised, but the rapid diagnostic tests (RDTs) used miss low-density infections. Reactive focal mass drug administration (rfMDA) may be safe and more effective.<h4>Methods</h4>We conducted a pragmatic cluster randomised controlled trial in Eswatini, a very low-endemic setting. 77 clusters were randomised to rfMDA using dihydroartemisin-piperaquine (DP) or RACD involving RDTs and artemether-lumefantrine. Interventions were delivered by the local programme. An intention-to-treat analysis was used to compare cluster-level cumulative confirmed malaria incidence among clusters with cases. Secondary outcomes included safety and aBMJ global healthEffectiveness and safety of reactive focal mass drug administration (rfMDA) using dihydroartemisinin-piperaquine to reduce malaria transmission in the very low-endemic setting of Eswatini: a pragmatic cluster randomised controlled trial.PMC82463015300375400A122394K24 AI144048Kunene SGosling RNhlabathi NDufour MKKalungero MHelb DPindolia DNtshalintshali NTesfa GPrach LMGreenhouse BHsiang MSBenjamin-Chung JBhangu KMalambe CDlamini BVilakati SDlamini NWhittemore BBaltzell KMngadi NMaphalala GfalseEffectiveness and safety of reactive focal mass drug administration (rfMDA) using dihydroartemisinin-piperaquine to reduce malaria transmission in the very low-endemic setting of Eswatini: a pragmatic cluster randomised controlled trial.<h4>Introduction</h4>To reduce malaria transmission in very low-endemic settings, screening and treatment near index cases (reactive case detection (RACD)), is widely practised, but the rapid diagnostic tests (RDTs) used miss low-density infections. Reactive focal mass drug administration (rfMDA) may be safe and more effective.<h4>Methods</h4>We conducted a pragmatic cluster randomised controlled trial in Eswatini, a very low-endemic setting. 77 clusters were randomised to rfMDA using dihydroartemisin-piperaquine (DP) or RACD involving RDTs and artemether-lumefantrine. Interventions were delivered by the local programme. An intention-to-treat analysis was used to compare cluster-level cumulative confirmed malaria incidence among clusters with cases. Secondary outcomes included safety and a2021-01-01T00:00:00Z2021 Jun2026-07-16T09:39:05.847Z2026-07-09T10:46:48.247ZS-EPMC82463013419347510.1136/bmjgh-2021-005021