Malaria vaccines, insecticide-treated bed nets, and preventive drugs are being rolled out together across districts in Cameroon and Côte d’Ivoire, and researchers are tracking exactly how well these combinations work in real-world conditions. No single malaria tool stops all infections, so countries must decide how to mix them with limited budgets. The OPTiMIX study addresses a critical gap: the lack of evidence on what happens when vaccines, nets treated with piperonyl butoxide, and seasonal or year-round chemoprevention are used together in routine health systems, not just in controlled trials. The team is measuring malaria and anaemia rates in child cohorts, while also testing a process-improvement framework to help local health workers and planners integrate these tools sustainably. If the research succeeds, national malaria programmes in Africa will have clear, costed evidence on which combinations of interventions reduce the most illness and death. That could shift how governments and donors allocate resources—away from guesswork and toward strategies that maximise community protection. The work also builds a transferable method for optimising co-implementation of any mix of public health tools, not just for malaria.
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Current malaria prevention tools offer only partial protection against malaria, hence co-implementation of malaria prevention strategies are preferred. Combining tools allows different points in the malaria transmission cycle to be targeted and/ or improve community protection against malaria as individuals may opt for one tool that is more acceptable to them in preference to having no protection. The impacts of different mixes of interventions on individual level and community protection against malaria in routine settings are poorly understood but essential information to support country level strategic planning with limited resources. In this proposal we aim to evaluate the effectiveness of co-implementation of national strategies of malaria vaccines (MVac), piperonyl butoxide and pyrethroid-treated long-lasting insecticidal nets (PBO-LLINs), and malaria chemoprevention (Perennial Malarial Chemoprevention - PMC and Seaonal Malaria Chemoprevention - SMC) on malaria incidence, and to identify sustainable and integrated supplementary delivery models that optimise acceptability and feasibility to these strategies. The OPTiMIX study team, a collaboration between the Fobang Institute of Innovation in Science and Technology (FINISTECH) Yaounde, Cameroon, The Institut Nacional de Sante Publique (INSP), Abidjan, Côte d'Ivoire and the London School of Hygiene and Tropical Medicine (LSHTM), London, UK have been working together since 2023 to monitor the roll-out of PMC in moderate-high malaria transmission study sites in Cameroon and Côte d'Ivoire. Each study site consists of a control district where the study population receives standard-of-care malaria prevention, and an intervention district where the population receives the new PMC intervention. The impact of PMC implementation is evaluated using active and passive cohorts to measure incidence of malaria and anaemia, intervention acceptability, feasibility and cost-effectiveness. In 2024, our PMC intervention sites started (or will start) to receive MVacs (RTS,S in Cameroon in March, and R21 in Côte d'Ivoire in October). In 2025 all study districts will receive PBO-LLINs, and in 2025 our control study district in Côte d'Ivoire will receive SMC. The routine co-implementation of this mix of interventions provides an exciting opportunity to optimise and measure the impacts of combinations of malaria interventions including MVacs. The OPTiMIX study will do this through the following three objectives: Objective 1: Measure the effectiveness, coverage, and safety of national co-implementation of combinations of MVac, PBO-LLINs and chemoprevention (PMC and SMC) at reducing the burden of malaria. This will be achieved through leveraging four large established infant and child cohorts at high risk of malaria. We will extend active and passive cohorts for 3 years to capture the individual and community impacts of various combinations of interventions. The main analysis will use Cox regression on the outcome of clinical malaria. Objective 2: Identify sustainable and integrated supplementary delivery models to support improved co-implementation of MVac, PBO-LLINs and chemoprevention. This will be achieved by applying a process improvement intervention (the LEAD framework) that supports key stakeholders at different levels of the delivery continuum in co-production and feedback cycles to create sustainable and integrated supplementary delivery models. We will assess supplementary delivery methods and interventions mixes through measures of acceptability and implementation feasibility. Objective 3: Develop and test a transferable process for assessing and optimising co-implementation of preventive malaria control interventions and elucidating the programme theories underpinning the process. Throughout the study we will build and test programme theories, ultimately deriving final programme theories underpinning MVac, PBO-LLINs and chemoprevention (PMC & SMC) co-implementation.
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