Multi-year optimization of malaria intervention: a mathematical model

Abstract

Malaria is a mosquito-borne, lethal disease that affects millions and kills hundreds of thousands of people each year. In this paper, we develop a model for allocating malaria interventions across geographic regions and time, subject to budget constraints, with the aim of minimizing the number of person-days of malaria infection. The model considers a range of several conditions: climatic characteristics, treatment efficacy, distribution costs, and treatment coverage. We couple an expanded susceptible-infected-recovered (SIR) compartment model for the disease dynamics with an integer linear programming (ILP) model for selecting the disease interventions. Our model produces an intervention plan for all regions, identifying which combination of interventions, with which level of coverage, to use in each region and year in a five-year planning horizon. Simulations using the model yield high-level, qualitative insights on optimal intervention policies: The optimal policy is different when considering a five-year time horizon than when considering only a single year, due to the effects that interventions have on the disease transmission dynamics. The vaccine intervention is rarely selected, except if its assumed cost is significantly lower than that predicted in the literature. Increasing the available budget causes the number of person-days of malaria infection to decrease linearly up to a point, after which the benefit of increased budget starts to taper. The optimal policy is highly dependent on assumptions about mosquito density, selecting different interventions for wet climates with high density than for dry climates with low density, and the interventions are found to be less effective at controlling malaria in the wet climates when attainable intervention coverage is 60% or lower. However, when intervention coverage of 80% is attainable, then malaria prevalence drops quickly.