In advance of the lecture/discussion portion of this session, participant groups will present their perspectives and ideas regarding country specific challenges to measuring transmission, including potential challenges, knowledge gaps, and opportunities of available tools. This second part of this session will feature presentations and discussions on entomological, parasitological, and serological approaches to quantify transmission and changes in transmission. Participants will discuss in groups how to interpret outcomes and understand the logistical, financial, and technical requirements for different approaches.

Learning Objectives:

• To learn country specific challenges to measuring transmission based on peer-to-peer mutual learning and exchange.
• To gain an improved understanding of entomological, parasitological, and serological malaria transmission estimates at different levels of transmission intensity.
• To gain a better appreciation of the temporal and spatial dynamics in entomological, parasitological, and serological transmission estimates.

This session will center on malaria transmission biology at a level relevant for malaria control and elimination. Participants will gain a better understanding of the strengths, weaknesses, and complications of currently available tools to interrupt malaria transmission. In addition, participants will share their experiences and knowledge of the different transmission blocking tools.

Learning Objectives:

• To gain a better understanding of the relative importance of parasite clearance, prophylaxis, and gametocyte clearance in malaria therapy for reducing transmission of P. falciparum.
• To gain a better understand of the relative importance of parasite clearance, hypnozoite radical cure, prophylaxis, and gametocyte clearance in malaria therapy for reducing transmission of P. vivax.
• To learn how to prioritize interventions based on malaria transmission characteristics.
• Participants will be able to critically appraise the strength and weaknesses of drug interventions and other interventions for their own malaria setting.

Vector control is the most important and most widely used method of malaria control and prevention. Evidence suggests that the greatest successes ever achieved against malaria have been due to vector control, mostly in the form of insecticide spaying outdoors and indoors, improved housing and environmental management in the early years, and more recently the use of insecticide treated bed nets (ITNs) in the past decade. Nearly 430 million ITNs were delivered between 2012 and 2014, and today about 50% of all persons at risk have access to the nets, up from just 3% in 2004 (World Malaria Report 2014). Many challenges and gaps still exist in the approaches that we have today.

This session will focus on identifying the most important of these challenges and examining mechanisms to address them in the short, medium, and long term. Key examples of these challenges include: 1) the spread of insecticide resistance, 2) increasing significance in outdoor malaria transmission relative to transmission occurring indoors, 3) lack of financial assurance to sustain vector control, 4) climate change and the spread of malaria mosquitoes, 5) poor understanding of ecology and behaviors of malaria vectors, 6) anthropological challenges related to human behaviors and occupation, and 7) inadequacies in human resource capacity to lead the vector control agenda in the next stages. While the malaria control community will continue to rely on vector control as its mainstay in the short and medium time, these challenges should be addressed proactively.

Learning Objectives:

• To gain an understanding of historical and recent successes of malaria vector control, but also major challenges that will hinder malaria elimination.
• To analyze existing evidence and clearly identify major challenges to malaria vector control in different ecological, political, and epidemiological settings.
• To identify opportunities for improving vector control and addressing current challenges, so as to accelerate effort towards malaria elimination.

This session will center on the current challenges with mosquito- and parasite-focused malaria elimination strategies. Faculty will present and facilitate a group discussion of examples of malaria elimination efforts based on reactive case detection, hotspot targeting and novel entomological interventions, timelines to success, and evaluation of intervention impact.

Learning Objectives:

• To gain an improved understanding of the logistical challenges and opportunities to target the human infectious reservoir for malaria.
• To gain a better understanding of mosquito factors that complicate current elimination efforts and become informed of recent developments in targeting outdoor biting mosquitoes.
• To understand the theory and practical consequences of heterogeneity in malaria exposure.
• To be able to critically review and discuss the value of hotspot-targeted interventions.

The continued emergence of resistance driven by large-scale programs implies an ongoing need to introduce innovation (i.e., new products) and innovative delivery strategies (e.g., MDA) in national programs. This requires changes at key levels of the malaria value chain: from rapid translation from development to access, facile regulatory and policy processes, and continued industry engagement. As part of this panel session, participants will gain a better understanding of current vector tools and how the ongoing revolution in product financing, access, and implementation will rapidly alter the options for country implementation.

Learning Objectives:

• To identify the key implications of the need for innovation in vector tool for country programming.
• To identify emerging changes in global capacity to accelerate the translation of vector tools to country access.
• To identify at least key factors driving and limiting industry engagement in the innovation space for malaria.

Malaria eradication is a long-term dynamic activity requiring a constant evaluation of the specific needs at different stages of the program with heterogeneity across regions. During this session, participants will discuss malaria eradication plans with respect to skill requirement in different circumstances and possible ways of attaining them.

Learning Objectives:

• To understand the skills needed in programs for malaria eradication.
• To understand the relevance of integrated skill mixes for malaria eradication.

Defining the most effective intervention mix for a given operational unit of intervention to achieve and maintain elimination requires a robust understanding of the malaria topology for that area and epidemiological setting. This session aims at providing a conceptual framework that can help program managers and implementers in defining “what” to do “where” and “for how long” in a dynamic but increasingly interconnected environment. Using examples for Swaziland and Namibia, participants will be asked what information they would like to have available to help define sustainable strategies to regional, national and sub-national elimination.

Learning Objectives:

• To consider new approaches and operational strategies to achieve and maintain elimination.
• To introduce the concept of “malaria topology” and the importance of human mobility when defining end-game strategies.
• To challenge current operational paradigms by redefining the appropriate unit of intervention and most effective intervention mix.

With the active scale-up of certain malaria eradication efforts, expanded challenges in management and training may occur. These challenges may be especially large in resource poor settings where skilled personnel of all cadres may be scarce.

Certain lessons can be learned from efforts and mistakes made in the scale up of anti-HIV/AIDS efforts over the past two decades in resource poor settings. This session will outline the specific efforts implemented to monitor and evaluate HIV/AIDS efforts, and look at a specific a national training program which involved multiple efforts and actors to respond to the training needs of a large scale expansion of new interventions.

Learning Objectives:

• To identify the important components of a monitoring and evaluation system.
• To become familiar with resources and tools to help manage, monitor and evaluate large scale-up efforts.
• To create a basic communications plan for a specific new advancement of implementation effort.
• To consider the national training needs and future programs for training needed in malaria eradication in resource poor countries or regions.

This session will engage participants in a discussion, leveraging on their individual experience. The goal is to address and contrast challenges and opportunities that malaria control programs face when P. vivax or P. falciparum is the most prevalent parasite. Topics to be addressed include human resource management including, workforce distribution, leadership, competencies; procurement and distribution of drugs; treatment protocols; and other policies, diagnosis, commitment, and engagement (i.e., community, sectoral, and other).

Learning Objectives:

1. To promote learning through shared experiences
2. To contrast operational management issues in the control and elimination of P. vivax and P. falciparum malaria based on health systems building blocks and similar frameworks.

This session will cover the importance of human behavior in determining the outcomes of malaria control strategies. In particular, participants will discuss how the epidemiology of malaria, and the process of naturally acquired immunity and asymptomatic infection, affect perceived incidence of disease. The group will examine how the difficulties in measuring and perceiving incidence will affect how people take up interventions, and on their efficacy.

Learning Objectives:

• To understand the unique challenges that individuals in malaria-endemic regions face when trying to assess the risk of infection, and the mechanisms driving these challenges.
• To understand how changing risk perceptions might alter timelines and feasibility/evaluation of control programs.

This session will provide background of malaria in Nigeria. Participants will discuss structures and operation of the national malaria program and funding of malaria interventions in Nigeria. The session will also highlight the universal long-lasting insecticidal nets mass campaign distributions and provide a brief summary of the Harvard-Nigeria malaria initiative.

Learning Objectives:

• To understand the Nigerian malaria epidemiological picture.
• To learn about control and elimination targets set for malaria in Nigeria.
• To review funding mechanism for malaria control efforts in Nigeria.
• To gain knowledge of malaria interventions in Nigeria and their deployment.

Zambia has transitioned over the past 15 years from a failing control program funded through a sector wide approach (SWAP), through aggressive and targeted scale-up for impact (SUFI) and is now in the midst of scaling up for elimination, with intense evaluation of a combination of interventions and strategies in the southern districts. This session will explore the historical progression of the Zambian malaria program, drivers towards the transition, partnerships for implementation, and perspectives for engagement of country leaders, the national control program, and funders.

Learning Objectives:

• To understand the national, donor, and economic drivers for the transition to SUFI and scaling up to elimination in Zambia.
• To identify key factors for success along the program transition to elimination strategy.
• To be able to discuss what key elements of the malaria control and elimination activities that yield benefits from operational research and detailed evaluation.

This session will provide a detailed evaluation of the transition in Zambia from scale up to elimination allowing for discussion of lessons learned across a variety of perspectives.

Learning Objectives:

• To understand economic impact of transition to scale up and elimination in Zambia and how this impacts on country aspirations.
• To identify examples of evaluation research questions that can be answered in the context of program scale up that can result in improved performance or change in strategy.
• To identify examples of how the change from control to elimination creates different challenges to delivery: including procurement, supply change management, staffing, communications, surveillance, and leadership.

With support from the Global Fund, the President’s Malaria Initiative, Roll Back Malaria and other partners, Zambia has invested greatly in malaria control since the early 2000s. The National Malaria Control Program has scaled up access to key interventions to prevent malaria transmission and treatment. Given the endemicity of malaria in almost all parts of Zambia, recent significant reductions in all-cause child mortality is considered a clear indication that the malaria control program has worked. This session will focus on examining how control interventions such as insecticide-treated nets have resulted in reductions in malaria mortality and confirmed outpatient malaria incidence. The session will illustrate the economic constraints that low-income countries face in sustaining malaria programs due to high levels of poverty. In addition, the session will review evidence from micro surveys that demonstrate that malaria control has reduced burden and generated significant economic returns in rural settings. But these studies also demonstrate the economic challenges of ensuring access to malaria interventions for poor households. In addition, the session will discuss some of the economic challenges of implementing a strategy to move the national program from low transmission to elimination.

Learning Objectives:

• To review evidence of the impact of malaria control interventions in Zambia and other resource poor settings.
• To understand the drivers of successful implementation of a national malaria control program.
• To assess the economic implications of changing strategies from control to elimination.
• To review lessons of demand side and supply side constraints to malaria control and elimination