{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T15:08:47Z","timestamp":1767971327704,"version":"3.49.0"},"reference-count":28,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","license":[{"start":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T00:00:00Z","timestamp":1743552000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,4,2]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>As countries strive for malaria elimination, it is crucial to gather sufficient evidence to confirm the absence of transmission. Routine surveillance data often lack the sensitivity to detect community transmission at low levels. In the Dominican Republic, community health workers (CHWs) have been deployed in malaria foci to perform active case detection. This study aimed to assess the added value of CHWs in enhancing the health system\u2019s malaria detection capabilities. Freedom from infection (FFI) is a statistical framework designed to demonstrate the absence of malaria by using routinely collected health data. We adapted this framework to include CHW data, estimating their contribution to the health system\u2019s malaria detection ability. The model was applied to facility and CHW data from 33 facilities across nine provinces in the Dominican Republic, covering the period from January 2018 to April 2022. The likelihood that a facility\u2019s catchment population is free from malaria infection (<jats:italic>P<\/jats:italic><jats:sc>free<\/jats:sc>) was achieved in 52% of facilities by using only routine data, sustained for an average of 13 months. With the addition of CHW data, 88% of facilities reached <jats:italic>P<\/jats:italic><jats:sc>free<\/jats:sc>, sustained for an average of 37 months. Incorporating CHW data enhanced the precision of model estimates by over 500-fold. The study demonstrated the near absence of malaria in several facility catchment populations. It highlighted the importance of community case management in supplementing routine surveillance, thereby improving the precision of malaria transmission estimates. These findings support the further application of the FFI framework to accelerate progress toward malaria elimination in the Dominican Republic.<\/jats:p>","DOI":"10.4269\/ajtmh.24-0404","type":"journal-article","created":{"date-parts":[[2025,1,21]],"date-time":"2025-01-21T20:14:03Z","timestamp":1737490443000},"page":"775-783","source":"Crossref","is-referenced-by-count":1,"title":["Incorporating Community Case Management in Risk-Based Surveillance for Malaria Elimination in the Dominican Republic"],"prefix":"10.4269","volume":"112","author":[{"given":"Isabel","family":"Byrne","sequence":"first","affiliation":[{"name":"Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luca","family":"Nelli","sequence":"additional","affiliation":[{"name":"School of Biodiversity, One Health & Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keyla","family":"Ure\u00f1a","sequence":"additional","affiliation":[{"name":"Centro de Prevencion y Control de Enfermedades Transmitidas por Vectores y Zoonosis, Ministerio de Salud P\u00fablica, Santo Domingo, Dominican Republic;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucc\u00e8ne","family":"D\u00e9sir","sequence":"additional","affiliation":[{"name":"The Carter Center, Atlanta, Georgia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia","family":"Hilario Rodriguez","sequence":"additional","affiliation":[{"name":"Centro de Prevencion y Control de Enfermedades Transmitidas por Vectores y Zoonosis, Ministerio de Salud P\u00fablica, Santo Domingo, Dominican Republic;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole","family":"Michel\u00e9n Str\u00f6fer","sequence":"additional","affiliation":[{"name":"Malaria Team, Clinton Health Access Initiative, Boston, Massachusetts;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin T.","family":"Lana","sequence":"additional","affiliation":[{"name":"Malaria Team, Clinton Health Access Initiative, Boston, Massachusetts;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory S.","family":"Noland","sequence":"additional","affiliation":[{"name":"The Carter Center, Atlanta, Georgia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manuel de Jes\u00fas","family":"Tejada Beato","sequence":"additional","affiliation":[{"name":"Centro de Prevencion y Control de Enfermedades Transmitidas por Vectores y Zoonosis, Ministerio de Salud P\u00fablica, Santo Domingo, Dominican Republic;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose Luis","family":"Cruz Raposo","sequence":"additional","affiliation":[{"name":"Centro de Prevencion y Control de Enfermedades Transmitidas por Vectores y Zoonosis, Ministerio de Salud P\u00fablica, Santo Domingo, Dominican Republic;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chris","family":"Drakeley","sequence":"additional","affiliation":[{"name":"Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen E. S.","family":"Hamre","sequence":"additional","affiliation":[{"name":"The Carter Center, Atlanta, Georgia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gillian","family":"Stresman","sequence":"additional","affiliation":[{"name":"Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom;"},{"name":"Department of Epidemiology, College of Public Health, University of South Florida, Tampa, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"World Malaria Report 2020: 20 Years of Global Progress and Challenges","year":"2020"},{"key":"b2","series-title":"Zeroing in on Malaria Elimination: Final Report of the E-2020 Initiative","year":"2021"},{"key":"b3","year":"2021"},{"key":"b4","year":"2022"},{"key":"b5","year":"2023"},{"key":"b6","series-title":"Infect Dis Poverty","first-page":"39","article-title":"Prevalence of malaria and lymphatic filariasis in bateyes of the Dominican Republic","volume":"8","author":"Keys","year":"2019"},{"key":"b7","series-title":"PLoS Negl Trop Dis","first-page":"e0003700","article-title":"Prospects for malaria elimination in Mesoamerica and Hispaniola","volume":"9","author":"Herrera","year":"2015"},{"key":"b8","series-title":"Rev Panam Salud Publica","first-page":"e92","article-title":"Malaria outbreak response in urban Santo Domingo, Dominican Republic: Lessons learned for community engagement","volume":"44","author":"Valdez","year":"2020"},{"key":"b9","series-title":"Disposici\u00f3n No. 000004 Del 13\/10\/2016 Que Aprueba La Estructura Organizativa y Funciones de Las Expresiones Territoriales Desconcentradas Del Ministerio de Salud P\u00fablica","year":"2016"},{"key":"b10"},{"key":"b11","series-title":"Trends Parasitol","first-page":"345","article-title":"Freedom from infection: Confirming interruption of malaria transmission","volume":"33","author":"Stresman","year":"2017"},{"key":"b12","series-title":"Trans R Soc Trop Med Hyg","first-page":"107","article-title":"Vectorial capacity and vector control: Reconsidering sensitivity to parameters for malaria elimination","volume":"110","author":"Brady","year":"2016"},{"key":"b13","series-title":"Vaccine","first-page":"D70","article-title":"The principles and feasibility of disease eradication","volume":"29","author":"Dowdle","year":"2011"},{"key":"b14","series-title":"BMC Infect Dis","first-page":"619","article-title":"A framework for evaluating health system surveillance sensitivity to support public health decision-making for malaria elimination: A case study from Indonesia","volume":"22","author":"Ahmad","year":"2021"},{"key":"b15","series-title":"BMJ Glob Health","first-page":"e014412","article-title":"Freedom from infection: Enhancing decision-making for malaria elimination","volume":"9","author":"Nelli","year":"2024"},{"key":"b16","series-title":"PLoS Med","first-page":"e1004318","article-title":"Successful elimination of falciparum malaria following the introduction of community-based health workers in Eastern Myanmar: A retrospective analysis","volume":"20","author":"Zaw","year":"2023"},{"key":"b17","series-title":"Open Data Kit: Tools to Build Information Services for Developing Regions","author":"Hartung","year":"2010"},{"key":"b18"},{"key":"b19","series-title":"BMJ Open","first-page":"e070482","article-title":"Supply-side and demand-side factors influencing uptake of malaria testing services in the community: Lessons for scale-up from a post-hoc analysis of a cluster randomised, community-based trial in western Kenya","volume":"13","author":"Kirui","year":"2023"},{"key":"b20","series-title":"Malar J","first-page":"51","article-title":"Global action for training in malaria elimination","volume":"17","author":"Wirth","year":"2018"},{"key":"b21","series-title":"Sci Rep","first-page":"12998","article-title":"Serological evaluation of risk factors for exposure to malaria in a pre-elimination setting in Malaysian Borneo","volume":"13","author":"Byrne","year":"2023"},{"key":"b22","series-title":"Malar J","first-page":"455","article-title":"Guiding placement of health facilities using multiple malaria criteria and an interactive tool","volume":"20","author":"Toh","year":"2021"},{"key":"b23","series-title":"Trop Med Int Health","first-page":"762","article-title":"Who develops severe malaria? 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