Early and sustained community engagement to reach unreached populations for malaria elimination in Lao People's Democratic Republic.

Malaria incidence in the Lao People's Democratic Republic has declined over the past 10 years. There is a continued risk of outbreaks, particularly in the Southern region, due to high-risk behaviors, primarily in remote ethnic communities among forest goers (individuals who regularly work or sleep in the forest), farmers on forest fringes, and vulnerable populations in these highly receptive areas. Conventional malaria control interventions alone in these areas are insufficient to push elimination beyond "the last mile". In 2022, an innovative approach to accelerate malaria elimination, termed locally as "Accelerator Strategies" was implemented. Activities included targeted drug administration and intermittent preventive treatment for forest goers and mobile populations, specifically farmers on forest fringes, as chemoprevention among individuals at increased risk of malaria irrespective of infectious status. Community engagement approaches were essential to ensure participation and acceptance as the intervention requires individuals without symptoms to take medicine. Three key enablers for community participation were identified as: (1) Service delivery and community engagement by the community members themselves; (2) Strong advocacy and political commitment from senior local political leaders, and village authorities and influencers and (3) Delivering people-centered services beyond the village with granular local data on risk behaviors, population movement and geographic information system mapping. Early and sustained community engagement resulted in high coverage of the interventions and greater acceptance by the community that resulted in a decreased malaria burden.