Résumé
Background: Despite wide use of insecticidal nets and indoor spraying, residual malaria transmission persists due to insecticide resistance and mosquito behaviors like early and outdoor biting. Ivermectin (IVM) kills mosquitoes post-blood feeding regardless of resistance. However, oral IVM's short efficacy and frequent dosing limits impact. Using pharmacokinetic data from a novel long-acting injectable IVM (BEPO ® technology), we modeled its effect on malaria transmission.Methods: We developed a mathematical model incorporating IVM's pharmacodynamic memory and stratifying humans by age and sex. Three regimens were evaluated: (i) monthly oral IVM at 3×300 µg/kg for 4 months, (ii) monthly oral IVM at 1×400 µg/kg for 3 months, and (iii) long-acting BEPO ® injection at 0.6 or 1.0 mg/kg. The model includes post-exposure effects on mosquitoes and the target population excludes women of childbearing age or pregnant women, and children under 15 kg. Efficacy data came from published oral studies and injectable data.Findings: Campaigns delivering ivermectin are projected to lower clinical prevalence, with slightly greater benefits in Burkina Faso-like seasonal settings when aligned with the transmission peak. Under perennial transmission and 50-90% coverage, oral regimens reduced total cases (all ages) by 7-11% (RIMDAMAL II K ), 9-14% (BOHEMIA), and 24-38% (RIMDAMAL II S ) over one year. A single longacting injectable IVM campaign achieved 16-29%, rising to 33-57%, 48-74%, and 59-78% with two, three, and four campaigns, respectively.Interpretations: Long-acting injectable ivermectin offers prolonged efficacy and simpler delivery to tackle residual malaria transmission. Phase 1 trials are timely and warranted.