Model‐Based Assessment of the Effects of Selective Free Healthcare and Differentiated Diagnosis on Malaria Burden in the Republic of Guinea

Abstract

BACKGROUND: Malaria remains a public health issue in Guinea, despite strengthened control measures, including free diagnosis and treatment policy. This study assesses, the potential effects of optimizing case management on malaria burden across different epidemiological archetypes. METHODS: The nine ecological archetypes, established during the subnational tailoring, were used as study settings. A cost function integrating out-of-pocket, distance, income and quality of care was developed to predict the Artemisinin-based combination therapy (ACT) access index. This model was used to construct the scenarios such as selective free healthcare, differentiated diagnosis (access to appropriate care from the first point of contact), and the combined. Simulations were performed using Epidemiological Modelling (EMOD) software to assess the effects, for the period 2025-2030. The main results included incidence, parasite prevalence, and severe cases averted. Analyses were performed using R software. The optimization scenarios were compared to the baseline reflecting current malaria control interventions. RESULTS: Reducing financial and geographical barriers improves access to malaria treatment, although disparities remain across and within archetypes. Free healthcare for children under five and differentiated diagnosis are particularly effective, raising the early access index to ACTs from 0.60 (Tougue) to 0.81 (Nzerekore). The effects are more pronounced in areas with low initial incidence such as Tougue, Siguiri, and Lelouma, where incidence drops below 50 cases per 1000 in 2028. The results highlight the effectiveness of age-targeted interventions. The combined strategy is promising, with the potential to prevent 13,428 complicated cases of paediatric malaria between 2025 and 2030 (95% CI: 7768-19,088). However, atypical contexts such as Kouroussa require more targeted approaches. CONCLUSION: Given limited resources, it is crucial to focus investments on effective interventions. This study shows that targeted selective free healthcare and differentiated screening improve access to ACTs, reduces malaria incidence and prevents severe cases, especially in children under five of age.