Mapping Hospitals That Treat Severe Malaria Cases in the United States: Evidence to Inform Health Systems Strategies for Intravenous Artesunate Supply.

Abstract

Severe malaria among travelers returning to the United States is a rare but life-threatening condition, for which standard of care is urgent treatment with intravenous artesunate (IVAS). Uncertainty about where future hospitalized severe malaria cases will present, the need for urgent treatment delivery, and high IVAS costs pose challenges for health systems planning. We mapped locations for hospitalized severe malaria cases diagnosed during 2012-2018 and reported to the US Centers for Disease Control and Prevention (CDC). We estimated driving times between each location and the nearest level 1 trauma center (L1TC), as settings that likely treat individuals with severe malaria and are candidate IVAS distribution points. We performed spatial optimization analysis, identifying sets of L1TC locations that minimized travel distances between hospitalized severe malaria cases and candidate IVAS supply points. We successfully adjudicated locations for 1466 of 1791 possible hospitalized severe malaria cases reported to the CDC during 2012-2018. Hospitalized severe malaria cases were reported from 292 of 3142 US counties (9.3%) in 46 US states; these hospitals were concentrated in New York, Maryland, Texas, the District of Columbia, and Pennsylvania with minimal year-to-year variation. Of the 1458 cases in the contiguous US, 95.8% were hospitalized within 2 hours driving time of an L1TC. Spatial optimization results were consistent across years. The geographic distribution of hospitals that treated severe malaria cases in the US was heterogeneous but relatively consistent across years. Mapping and spatial optimization identified locations that could be higher priority for on-site IVAS supply.