A new capsule can reside in the gut to deliver drugs for weeks and possibly even months, offering a potential weapon against malaria and other diseases for which adherence to long-term therapy remains challenging, researchers say. The capsule's ultra-long-lasting drug delivery, successfully tested here in pigs, could help bolster the success of malaria elimination campaigns, which rely on treatment adherence and cost-effective approaches that reach large, rural populations. Only 50% of people in industrialized countries and about 30% in developing countries take long-term medications as prescribed, according to the World Health Organization. In the U.S. alone, treatment non-adherence is responsible for $100 billion in health care costs each year. Poor adherence poses a major barrier to combating diseases like malaria, which persist despite available effective therapies. To improve treatment adherence, Andrew Bellinger and colleagues have designed an ingestible capsule that expands into a star-shaped form - preventing its exit from the stomach and allowing delivery of the drug for extended periods. Bellinger et al. tested a formulation of ivermectin, a widely used anti-parasitic drug that disrupts malaria transmission by killing infected mosquitoes. In pigs, the device slowly released ivermectin for 10 days without causing injury to the stomach or obstructing the passage of food, before breaking apart and passing safely out of the body. Using mathematical models based on human field data, the scientists showed that long-lasting ivermectin combined with standard anti-malarial drugs boosted the likelihood of achieving local malaria elimination. The star-shaped capsule may be adapted to deliver other therapies, such as for HIV and tuberculosis, the authors emphasize.