Ghana

Non-compliance is a primary barrier to attaining elimination goals. This study aims to utilize data captured in MDA registers to address non-compliance in the Ahanta West District of Ghana, which has been identified as a hotspot of LF transmission with >1% microfilaria (mf) prevalence after 15-16 rounds of MDA. On the basis of information identified in the register, this study proposes to deploy two strategies:

1. Engage and Treat individuals who were ill, missed treatment, or were unable to participate during the last MDA, and
2. Test and Treat for individuals who might be systemically non-compliant or afraid of adverse events. The use of MDA registers to assist in locating non-compliant individuals is novel and would provide valuable evidence for other programs and represents an alternative strategy for countries struggling with the end game. It may also help provide insight as to whether systematically non-compliant individuals truly serve as a reservoir for LF in areas designated as hotspots. Qualitative data collection will aid in understanding reasons for systematic non-compliance and may lead to changes in social mobilization strategies.

Ghana aims to eliminate onchocerciasis by 2025. Currently, all data points for mass drug administrations are collected on paper. Paper-based data collection does not allow for rapid evaluation and course correction throughout the implementation of the MDA. This study proposes a collaboration between the monitoring and evaluation division of the Ghana Health Service and the Clinical Informatics Research Unit at the University of Southampton. The study aims to answer the primary research question: Can community-driven electronic data collection, and near real-time provision of source data and interactive visualizations better support decision-makers on approaches to evaluating and managing MDAs for onchocerciasis?

Primary research question

Is there evidence of on-going or recent ocular Ct transmission in communities of northern Ghana felt to be at increased risk of recrudescence, at least two years since they were identified with Ct infection and or high anti-Pgp3 seroprevalence during pre-validation trachoma surveillance surveys?

Secondary research questions

What is the geographical extent of the boundaries of any persistent Ct infection and on-going transmission in the post-elimination setting?

What is the community-level (anti-Pgp3) prevalence of seropositivity for the multiplex bead array (MBA) (and possibly ELISA) as compared to the lateral flow assay (LFA)?

This social science study will address the following:

Formative question: What were the successes and challenges of the LF MMDP pilot in the Upper East region for increasing the capacity of health workers of all levels and improving the ability of patients to manage LF morbidity?

Intervention question: Can a modified capacity strengthening package, developed based on the formative research results, be effective at increasing the capacity of health workers of all levels and improving the ability of patients to manage LF morbidity?

• What factors are associated with the availability, accessibility, and acceptability of MDA?
• What is the impact of an adapted and tailored intervention package on effective coverage?

To determine if there is evidence of on-going or recent transmission in the “hotspot” communities of increased risk two years after they were identified during the pre-validation surveys (clinical, antibody and infection data).

Which strategies best strengthen strategic decision making for resilient and responsive health systems at the district level in Ghana, Malawi, Uganda and Tanzania?

To strengthen the capacity of the 5 African university departments hosting the Malaria Capacity Development Consortium (MCDC) programme

Field validation of the diagnostic performance of the Wb123/Ov16 biplex rapid diagnostic test and Wb123 ELISA, compared to the filariasis test strip (FTS) in a setting initially found to be non-endemic for lymphatic filariasis, in which clinical cases have been identified.

To determine the feasibility of the use of entomological traps by community members for onchocerciasis and lymphatic filariasis entomological assessments.

To determine if PCR or serology techniques are better than TF for assessing Trachoma prevalence during the surveillance phase of Trachoma Elimination Programs.

Non-inferiority study comparing a 20mg/kg dosing strategy of azithromycin to a 30mg/kg dosing strategy in the treatment of yaws 

Test STH-TAS,Understand the age prevalence of LF Antibody in different setting.

Randomized clinical trail comparing treatment with Albendazole and Ivermectin to Ivermectin alone for Onchocerciasis.