Country operational research priorities pending.
Through funding from the Wellcome Trust to develop a global atlas of podoconiosis. We aim to advance new knowledge on the geographical distribution and spatial epidemiology of the disease.
i. Conduct national cross-sectional surveys in selected countries to validate the environmental predictive model developed using the mapping data in Ethiopia.
ii. Create evidence consensus maps, develop risk maps and ground-truthing work and delineate the spatial distribution and geographical limits of podoconiosis globally.
iii. Estimate the global burden of podoconiosis by quantifying the number affected, the population at risk and DALYs attributable.
iv. Estimate how much it will cost to control or eliminate podoconiosis globally.
The DeWorm3 Project is a series of hybrid trials testing the feasibility of interrupting the transmission of soil transmitted helminths (STH), while conducting implementation science research that contextualizes clinical research findings and provides guidance on opportunities to optimize delivery of STH interventions.
The purpose of DeWorm3 implementation science studies is to ensure rapid and efficient translation of evidence into practice. Research methods include: (1) stakeholder mapping and network analysis, (2) qualitative research, (3) structural readiness surveys, (4) process mapping, and (5) economic evaluation (costing and cost-effectiveness).
Implementation science research aims include:
1)To systematically identify stakeholders influencing standard of care targeted and community-wide MDA and map their potential role and involvement in scale-up of community-wide MDA for STH.
2)To identify implementation-related barriers and facilitators to community-wide MDA for STH from the perspective of various stakeholders.
3)To quantify the readiness of the health system to deliver community-wide MDA for STH programs.
4)To map the intervention delivery process and identify any discrepancies between planned and implemented activities in order to optimize the trial intervention.
5)To compare the financial and economic costs and incremental cost-effectiveness of community-wide and targeted MDA for STH in the short- and long-term.
Developing new diagnostic tools to monitor insecticide resistance in sandflies in India
Assess the overall acceptability of the 3-drug treatment in the community as compared to the 2-drug treatment
Determine whether doxycycline treatment daily for 6 weeks improves clinical outcomes (swelling, acute attacks) in lymphedema patients.
Comparison of safety profile and acceptability between triple drug therapy (IVM,DEC,ALB) and standard two-drug therapy (DEC, ALB), plus STH evaluation.
To determine the frequency, type and severity of adverse events following triple-drug therapy (IVM+DEC+ALB, IDA) compared to the standard two-drug treatment (DEC+ALB, DA) in infected and uninfected individuals in a community.
To compare the efficacy of IDA vs. DA administered in communities for clearance of Mf and filarial antigenemia (Ag) in cohort and effectiveness (prevalence) in community settings. To assess the presence and intensity of filarial infection on the frequency and severity of adverse events. To compare community acceptance of MDA with IDA vs. DA.
Develop and validate sampling strategies for monitoring vector infection that would be useful to evaluate the success of LF-elimination programmes.
Findings and Lessons Learned:
This represents a follow-up to a longitudinal study with data collection in 2010 and 2012 (previous funding) and now with a third time point in 2015. At all 3 time points a rigorous mosquito sampling protocol was applied and the results were analyzed to detect filarial DNA by PCR. To test the reproducibility of the results, at each time point the survey teams conducted two independent, sequential samples of approximately 11,000 mosquitoes each. In addition to surveying the entire PHC area, a nested hotspot survey was conducted in areas where there has been historically high transmission. One very important outcome of this study is the development of a standardized protocol for sampling culex mosquitoes that is statistically rigorous and reproducible. The study showed that MX can be a valuable tool for monitoring decreasing prevalence over-time. The authors propose a threshold of 0.5% in culex be used to measure 0% Ag prevalence in children for stopping MDA.