Tanzania

Country operational research priorities:

Lymphatic Filariasis (LF)
1.      Strengthening the Transmission Assessment Survey (TAS) in LF/Onchocerciasis endemic areas
2.      Xenomonitoring of LF during and post TAS
3.      Morbidity Mapping for LF using electronic methods
4.      LF surveillance in Post-TAS districts


Schistosomiasis (SCH)
1.      Determining the targeted population for SCH treatment
2.      Treating SCH high-risk adults in highly endemic areas
3.      Treatment of the focal population for SCH


Soil-Transmitted Helminthiasis (STH) and other Helminths
1.      Community treatment of Albendazole after stopping LF treatment  
2.      Monitoring STH infection in pre-school and school-aged children
3.      Impact of STH and SCH treatment  on other helminths in Pastoralist communities

Onchocesiasis (Oncho)
1.     Strengthening TAS in Oncho-LF endemic areas
2.     Steps towards Stopping MDA in LF/Oncho co endemic districts


Trachoma
1.      Best approach to increase Trachomatous Trichiasis patients' identification and surgery uptake

Cross-cutting
1.      Cost-effectiveness of neglected tropical disease (NTD) interventions in Tanzania
2.      The impact of WASH and Vector Control interventions on NTDs
3.      Best ways of strengthening supply chain for NTD commodities
4.      Improving knowledge on NTDs using through partnerships with mobile phone companies
5.      Estimating the population of school-aged children
6.      What are the effective and appropriate diagnostics and technologies suitable for case detection at different levels?
7.      Understating sociocultural complexities, risk and management of NTDs towards their elimination
8.      Best approach for improving coverage in Nomadic/hard-to-reach communities
9.      Best ways to engage private sector and NGDOs in NTD interventions

Studies

Main objectives are firstly to identify and understand better the factors behind low and unequal MDA coverage and compliance in trachoma endemic areas in Tanzania and Kenya with nomadic populations, secondly to prioritize factors in terms of amenability to intervention. The researcher will then use the evidence generated to design specific interventions that could improve the reach and impact of campaigns of Zithromax MDA in both countries.  While there are contextual differences between nomadic societies throughout Africa, research among the Masai in Tanzania and Kenya should inform programme services in other settings with nomadic populations. Particular attention will be given to gender-sensitivity; that is, interventions that will improve access and use by women as well as men.

Diseases: Trachoma

To assess if introducing point-of-care Circulating Cathodic Antigen rapid test to community health workers will increase access, compliance and coverage to treatment among adult individuals at Kome Island in North-Western Tanzania, an area on the Lake Victoria highly endemic for schistosomiasis

Districts:
Diseases: Schistosomiasis

To investigate prevalence of ocular chlamydial infection and associated risk factors in children aged 1-9 year in Manyoni district

Districts: Mpwapwa District
Diseases: Trachoma

The Starworms project aims to strengthen the monitoring and surveillance of drug efficacy and anthelmintic resistance in soil-transmitted helminth (STH) programs. As such, it will support deworming programs in their quest to eliminate STHs as a public health problem by 2020. The specific objectives are (1) to validate diagnostic tools to monitor drug efficacy and the spread of anthelmintic resistance, (2) to create a surveillance system that monitors the global patterns of drug efficacy and spread of anthelmintic resistance in STH programs, and (3) to develop supporting tools to plan, analyze and follow up on surveys on drug efficacy and the spread of anthelmintic resistance.

Districts: Pemba

Our proposal will study the interaction between humans, livestock and wildlife and the role of this transition zone in the transmission of trypanosomes at the edge of the Serengeti National Park in Tanzania. To assess whether focussed control of tsetse is effective, we will develop mathematical models of the transmission of trypanosomes in the transition zone from wildlife-dominated areas on the park boundaries through to livestock-dominated areas outside the parks. The models will enable us to predict the likely extent, duration and cost of interventions required to interrupt the transmission of trypanosomes at boundary areas. 

To determine the validity and programmatic feasibility of an integrated transmission assessment survey (F-TAS), to be used to simultaneously assess Onchocerciasis (Oncho) and Lymphatic Filariasis (LF) prevalence in areas co-endemic for the two infections that have completed the recommended treatment for one or both infections.

Districts: Morogoro District

To compare Ov16 ELISA and Ov16 rapid diagnostic test results, and better understand the significance of Ov16 serology in hypo-, meso- and hyper-endemic settings post-treatment.

Districts:
Diseases: Onchocerciasis

To assess filarial exposure in the study population and mosquito infection status prior to and after the start of intensified malaria control interventions.

Districts: Lake Victoria

To field-test the Pgp3 lateral flow assay to compare data obtained in the field on the rapid test to that from DBS collected from the same individual tested on the Pgp3 multiplex bead array.

Districts: Kongwa
Diseases: Trachoma

Is molecular detection of schistosome infection (patent and pre-patent) in snails a useful tool for program managers as prevalence and intensity of infection in people approaches very low levels?

Districts: Zanzibar
Diseases: Schistosomiasis

How do villages which do not show substantial decreases in the prevalence of schistosomiasis despite repeated, high coverage mass drug administration (persistent hot-spot villages) differ from villages which show substantial decrease in prevalence across various factors (declining prevalence villages)?

Districts:
Diseases: Schistosomiasis

Economic evaluation of SCORE projects with priority given to elimination studies

 

Districts: Zanzibar
Diseases: Schistosomiasis

To evaluate strategies to improve the sensitivity of the TAS for detecting evidence of recent lymphatic filariasis transmission in an evaluation unit (EU). The TAS Strengthening Study in Tanzania is designed to assess additional indicators that may be added to the current TAS platform in order to strengthen the resulting stopping or surveillance decisions. A comprehensive analysis will be conducted to understand the correlation between antigen and antibody in adults and children with the mosquito data. A spatial analysis looking at microfoci of infection will also be conducted. Because the EU is also endemic for onchocerciasis, the new Ov16 monoplex RDT was used in the field. The Wb123 and Ov16 antibodies were assessed via ELISA in the NIMR lab in Tanga and the results will soon be compiled.  Xenomonitoring work to assess Culex and Anopheles mosquitoes, as well as black flies, is underway.

Preliminary Findings and Lessons Learned

The ultimate goal of this study is to strengthen the existing TAS platform so that the programs can be more confident with their stopping and surveillance decisions.   In order to strengthen the existing TAS platform we need to better understand which target population(s) and diagnostic indicator(s) are best-suited for identifying areas with persistent transmission that is not expected to cease on its own, knowing that the answer may vary according the primary vector and stage of the program.  In the selected sites a community-based TAS was conducted using the standard sampling of 6-7 year olds while a community TAS (individuals >8 years) was conducted concurrently.  All samples were tested via FTS and DBS (for Wb123 ELISA).  In these same communities a molecular xenomonitoring study will take place and the mosquitoes will be tested for filarial DNA to relate back to the human specimens.  To date human sampling has been completed in all sites and laboratory analysis of the specimens is complete. Mosquito collection has been completed in Haiti and Tanzania and the PCR analysis has been completed in Haiti and is planned for Tanzania (pending the arrival of a new PCR machine).  In American Samoa xenomonitoring has been delayed due to weather conditions and arbovirus outbreaks; work is expected to commence spring 2018.

Districts: Muheza

Demonstrate the utility of a new mapping strategy based on school cluster random sampling Using PPES. A secondary objective is to assess the value of laboratory-based antibody assays as confirmatory tests and additional diagnostic tools for measuring LF transmission. 

Districts:

Monitor recrudescence of STH after TAS to improve planning of STH programs and more effective use of STH drugs.

Districts: Lushoto

Follow-up LF TAS and comparison of ICT and Filariasis Strip Test in a post-MDA surveillance setting.

The multi-country studies on the same topic led to the endorsement by WHO for the FTS as an approved diagnostic tool.

Districts: Tandahimba

Analyze the relationships between the prevalence of the clinical sign follicular trachoma (TF) and the prevalence of infection and antibody to determine whether it may be appropriate to consider one or more alternative indicators for deciding whether trachoma programs can stop MDA.

Districts:
Diseases: Trachoma

SCORE Data Collection on Mobile Devises

Districts:
Diseases: Schistosomiasis

Cost Studies in SCORE Gaining and Sustaining

Districts:
Diseases: Schistosomiasis

Human Diagnostics Tool Development (CAA diagnostic tool)

Districts:
Diseases: Schistosomiasis

Part of gaining control studies

Districts:
Diseases: Schistosomiasis

Schistosome Population Genetics in Gaining Control Studies in Niger (Sh) and Tanzania (Sm)

Districts:
Diseases: Schistosomiasis

Gaining Control: >25% Prevalence MDA strategies; and subtle morbidity of Cohort; Population genetics, and snail monitoring

Districts:

(1) Is it possible to eliminate schistosomiasis as a public health problem on Unguja in three years and to interrupt transmission in five years? (2) Is it possible to control schistosomiasis throughout Pemba (prevalence <10%) in three years and to eliminate it as a public health problem in five years? (3) What are the costs, successful strategies, barriers, etc. associated with three different interventions (MDA, vector control, and behavior change)?

Districts:
Diseases: Schistosomiasis