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Developing an appropriate model of care for lymphatic filariasis and leprosy patients who need MMDP services in Bihar State, India
What is the comparative effect of enhancing the existing MMDP services with or without community-based components in significantly reducing the burden of Acute Attacks (AA), Hydrocele, and Mental Health (MH) issues among people affected by LF?
The influence of stigma on social participation and mental well-being amongst men and women affected/disabled by lymphatic filariasis and leprosy in the districts of Jaunpur and Patna in India
To what extent does stigma affect social participation and mental wellbeing among men and women affected/disabled by lymphatic filariasis or leprosy in Jaunpur in Uttar Pradesh and Patna in Bihar?
Assessing the effectiveness of using the Community Directed Intervention (CDI) approach to improve community ownership of Mass Drug Administration (MDA) for Neglected Tropical Diseases (NTDs) in Malawi
This project intends to assess the effectiveness of using the Community Directed Intervention (CDI) approach as a vehicle for delivery of mass drug administration (MDA) campaigns against targeted NTDs namely, schistosomiasis and soil-transmitted helminths (STH) such as Ascaris lumbricoides (roundworms), Trichuris trichiura (whip worms) and Ancylostoma sp. (hookworms) in selected districts of Malawi. The idea is to take advantage of the logistical setup, organizational strength and high degree of efficiency of the national NTD programme to improve delivery of the current MDA efforts to control selected and highly prioritized NTDs of schistosomiasis and STH and to enhance community ownership of the interventions in selected rural and remote communities by using the CDI approach. The primary research question is: Can the CDI approach be effectively used to deliver MDA to control NTDs at community level in rural Malawian districts?
This study aims to understand the relationship between trachomatous trichiasis (TT) and mental health disorders over an 18-month study period, by answering the following questions:
- What is the impact of the blinding stage of trachoma (Trachomatous Trichiasis) on common mental disorders such as depression, anxiety and suicidality?
- Will the validation of the 5-Question Stigma Indicators (5-QSI) generic stigma tool help to measure and monitor stigma in trachomatous trichiasis patients in Ethiopia
- What are the drivers for mental disorders in TT patients
- Is there a difference in depression, anxiety and suicidality prevalence between TT cases accepting vs declining TT surgery; and un-operated vs postoperative TT cases? The research team will be trained on good clinical practice through the WHO Mental Health Gap Action Programme (mhGAP). Following interviews, any patient with TT will be referred for surgery and patients found with a mental health disorder will be referred for care. If a negative impact of blinding trachoma on mental health is noted, the researchers plan to use the results of the study to advocate for additional funding for the trachoma program and highlight the need to address mental health in Ethiopia.
Strategies for the ENdgame: Targeting Infections among Non-compliants in the Elimination of Lymphatic filariasis (SENTINEL)
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:
- Engage and Treat individuals who were ill, missed treatment, or were unable to participate during the last MDA, and
- 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.
Bringing near real-time data solutions to MDA in Ghana – progress towards elimination of Onchocerciasis
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?
Improving outcome of future transmission assessment surveys and community compliance for MDA in 14 LF endemic districts of Uttar Pradesh.
The success of MDA programs requires effective planning, community engagement, and delivery by community drug distributors. This proposal seeks to assess barriers and facilitators of effective coverage. Using in depth interviews, focus group discussions, and surveys, they will investigate factors related to acceptance, availability, and accessibility of MDA from the perspectives of drug distributors, healthcare workers, community leaders, the NTD program, and community members. Using the findings from the formative phase, an intervention package will be developed and implemented during MDA, followed by an evaluation of the impact of the intervention on coverage.
This project is part of a larger series of four studies that use a mixed methods approach to understand why particular districts that have undergone 5+ years of MDA are failing or are likely to fail transmission assessment surveys (TAS). Other studies include 169.1D Ghana, 169.2U Burkina Faso, and 177U Nepal. This study in Uttar Pradesh also provides a second opportunity to deploy the rapid ethnographic approach that will be first tested in Nepal. Team members from HERD Nepal will be traveling to India to train their team on the technique and assist with roll out.
Improving Mass Drug Administration After Pre-Transmission Assessment Survey (Pre-TAS) Failure: A Mixed Methods Study in Nepal
This study builds on the methods developed for the operational studies ongoing in Ghana and Burkina Faso. The first two research questions are the same as those earlier studies with two new questions added here- question 3 on triple drug therapy (ivermectin, DEC, albendazole – IDA) and 4 on the use of a new rapid ethnography approach.
- What factors are associated with effective (and lower) MDA coverage as defined as availability, accessibility, and acceptability in settings that have repeatedly failed Pre-TAS?
- What is the impact of an adapted and tailored intervention package on achieving effective coverage?
- What messages and community engagement approaches are needed to ensure the acceptability of IDA triple drug therapy in Nepal?
- How does the rapid ethnography approach compare to more traditional qualitative analysis methods in terms of cost, timeliness, and ability to provide required information for programmatic decisions? Can local capacity for use of this approach be built rapidly?
- To evaluate strategies for the elimination of trachoma by evaluating potential makers that show interruption of transmission of C. trachomatis
- To determine the prevalence of ocular chlamydial infection among children aged 1 – 9 years old in Mpwapwa and Kalambo District, Tanzania
- To determine the associated risk factors of ocular Chlamydia infection among children aged 1 – 9 years old in Mpwapwa and Kalambo District, Tanzania
- To determine the usability of antibody test to detect Chlamydia antigen pgp3 using lateral flow assay
- To examine the longevity of the antibody response to trachoma antigens in a high and low-prevalence setting
Interrogating “big data” to develop a user-friendly analysis framework for gender equity in MDA to ensure no one is left behind in Neglected Tropical Disease interventions in Nigeria
To develop and pilot a standardised analytical framework for the spatial and temporal analysis of routinely collected gender disaggregated NTD programme data. This will allow increased understanding and spatial visualisation of the influence of gendered programmatic inputs, external geographic and social factors on the equity of programmatic outputs, particularly access to mass administration of medicines (MAM).
Trachomatous Trichiasis Management in Tanzania: Investigation of the productivity of case finding and referral of patients to trichiasis surgery services
One of important pillar of Trachoma elimination as a public health problem is to manage through epilation and surgery trachomatous trichiasis (TT) to reach in endemic district less than 0.1% of TT prevalence or less than 0.2% prevalence in adults of 15 years and older. However, surveys in 3 districts of Tanzania where numbers of TT surgeries were performed showed an unexpected higher prevalence despite intervention. This mixed methods study will help to address the main question as to why trachoma impact surveys demonstrating unexpectedly high TT prevalence in communities where TT surgical intervention is ongoing and how could this intervention/burden gap be addressed? The aim is to look at the case finding techniques effectiveness in all the communities and factors that affect TT referral and quality surgical services.
Developing a surveillance framework for the post-elimination phase of the lymphatic filariasis programme in Bangladesh
- Can the micro-stratification of lymphatic filariasis (LF) transmission assessment surveys positive case and clinical case data be used to identify, map and monitor transmission hotspots as part of an enhanced endgame surveillance strategy?
- Can targeted molecular xenomonitoring detect ongoing transmission [to the same extent as human surveillance] in defined LF transmission hotspots?
Improved delivery of / access to Morbidity Management and Disability Prevention (MMDP) / Disease Management, Disability and Inclusion (DMDI) for persons affected by lymphatic filariasis, leprosy, and/or konzo in Nampula, Mozambique
Formative: What is the capacity of the Mozambican health system in general, and the NTD programme more specifically, to provide MMDP/DMDI services for people affected by leprosy, LF and konzo, and what are some of the barriers and facilitators to access these services?
Intervention: Which strategies are currently in place to provide quality healthcare for persons with disabilities, especially those that are caused by leprosy, LF and konzo, and how are MMDP/DMDI services organized vis-à-vis other disease control programs/health service delivery platforms?
Reaching semi-nomadic groups using a test and treat (with doxycycline) strategy in a challenging onchocerciasis focus in West Region of Cameroon
- Is mobile outreach with a doxycycline test and treat strategy (TTd) an effective strategy in reducing onchocerciasis prevalence and intensity of infection amongst hard-to-reach nomadic groups in Massangam health area (HA)?
- What is the variation in prevalence of onchocerciasis and intensity of infection (community microfilaria load (CML)) in the different age and sex groups of hard-to-reach nomad community in the Massangam HA?
- What was the coverage of ivermectin mass drug administration in the nomad population with respect to the last round of ivermectin MDA?
- What is the cost of the mobile outreach strategy in this context, per person screened and treated?
Is there still LF transmission after successful TAS 3?
The Impact of an Integrated Health System Approach in Improving Access to Morbidity Management and Disability Prevention Services for Persons with Leprosy, Hydrocele, and Lymphoedema in Coastal Kenya
Formative: To what extent do individuals have quality of life and access to and utilize MMDP services within the healthcare system; and what are the barriers and facilitators (affordability, availability, approachability, acceptability, and appropriateness) of 1) access to and utilization of quality MMDP healthcare services and 2) management of morbidities at home?
Intervention: What is the effect of an integrated health system approach on access to MMDP healthcare services as measured by affordability, accessibility, acceptability, and availability; and on utilization of services and quality of life?
Post-validation survey for the elimination of blinding trachoma to evaluate the effectiveness of a serological surveillance strategy in two provinces of Morocco
Conduct district-wide field trials of the Pgp3 lateral flow assay to measure the seroprevalence of antibodies against the Chlamydia trachomatis antigen Pgp3 in low-prevalence settings.
Would the same programmatic decisions for Oncho Elimination Mapping be made based off of the Ov16 RDT results as compared to the Ov16 SD ELISA results in 7 woredas included in OEM in Ethiopia?
Evaluate the current status of transmission of onchocerciasis in a hyperendemic area treated for many years and in a hypoendemic area treated for lymphatic filariasis for 5 years using the Ov16 ELISA and supplemented by entomology results from a previous study
IMPRESS – Improving access to integrated Morbidity management and disability PREvention Services through Stigma reduction for people with lower limb lymphoedema in Ethiopia: Feasibility and quasi-experimental study
Formative: What is the capacity of the integrated morbidity management and disability prevention (MMDP) programme to incorporate a stigma reduction intervention for people with lower limb lymphoedema, and what are the barriers and facilitators to this?
Intervention: Is the stigma reduction intervention effective in increasing demand and access to services within an integrated MMDP programme for people with lower limb lymphoedema?
Operational research to develop an M&E study to guide a triple drug stopping decision for lymphatic filariasis in India
What is the indicator(s) and accompanying M&E strategy that enables country programs to determine when the risk of ongoing transmission of LF has been reduced so that IDA can be stopped with little risk of resurgence of transmission?
What is the effectiveness of appropriately dosed IDA in clearing microfilariae (Mf) from Mf positive people who (i) reported taking triple drug therapy with ivermectin, diethylcarbamazine, and albendazole (IDA) in August 2018, and (ii) did not report recently taking IDA.
This will be investigated by:
- assessing the baseline (current) Mf presence and density before re/treatment with IDA, against which post-treatment Mf presence and density can be compared
- assessing the peak plasma concentration levels of ivermectin, DEC and albendazole in treated Mf positive individuals to identify whether the recommended dosages of medications are sufficient for achieving effective plasma concentrations
- assessing Mf clearance one week following directly observed IDA re/treatment
Assessing drug coverage following mass drug administration to monitor the impact of the WHO recommended three-drug regimen of ivermectin, diethylcarbamazine, and albendazole for the elimination of lymphatic filariasis
To validate the reported coverage of the 2018 mass drug administration in American Samoa in order to assess the impact of triple drug therapy with ivermectin, diethylcarbamazine, and albendazole (IDA) for lymphatic filariasis on infection prevalence
A pilot study to identify meaningful and measurable targets for detecting the control of schistosomiasis-related morbidity in Africa. The overall study is designed to answer the following primary evaluation questions:
- What are the infection levels of Schistosoma mansoni and S. haematobium below which there is little, or no, detectable schistosomiasis-associated morbidity?
- What are the optimal morbidity markers for S. mansoni and S. haematobium?
- What are the optimal species-specific morbidity goals for which schistosomiasis control programs should be aiming?
Collaborative effort to address intestinal worms through education, medical care, health assessments, quizzes/contests in school
The effectiveness of motivating locals to address intestinal worms through education, medical care and health assessments.
Operational research to compare the confirmatory mapping tool and xenomonitoring indicator (infectivity rate of L3 of Wuchereria bancrofti) in Monrovia to assess the necessity to implement MDA
What is the most appropriate method to evaluate the presence of W. bancrofti transmission in urban conurbations to establish if MDA is necessary for LF elimination?
Field friendly biometry to ease cohort studies in resource-limited settings: application to the Test and Treat for onchocerciasis project in Central Cameroon
Can a biometric recognition system, in the context of “Test and Treat”, facilitate individual follow-up by linking participant data at different time-points?
Pilot a strategy for mapping and treating Onchocerciasis and Lymphatic Filariasis in Loa loa coendemic areas
Investigation of communities at increased risk of trachoma recrudescence & a model post-elimination surveillance strategy
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 study aims to determine if the addition of lymphatic stimulating activities to community-based home-care for lymphoedema can improve outcomes for people affecetd by moderate to late stage disease.