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

How to best support close-to-community providers in their critical interface role between health systems and communities

What are the best approaches to develop sustainable and equitable approaches to human resources for health, health financing and governance in post conflict health systems?

What are the most strategic approaches to building capacity for gender equity analysis in health systems?

Determine the best health systems approaches for:

1. Improved planning and delivery of integrated programmes; 
2. Increased and sustained access to NTD drugs; 
3. Harmonised inter-sectoral approach; and 
4. Strong and generalisable evidence base for integrated elimination and control of NTDs.

Developing new diagnostic tools to monitor insecticide resistance in sandflies in India

Improving effectiveness of vector control against Visceral Leishmaniasis

Defining the insecticide resistance status of dengue vectors in Jeddah and Makkah; essential prerequisite to developing an effective response in the event of an outbreak in these important sites.

Assessing treatment needs for school-aged children and assisting Ministry of Health to develop an effective control programme

Understanding the basic pharmacology of praziquantel tailored to paediatric setting and developing a treatment access plan for this age class

Helping increase and sustain the scale-up of preventive chemotherapy campaigns in West and Central Africa

Deliver at least one novel pre-clinical candidate capable of delivering a macrofilaricide treatment for onchocerciasis (and lymphatic filariasis) within a seven-day treatment period or less.

Establish the best registered drug for deployment as a macrofilaricide alone and/or in combination with standard anti-filarial drugs.

Late lead optimisation

Establish the most promising template for final lead optimization from a screen of >10000 compounds from the BioFocus library which revealed compounds with very good anti-Wolbachia activity.

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

The development of Trypanosoma brucei within the tsetse vector is accompanied by the expression of several stage-specific families of GPI-anchored surface glycoproteins. We recently discovered that saliva from T.brucei-infected tsetse flies is enriched with Brucei Alanine-Rich Proteins (BARP), VSG and a novel family of GPI-anchored surface glycoproteins. The latter are phylogenetically grouped within the Clade IV of family 50 of trypanosome surface proteins and are encoded by five paralogs, whose products are over 90% identical in sequence. Immunofluorescence and transcript analysis showed that Clade IV proteins are expressed on the surface of metacyclic trypanosomes and also on epimastigotes and pre-metacyclic forms although in lower abundance. This expression pattern opposes that of BARP, which is highly expressed in the epimastigote stage and diminishes during differentiation to metacyclics. Because Clade IV proteins are almost identical in sequence and are heavily expressed in the metacyclic stage, we named them Metacyclic Invariant.

To develop a polyspecific, non-cold chain liquid snake antivenom with unparalleled sub-Saharan African efficacy

Cutaneous Leishmaniasis (CL) is exclusively transmitted by the bite of a female sand fly. In collaboration with the Saudi Arabian Ministry of Health, we have developed a programme aiming to prevent and control CL in this country. The programme focuses, among other aspects, in developing a rapid diagnostic test based on the patient’s anti-alpha-Gal response, and in identifying markers for disease exposure. We recently found evidence that treatment efficacy against Old World CL varies with parasite species, geographical locations and the development of secondary infections. This has implications on the treatment of this debilitating disease. The severity of a leishmaniasis ulcer partly depends on the patient’s previous exposure to sand fly bites. This explains the increased protection against CL in individuals living in CL-endemic areas and supports development of potential vaccine models based on sand fly salivary proteins. Furthermore, Old World CL patients produce high levels of anti-Gal antibodies (i.e. recognise terminal alpha-galactosyl epitopes). This discovery is currently being exploited for the making of rapid diagnostic tools and a potential protective glycovaccine model against CL. We hope that these tools can soon be applied in other CL-endemic countries, including refugee settings.

Determine whether doxycycline treatment daily for 6 weeks improves clinical outcomes (swelling, acute attacks) in lymphedema patients.

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

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.

Assess the overall acceptability of the 3-drug treatment in the community as compared to the 2-drug treatment

Clinical Trial Triple Drug Study for LF

To compare the performance of antigen (FTS) and antibody (Wb123 monoplex) tools in programmatic settings (TAS).

Preliminary Findings and Lessons Learned

The goal of this study is to compare the performance of antigen (FTS) and antibody (Wb123 monoplex, Wb123 ELISA, multiplex) tools in programmatic settings (TAS). In order to strengthen the existing TAS platform we need to better understand which diagnostic indicator(s) are best-suited for making programmatic decisions. The TAS was conducted in Trou de Nord and Plaisance EUs.  Both EUs passed the TAS, but positive FTS were identified (4 and 2, respectively). However the Wb123 RDT found ZERO positive children, of the over 2000 tested. While the Wb123 ELISA testing is still ongoing, this initial result agrees with findings from other studies, all of which suggest that the Wb123 RDT is too insensitive a tool to be of programmatic use.

Assess the overall acceptability of the 3-drug treatment in the community as compared to the 2-drug treatment

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 American Samoa 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.  Xenomonitoring work to assess Aedes mosquitoes 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.

• To define a cost-effective and accurate method to map ivermectin-naïve districts for Onchocerciasis, Lymphatic Filariasis and Loiasis and identify districts eligible for safe treatment with ivermectin MDA.
• To validate a statistical model of Loiasis prevalence and intensity by comparing the model results to data from a prevalence assessment.

The TUMIKIA Project aims to determine whether combining school- and community-based deworming is more effective at controling and eliminating soil-transmitted helminths (STH or intestinal worms) in Kenya than school-based deworming alone. 

The two-year trial will provide the drug albendazole to all residents from 150 communities in Kwale County, Kenya. There are three study groups:

1. Base: annual school-based deworming (ages 2-14)
2. Increased coverage: annual school- and community-based deworming (ages 2-99)
3. Increased coverage and frequency: bi-annual school- and community-based deworming (ages 2-99)

TUMIKIA stands for 'Tuangamize Minyoo Kenya Imarisha Afya,' which means “eradicate worms in Kenya to improve health,” in Swahili. 

Download the TUMIKIA Research Brief [pdf]

To assess the relationships between the prevalence of the clinical sign TF compared to prevalence of infection and antibody in Chikwawa and Mchinji districts