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Community implementation and comparison of Human landing and Non human landing collection methods for vectors of Wuchereria bancrofti and Onchocerca volvulus for entomological monitoring of transmission (Burkina Faso)

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

Countries: Burkina Faso

Development and validation of sampling strategies for xenomonitoring of infection in Culex vector by PCR as a surveillance tool for assessing post-MDA lymphatic filariasis transmission

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.

Countries: India

Tandahimba Post-MDA TAS2 (WB123) and ICT-FST Comparison

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.

Countries: Tanzania

Monitor STH in PSAC and WCBA following cessation of LF MDA (Tanzania)

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

Countries: Tanzania

Monitor STH in PSAC and WCBA following cessation of LF MDA (Togo)

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

Countries: Togo

mHealth Platforms - Operational Research to optimize approaches to improve data flow and accounting

Determine the best data-capture system and implementation model to overcome data flow challenges faced by national MDA programs. Test and compare the effectiveness of 4 different data-tracking platforms currently in use (or development) in NTD endemic countries: 1) Build on existing national capacity, 2) Cloud-based SMS system, 3) Robo-call platform.

Preliminary study findings:

o The current process for tracking treatment information through paper-based forms can be complicated and leaves room for human error, as multiple aggregations of data must be collected manually between administrative levels before reaching the national level. 

o This study found that the process of collecting and reporting paper records on the stock and delivery of ivermectin, albendazole and Praziquantel took between two and three months. 

o The study found that robo-call surveys have the potential to add a new stream of information on drug stock between national supervisors and sub-district implementation teams, allowing program staff to take corrective actions in response to issues with drug supply.

o The proactive timing of the calls as well as the interactive component of responding to verbal questions through the phone makes this system useful to supervisors. 

o Robo-calls were found to be helpful to monitor drug levels prior to MDA at sub-district level and to ensure appropriate quantities of drug stock were reaching lower administrative level, but as post-MDA drug stock is returned to the district level, physical observation of district-level storerooms was the most effective way to assess drug quantities post-MDA.  

o SMS reporting made data accessible at the national level and to administrative units in real time. 

o Less than half of the registered supervisors submitted SMS reports, resulting in a significant difference in the number and type of treatments reported when compared to paper forms. 

o Greater training and ongoing management is needed to take full advantage of the speed and data accuracy improvements from robo-call and SMS surveys.

 

Countries: Uganda

Development and testing of Educational Board game (Worms and Ladders) for soil transmitted helminthiasis control

To develop a health education game on Soil Transmitted Helminthiasis (STH) transmission and to evaluate the potential of the game to promote behavioural changes among school children for the prevention of STH infections after treatment. Our primary research questions are: 1. Can our health education board game (Worms and Ladders) developed to teach transmission and control of STH cause any significant changes in the health behaviours of school aged children to reduce reinfection and transmission of STH after mass treatment? 2. Will the health messages learnt while playing our board game promote significant knowledge about the causes, transmission and control of STH among school children? 3. Will the combination of intervention (mass chemotherapy/Health education) have any significant impact of reducing STH reinfection in school children?

Countries: Nigeria

Alternative approaches to coverage surveys (Uganda)

To compare coverage evaluation methods to identify a method that is statistically rigorous and feasible for programs. This study will focus on assessing MDA coverage for lymphatic filariasis by comparing the cost, time and feasibility of 3 different methods: the EPI approach (n=1768), LQAS design (n=95) and probability sampling alternatives (n=1768).

Primary Findings and Lessons Learned

Coverage surveys are an important tool for programs to evaluate their reporting systems and to determine whether effective MDA coverage has been achieved. However, for various reasons coverage surveys are seldom implemented.  Some key challenges are: perceived technical difficulty, lack of resources, and lack of standardized guidance on how to conduct coverage surveys.  This protocol seeks to address the 1st and 3rd points by comparing the feasibility of three different coverage survey methods (EPI approach, LQAS, and segmentation).     This study was completed in 3 districts in Burkina Faso.  All 3 districts found that their survey coverage was above the WHO target threshold (65% for LF).  Furthermore, in all 3 cases the survey coverage validated (or nearly validated) the reported coverage. Taken together this suggests that the Burkina Faso program is working well.   The feasibility results found all 3 methods to be very similar with regards to time, cost and perceived difficulty.  Because only the segmentation approach results in a probability sample, this method was recommended by the M&E Working Group and ultimately approved by the STAG.  Since the approval, significant work has been underway to create guidelines for conducting coverage surveys for preventive chemotherapy.  An excel tool was created to improve the usability of the tool and online learning modules are currently in the works.

Countries: Uganda

Alternative approaches to coverage surveys (Burkina Faso)

Compare coverage evaluation methods to identify a method that is statistically rigorous and feasible for programs. This study will focus on assessing MDA coverage for lymphatic filariasis by comparing the cost, time and feasibility of 3 different methods: the EPI approach (n=1768), LQAS design (n=95) and probability sampling alternatives (n=1768).

Primary Findings and Lessons Learned

Coverage surveys are an important tool for programs to evaluate their reporting systems and to determine whether effective MDA coverage has been achieved. However, for various reasons coverage surveys are seldom implemented.  Some key challenges are: perceived technical difficulty, lack of resources, and lack of standardized guidance on how to conduct coverage surveys.  This protocol seeks to address the 1st and 3rd points by comparing the feasibility of three different coverage survey methods (EPI approach, LQAS, and segmentation).     This study was completed in 3 districts in Burkina Faso.  All 3 districts found that their survey coverage was above the WHO target threshold (65% for LF).  Furthermore, in all 3 cases the survey coverage validated (or nearly validated) the reported coverage. Taken together this suggests that the Burkina Faso program is working well.   The feasibility results found all 3 methods to be very similar with regards to time, cost and perceived difficulty.  Because only the segmentation approach results in a probability sample, this method was recommended by the M&E Working Group and ultimately approved by the STAG.  Since the approval, significant work has been underway to create guidelines for conducting coverage surveys for preventive chemotherapy.  An excel tool was created to improve the usability of the tool and online learning modules are currently in the works.

 

Countries: Burkina Faso

Alternative approaches to coverage surveys (Malawi)

Compare coverage evaluation methods to identify a method that is statistically rigorous and feasible for programs. This study will focus on assessing MDA coverage for lymphatic filariasis by comparing the cost, time and feasibility of the EPI approach (n=1768), LQAS design (n=95) and probability sampling alternatives (n=1768).

Primary Findings and Lessons Learned

Coverage surveys are an important tool for programs to evaluate their reporting systems and to determine whether effective MDA coverage has been achieved. However, for various reasons coverage surveys are seldom implemented.  Some key challenges are: perceived technical difficulty, lack of resources, and lack of standardized guidance on how to conduct coverage surveys.  This protocol seeks to address the 1st and 3rd points by comparing the feasibility of three different coverage survey methods (EPI approach, LQAS, and segmentation).     This study was completed in 3 districts in Burkina Faso.  All 3 districts found that their survey coverage was above the WHO target threshold (65% for LF).  Furthermore, in all 3 cases the survey coverage validated (or nearly validated) the reported coverage. Taken together this suggests that the Burkina Faso program is working well.   The feasibility results found all 3 methods to be very similar with regards to time, cost and perceived difficulty.  Because only the segmentation approach results in a probability sample, this method was recommended by the M&E Working Group and ultimately approved by the STAG.  Since the approval, significant work has been underway to create guidelines for conducting coverage surveys for preventive chemotherapy.  An excel tool was created to improve the usability of the tool and online learning modules are currently in the works.

Countries: Malawi

Assessing school-based MDA recall with community-based coverage surveys in Cambodia

The purpose of this study is to assess the feasibility of a community-based survey for measuring coverage of school-based MDA, specifically by looking at the reliability of child and parental recall for MDAs targeting soil-transmitted helminths.

Preliminary Findings and Lessons Learned:

There is currently little to no evidence on the reliability of young children at recalling whether or not they participated MDA. This issue is important because where MDA is school-based, parents may not be able to provide accurate proxy responses on behalf of their children. A study was conducted in Cambodia whereby gold standard registers of all children were created, based on school enrollment rosters. During the MDA outside observers (local to the region) recorder whether or not each child in the register received the drug. Then a month later the team went back and conducted a household survey and asked children to recall whether or not they participated in the MDA. The study was conducted according to the protocol. 600 children were followed up in the household survey, all of whom are enrolled in school and were listed on the gold standard register. Unfortunately there was some miscommunication and the site selected by the program team was one of the highest coverage sites in the country. While great for the Cambodian program, this means that the true coverage for the 600 individuals was 100%. All 600 children accurately recalled that they had participated in the MDA. With these results we are not able to assess recall. Of the parents who were surveyed, 97% correctly knew that their child had participated in MDA while 3% said that they did not know.

The result of greatest interest was the ability of the children to accurately identify which drug they took as part of the MDA. Children were shown 3 different drugs (Albendazole, Mebendazole and a decoy pill not available in the area). 15% of children and 5% of adults mistakenly believed the child had taken the decoy pill. This study did, however, gather interesting information on the frequency of unprogrammed deworming. 12% of parents (and 5% of children) said that the child had received some deworming medication outside of school. The majority of this came from health centers.

Countries: Cambodia

Piloting the Supervisor's Coverage Tool in Ethiopia: an in-process monitoring tool for MDA at the district-level

This study is piloting the Supervisor's Coverage Tool (formerly the Coverage Supervision Tool, or CST) approach that is meant to provide a platform for district- and sub-district-level supervisors to monitor the success of the last MDA. It is meant to be conducted at the sub-district level two weeks following MDA and provides a pass/fail result regarding whether the target coverage threshold was met. It is designed as a quick and inexpensive in-process monitoring tool for use by sub-national level NTD management teams/supervisors to help improve or maintain the success of future MDA rounds.

Preliminary Findings and Lessons Learned

A recurring request from the national neglected tropical disease (NTD) programme teams is for a quick, inexpensive and simple tool that the programmes can use to assess preventive chemotherapy (PC) coverage. Consequently, the WHO, in collaboration with partners, has developed a Supervisor’s Coverage Tool (SCT) that can be used to improve the coverage of PC delivered through mass drug administration (MDA). The SCT gives supervisors a supportive supervision tool with which to strengthen the performance of the community drug distributors (CDDs) and their first-level supervisors, providing an opportunity to identify and solve problems related to low MDA coverage.
This tool was first piloted in the Benishangul-Gumuz region in western Ethiopia in close collaboration with RTI and the regional health bureau. The results suggested that the tool was both feasible for district-level staff to implement and resulted in programmatically useful information.
The methodology behind this tool was presented at the WHO Working Group on Monitoring and Evaluation of Preventive Chemotherapy (WG M&E) in 2015 and 2016. Evidence from four field studies in Ethiopia, Nigeria (two separate occasions) and the Philippines confirms the value and feasibility of using the Supervisor’s Coverage Tool (SCT) by sub-district health supervisors.
Consequently, the Scientific and Technical Advisory Group for Neglected Tropical Diseases has recommended that the SCT be made available to national programmes for immediate use. Information from SCT should be used to take appropriate data-driven, corrective action at sub-district levels. Additional evidence will be gathered about the tool’s use and applications in other treatment settings such as school-based platforms and urban settings.

Countries: Ethiopia

Evaluation of CCA urine-tests for diagnosis of Schistosoma guineensis infection in Cameroon

To determine if the circulating cathodic antigen (CCA) rapid diagnostic test is as effective as the Kato-Katz (KK) test in diagnosing S. guinensis

Countries: Cameroon
Diseases: Schistosomiasis

Multi-country comparison of diagnostics tools for Onchocerca volvulus, Wuchereria bancrofti and Loa loa

Comparison of different diagnostic tools during onchocerciasis, lymphatic filariasis and Loa loa mapping and epidemiological assessments, including Ov16 ELISA, OV16 rapid diagnostic test (RDT) and skin snip test. (Refer to 065.1, 065.2, 065.3, 65.6 & 65.7.)

Countries:

Correlating Ov16 Serology with Skin Snip Assessments (Mali)

To compare different diagnostic tools during onchocerciasis epidemiological assessments, including Ov16 ELISA, OV16 rapid diagnostic test (RDT) and skin snip test.

Countries: Mali
Diseases: Onchocerciasis

Correlating Ov16 Serology with Skin Snip Assessments (Gabon)

Comparison of different diagnostic tools during onchocerciasis mapping, including Ov16 ELISA, OV16 rapid diagnostic test (RDT) and skin snip test.

Countries: Gabon

Correlating Ov16 Serology with Skin Snip Assessments (DRC)

To compare different diagnostic tools during onchocerciasis mapping, including Ov16 ELISA, OV16 rapid diagnostic test (RDT) and skin snip test.

Countries: Dem. Rep. of Congo

Alternative approaches to coverage surveys (Honduras)

Develop a program evaluation tool to permit program managers to effectively assess coverage and compliance. This study will focus on assessing MDA coverage for lymphatic filariasis by comparing the cost, time and feasibility of the EPI approach (n=480), LQAS design (n=95) and probability sampling alternatives (n=480).

Preliminary study findings:

  • All three survey methods were feasible for the teams to implement and cost <$5,000.
  • Preschool deworming coverage, provided through the community-based MDA, was <60%.
  • The main reason for refusing the medication was that the child had recently been dewormed.
  • Approximately 80% of preschool children surveyed received at least one dose of unprogrammed deworming in the past 12 months.
  • The main sources of unprogrammed deworming were health centers, local pharmacies, and bodegas.
Countries: Honduras

Integrated Remapping of lymphatic filariasis and loiasis (Cameroon)

Defining what are the appropriate tools to map LF in Loa endemic areas. Identifying if there is a Loa infection threshold that triggers the cross-reactivity in the ICT cards.

Countries: Cameroon

A Sustainable Community-Health Program: Controlling Hookworm Infection Among Adults in a Community

Identify the set of action that will generate a sustainable program of controlling the prevalence of hookworm infection among adults in a community.

Countries:

Solidarity and Ethics of Care: Strengthening the Sustainability of Controlling Hookworm Infection Among Adults

Measure the solidarity and ethics of care to strengthen the sustainability of community-based healthcare in controlling hookworm infection among adults

Countries: Philippines

Development of novel survey methodology for re-mapping LF in low prevalence areas (Ethiopia)

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. 

Countries: Ethiopia

Rapid Answer Projects (RAPs)

Literature review, meta-analyses; 3 RAPs published; one RAP white paper; see SCORE website http://score.uga.edu/projects/rapid-answers-project/

Countries:
Diseases: Schistosomiasis

Riverine Prawns

What is the the impact of riverine prawns on infections in humans? Studies are to be conducted on interrupting seasonal transmission of Schistosomiasis and ecologic assessment of riverine prawns on infections in humans.

Countries: Cote d'Ivoire
Diseases: Schistosomiasis

Elimination of S. haematobium in Seasonal Transmission Sites

This study will include comparing 1) MDA as usual 2) double treatment with two closely-spaced MDAs (consistent with the recommendation based on mathematical models) 3) twice yearly MDA and 4) double MDA plus snail control.

Countries: Cote d'Ivoire
Diseases: Schistosomiasis

Randomized Control Trial Comparing Efficacy of a Single Dose of Treatment of Yaws with 20 mg/kg Versus 30 mg/kg of Azithromycin

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

Countries: Papua New Guinea | Ghana
Diseases: Yaws

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