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Integrated Mapping of Onchocerciasis, Lymphatic Filariasis, and Loiasis in Cameroon

To pilot a strategy for mapping and treating Onchocerciasis and Lymphatic Filariasis in Loa loa co-endemic areas.

Countries: Cameroon

BURDEN ASSESSMENT OF PODOCONIOSIS IN WAYU TUKA WOREDA, EAST WOLLEGA ZONE, WESTERN ETHIOPIA

What is the burden of podoconiosis lymphoedema and acute attack in Western Ethiopia?

 

Countries:
Diseases: Podoconiosis

TAS Strengthening in Haiti

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 Haiti 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 Culex mosquitoes will be conducted in the same sites as the human sampling. 

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.

Countries: Haiti

TAS Strengthening in Tanzania

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.

Countries: Tanzania

LFTAS + Biplex + DBS in Oncho endemic areas in Cameroon

To assess if transmission assessment surveys (TAS) for lymphatic filariasis (LF) are a feasible platform to integrate transmission assessment for onchocerciasis, using the same age group (6-7 years old) and the same prevalence threshold (<2%) that the LF programs utilize.

1. To perform the TAS for stopping LF MDA and use it as platform for Oncho impact assessment.
2. To assess the level of endemicity of Oncho following at least five rounds of MDA in hypo, meso and hyper endemic districts.
3. To study the performance of the Wb123/Ov16 Biplex rapid diagnostic test (RDT) to assess Oncho and LF transmission interruption.

 

Preliminary study findings:

  • This study involved an integrated impact assessment of onchocerciasis and lymphatic filariasis using the LF TAS platform and the serologic rapid text Biplex in the Northern area of Cameroon.
  • The study sites covered 31 health districts in the Far-North and North regions, constituting nine evaluation units, for which TAS1 was planned.
  • Community-based cluster surveys were conducted collecting GPS and demographic information, lymphedema symptoms, and testing by FTS, by Wb123/Ov16 Biplex, and by Night Blood Smear of 6 and 7 year old children.
  • In total, 13,957 children were recruited from 267 enumeration units (villages).
  • Ten children showed evidence of LF exposure or infection: 4 were positive by FTS and 6 were positive by Wb123 (via biplex).  No children tested positive for both FTS and Wb123. 
  • Night blood smears - conducted in children who were positive by FTS and by Wb123/Ov16 Biplex - were all negative.
  • For onchocerciasis, one individual was Ov16 positive (by Biplex).

In conclusion, all nine evaluation units passed the TAS1 assessment. As for onchocerciasis, study results are consistent with the previous hypo-endemic status of the area.

Countries: Cameroon

Assessment of LF status in Two Urban Settings of Benin (Cotonou and Porto-Novo)

To determine whether there is LF transmission in Cotonou and Porto-Novo, which are the two main urban locations of Benin where the LF status is undetermined. A study will be conducted to evaluate the prevalence of LF using antigenemia and antibody testing (FTS and Wb123). An entomological survey will be implemented to understand the dynamic of LF transmission and potential barriers to LF MDA in urban settings. 

Preliminary study findings:

  • While mass drug administration (MDA) in Benin is on track to eliminate LF in most endemic cities, 50 such cities – including the country’s largest cities, Cotonou and Porto Novo – never received treatements.
  • In 2016, more than 15 years after mapping, LF endemicity was re-evaluated in Cotonou and Porto Novo to put in place adequate strategies for LF elimination. This study constituted that re-mapping effort.
  • The various surveys, conducted in vectors and humans through collection of entomological and parasitological data, reveal an absence of LF transmission in Cotonou and Porto Novo.
  • The results demonstrate that the number of cities endemic for LF in Benin has dropped from 50 to 48.
  • However, the study revealed a lack of awareness of LF by residents and health workers, highlighting the need for more education and awareness raising on the disease.
Countries: Benin

Understanding the best uses of the Supervisor's Coverage Tool for monitoring school-based distributions

To compare the feasibility and programmatic implications of employing the Supervisor's Coverage Tool in schools vs. communities to monitor a school-based MDA.

The Supervisor’s Coverage Tool (SCT) is a rapid in-process monitoring tool for improving mass drug administration (MDA) coverage that has been approved by WHO for use in communities.  However, questions remain as to whether it may also serve as a useful tool when implemented in schools.  To answer this question, a direct comparison of school- vs. community-based SCT implementation was conducted in 13 Supervision Areas (SAs) in 7 Local Government Areas (LGAs), in 3 states in Nigeria.  Within each SA, one SCT was conducted in the school and an independent SCT was conducted in a village within the catchment area of the same school. The SCTs were all monitoring the coverage for the same school-based MDA for praziquantel and mebendazole. The goal was to understand how the information learned through the SCT would vary based on the two different sampling frames. 

Findings and lessons learned:

-          The SCT helped find targeted schools for which a mass drug administration (MDA) was planned but were missed. Several unregistered (illegal) schools were missed as their existence was not known, therefore they were not targeted and included in the MDA; however, upon identification of these schools through the SCT, the schools were reached during mop-up and added to the database for future MDAs.

-          An existing school feeding program increased students’ praziquantel intake in all northern Nigeria schools that were visited.

-          In two SAs, school SCT results showed good coverage; however, the actual reported school coverage was below the recommended threshold. The discrepancy was due to a great number of student absences because of farming activities or drop outs after enrolment. Since any selected student who is absent is skipped by the SCT and a new student is selected in their place, the resulting coverage classification could be an inflation of the true coverage.

-          Surveyors preferred SCT implementation in schools vs. community because household enumeration can be time-consuming.

-          When SCT results from the school and the village were directly compared for the same population, the community-based SCT always resulted in an equal or lower classification of coverage, likely because community-based SCTs include the entire target population in the sampling frame, as opposed to being limited to school-attending children.

Countries: Nigeria

Supervisor's Coverage Tool for school-based STH and community-based LF in Philippines

To determine the feasibility and best practices of using the Supervisor's Coverage Tool to monitor community and school-based distribution and integrated MDA.

The Supervisor’s Coverage Tool (SCT) is a rapid, simple, and inexpensive tool designed for use in Neglected Tropical Diseases (NTD) programs mass drug administration (MDA) to monitor drug coverage and compliance, to supervise community drug distributors (CDD), and to identify areas that may need mop-up. After successfully piloting the SCT in Ethiopia and Nigeria in 2015, additional testing of the tool was suggested to assess the feasibility of the tool in different regions and new settings. Therefore, the SCT was implemented in the Philippines in July 2016.

After the completion of training, the field work was conducted in two provinces, in six Supervision Areas (SA) consisting of one or more puroks (subdivisions) per barangay (village). Two survey populations were represented in the SCT implementation covering a community-based distribution for Lymphatic Filariasis (LF), excluding children aged 5-18 years and a school-based distribution for LF for all children aged 5-18 years. 

Findings and lessons learned:

  • The most common reasons for not swallowing drugs were fear of side effects, not feeling well, forgetting, being too busy, and the taste of the medicine.
  • When an accurate register of all the households in the SA exists, it is possible to complete the SCT in each SA in less than a day because the registers greatly aid the random selection process.
  • Implementing the SCT during the last week or two of the MDA was advantageous as it enabled the program to implement the action plan to improve the current MDA using the personnel, budget, and infrastructure that was already in place for the MDA.
  • It is important to consider whether or not Community Drug Distributors (CDD) should accompany the SCT teams during interviews, as their presence may influence the answers of the respondents.
  • It is strongly recommended that when possible, CDDs use directly observed treatment (DOT). If DOT is not possible, CDDs should remind participants that there is no advantage in delaying swallowing the drugs, and that it is actually better when everyone swallows the drugs at the same time.
  • Overall, the Philippines SCT pilot was a success, as it was the first time it was implemented in the Western Pacific region, and it was also used to monitor multiple distributions (both school- and community-based). 
Countries: Philippines

Stigma Assessment and Reduction of Impact (SARI) Project

How effective are the following stigma reduction interventions when implemented in pairs to decrease leprosy-related stigma: 1) counselling and empowerment, 2) socio economic development, and 3) contact between community and people affected?

Countries: Indonesia

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