Projects

STH DNA Diagnostic Testing (Argentina)

To refine the use of multi-parallel quantitative real-time PCR (qPCR) for STH parasites. Those parasites included in this proposal are Ascaris lumbricoides, Ancylostoma duodenale, Necator americanus, Strongyloides stercoralis and Trichuris trichiura. Collect parasites of all five species in Argentina.

Countries: Argentina

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

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: Tanzania

Evaluation of LF diagnostic Tools in Loa-Endemic Areas

To assess the specificity of diagnostic tools in Loa co-endemic areas and to conduct a prospective assessment of the impact of ALB MDA and Vector control on malaria, LF and STH indicators.

Countries: Cameroon

Defining the Profile of LF Antibody Reactivity following MDA

Determine age-specific prevalence of LF Antibody following MDA to inform surveillance strategies.

Countries: French Polynesia

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

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

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

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

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