Blantyre Institute for Community Outreach (BICO)
Evaluation of alternative indicators for stopping trachoma mass drug administration
To assess the relationships between the prevalence of the clinical sign TF compared to prevalence of infection and antibody in Chikwawa and Mchinji districts
Currently MDA is stopped when TF in children aged 1-9 years is below 5%. However, the relationship between TF, presence of infection and antibody has not been studied in a sufficient number of settings to enable predictions of outcome to be confidently made based on baseline prevalence, intervention coverage, and the prevalence of disease and infection at the time of impact survey. There are several districts in Malawi with TF prevalence between 5 and 9.9% which are eligible for one year of interventions, including a single round of MDA. This study will add important data to be used to model outcomes of interventions conducted by trachoma elimination programs, and in particular, help develop operational guidelines for stopping MDA.
Bringing Down Hurdles for Female Genital Schistosomiasis Access to Care: A Multi-Country Socio-Structural Integrated Approach to Developing A Community-Based Teaching Platform
This study aims to answer: Can female genital schistosomiasis (FGS) screening be successfully promoted through a community-based teaching intervention addresing stigma and other socio-structural barriers to increase health-seeking behaviors nested in broader sexual and reproductive health prevention services. It pilots an approach that combines awareness, anti-stigma education, and integrated screening for FGS. Investigators will work with women, adolescent girls, and key stakeholders to develop a community-based teaching platform for FGS, cervical cancer, HIV, and STIs that could decrease the burden of genital tract morbidity in women of reproductive age. Zambia will serve as the main study site and once the team has developed the intervention, it will be rolled out remotely to Malawi and Tanzania. Additionally, the team plans to adapt validated HIV stigma indicators to include FGS and pilot test the scale throughout the course of the project.
Exploring alternative indicators for trachoma endpoint decision-making (Malawi)
Analyze the relationships between the prevalence of the clinical sign follicular trachoma (TF) and the prevalence of infection and antibody to determine whether it may be appropriate to consider one or more alternative indicators for deciding whether trachoma programs can stop MDA.
Evaluating treatment coverage for trachoma in two districts in Malawi
To measure the feasibility of using a PPES sampling approach with segmentation within each EA to measure coverage. In addition to collecting data on coverage the team also used mobile devices to collect data on time and distance traveled as well as the availability of village registers. These data contribute to the larger coverage evaluation study taking place in multiple countries.
Preliminary 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 pilot a newly refined probability sampling with segmentation approach in 2 districts in Malawi. The two surveys found that the survey coverage was above the WHO target thresholds for Zithromax. Furthermore, the team found the survey methodology to be clear and feasible to implement. This adds further evidence to the previous studies that support the use of the segmentation approach for coverage surveys across all 5 PC NTDs.
The DeWorm3 Project is a series of hybrid trials testing the feasibility of interrupting the transmission of soil transmitted helminths (STH), while conducting implementation science research that contextualizes clinical research findings and provides guidance on opportunities to optimize delivery of STH interventions.
The purpose of DeWorm3 implementation science studies is to ensure rapid and efficient translation of evidence into practice. Research methods include: (1) stakeholder mapping and network analysis, (2) qualitative research, (3) structural readiness surveys, (4) process mapping, and (5) economic evaluation (costing and cost-effectiveness).
Implementation science research aims include:
1)To systematically identify stakeholders influencing standard of care targeted and community-wide MDA and map their potential role and involvement in scale-up of community-wide MDA for STH.
2)To identify implementation-related barriers and facilitators to community-wide MDA for STH from the perspective of various stakeholders.
3)To quantify the readiness of the health system to deliver community-wide MDA for STH programs.
4)To map the intervention delivery process and identify any discrepancies between planned and implemented activities in order to optimize the trial intervention.
5)To compare the financial and economic costs and incremental cost-effectiveness of community-wide and targeted MDA for STH in the short- and long-term.
Bringing Down Hurdles for Female Genital Schistosomiasis Access to Care: A Multi-Country Socio-Structural Integrated Approach to Developing A Community-Based Teaching Platform
This study aims to answer: Can female genital schistosomiasis (FGS) screening be successfully promoted through a community-based teaching intervention addresing stigma and other socio-structural barriers to increase health-seeking behaviors nested in broader sexual and reproductive health prevention services. It pilots an approach that combines awareness, anti-stigma education, and integrated screening for FGS. Investigators will work with women, adolescent girls, and key stakeholders to develop a community-based teaching platform for FGS, cervical cancer, HIV, and STIs that could decrease the burden of genital tract morbidity in women of reproductive age. Zambia will serve as the main study site and once the team has developed the intervention, it will be rolled out remotely to Malawi and Tanzania. Additionally, the team plans to adapt validated HIV stigma indicators to include FGS and pilot test the scale throughout the course of the project.
Exploring alternative indicators for trachoma endpoint decision-making (Malawi)
Analyze the relationships between the prevalence of the clinical sign follicular trachoma (TF) and the prevalence of infection and antibody to determine whether it may be appropriate to consider one or more alternative indicators for deciding whether trachoma programs can stop MDA.
The DeWorm3 Project is a series of hybrid trials testing the feasibility of interrupting the transmission of soil transmitted helminths (STH), while conducting implementation science research that contextualizes clinical research findings and provides guidance on opportunities to optimize delivery of STH interventions.
The purpose of DeWorm3 implementation science studies is to ensure rapid and efficient translation of evidence into practice. Research methods include: (1) stakeholder mapping and network analysis, (2) qualitative research, (3) structural readiness surveys, (4) process mapping, and (5) economic evaluation (costing and cost-effectiveness).
Implementation science research aims include:
1)To systematically identify stakeholders influencing standard of care targeted and community-wide MDA and map their potential role and involvement in scale-up of community-wide MDA for STH.
2)To identify implementation-related barriers and facilitators to community-wide MDA for STH from the perspective of various stakeholders.
3)To quantify the readiness of the health system to deliver community-wide MDA for STH programs.
4)To map the intervention delivery process and identify any discrepancies between planned and implemented activities in order to optimize the trial intervention.
5)To compare the financial and economic costs and incremental cost-effectiveness of community-wide and targeted MDA for STH in the short- and long-term.