Kenya Medical Research Institute (KEMRI)

• What is the indicator(s) and accompanying M&E strategy that enables country programs to determine when the risk of ongoing transmission of lymphatic filariasis has been reduced so that triple drug therapy with ivermectin, diethylcarbamazine, and albendazole (IDA) can be stopped with little risk of resurgence of transmission?
• Can the use of a tailored social mobilization package be used to strengthen community and health system participation and achieve >80% coverage for IDA in Kenya?

To assess the socio-economic factors contributing to low access to MDA, to identify the existing health services opportunities and other outlets specific to various socio-economic groups that could be used for improving access to MDA, and to develop feasible field-applicable strategies that can be used to reach groups with consistently low access to MDA.

What is/are the most suitable indicator(s) for monitoring IDA treatment regimen against LF and for making IDA stopping decisions?

To determine the current status of LF using a combination of seroepidemiological tools to determine prevalence of circulating filarial antigen (CFA) and antifilarial antibodies.

Preliminary study findings:

• 2,976 individuals (age: 2 to 100 years) were tested for circulating filariail antigen using the immunochromatographic (ICT) test during daytime visits. Night-time blood samples to detect microfilariae (MF) were requested from those who tested positive via the ICT test.
• Out of the 38 persons found to be positive for LF infection by ICT test, 33 provided a night-time blood sample for examination of MF. Overall, nine individuals were found to be MF positive, with the highest prevalence in Ndau Island.
• The current study suggests that LF transmission may be absent in Taita-Taveta and Tana River counties in coastal Kenya and therefore transmission assessment surveys (TAS) should be considered with a view to stopping MDA. By contrast, evidence for ongoing transmission in Kwale, Kilifi and Lamu counties indicates the need for further MDA rounds in these counties.

• Additionally, the study demonstrated the feasibility of conducting integrated serosurveillance of several infectious diseases of public health interest, as well as levels of seroprotection against vaccine preventable diseases. The findings of the current study underscore the added value of using multiplex antibody measurements to guide and monitor LF elimination efforts.

Formative: To what extent do individuals have quality of life and access to and utilize MMDP services within the healthcare system; and what are the barriers and facilitators (affordability, availability, approachability, acceptability, and appropriateness) of 1) access to and utilization of quality MMDP healthcare services and 2) management of morbidities at home?

Intervention: What is the effect of an integrated health system approach on access to MMDP healthcare services as measured by affordability, accessibility, acceptability, and availability; and on utilization of services and quality of life?

Would the same programmatic decisions for Oncho Elimination Mapping be made based off of the Ov16 rapid diagnostic test results as compared to the Ov16 SD ELISA results?

Can geostatistical models leverage the wealth of well-characterized private and public sector data in Kenya to improve STH prevalence predictions, leading to better program decisions with minimal field cost?

Does greater program engagement and ownership lead to model adoption?

What is the persistence of Trichuris trichiura infection in a high transmission setting?

1.    Can recrudescence or persistence of trachoma in Narok South, Narok West and Narok East be confirmed through the use of alternative indicators (Ct infection and anti-Ct antibodies)? 
2.    What impact have programmatic adaptations been in addressing confirmed persistence and recrudescence in Kajiado West, Central and South?

3. Is there any evidence of geographical locations and/or particular groups of high on-going transmission that should be targeted through programmatic adaptations and innovative approaches? 
4. What are the key factors (programmatic, epidemiological or contextual) that are facilitating persistence or recrudescence in Narok South, West and East and how should trachoma programming be adapted accordingly to ensure trachoma elimination is achieved? 
5.  In communities in Kajiado South, Central and West, are communities with very high Ct infection (>20% in children aged 1-9 years), a result of severe re-infection events or issues with programme MDA coverage.