Our proposal will study the interaction between humans, livestock and wildlife and the role of this transition zone in the transmission of trypanosomes at the edge of the Serengeti National Park in Tanzania. To assess whether focussed control of tsetse is effective, we will develop mathematical models of the transmission of trypanosomes in the transition zone from wildlife-dominated areas on the park boundaries through to livestock-dominated areas outside the parks. The models will enable us to predict the likely extent, duration and cost of interventions required to interrupt the transmission of trypanosomes at boundary areas.
Cutaneous Leishmaniasis (CL) is exclusively transmitted by the bite of a female sand fly. In collaboration with the Saudi Arabian Ministry of Health, we have developed a programme aiming to prevent and control CL in this country. The programme focuses, among other aspects, in developing a rapid diagnostic test based on the patient’s anti-alpha-Gal response, and in identifying markers for disease exposure. We recently found evidence that treatment efficacy against Old World CL varies with parasite species, geographical locations and the development of secondary infections. This has implications on the treatment of this debilitating disease. The severity of a leishmaniasis ulcer partly depends on the patient’s previous exposure to sand fly bites. This explains the increased protection against CL in individuals living in CL-endemic areas and supports development of potential vaccine models based on sand fly salivary proteins. Furthermore, Old World CL patients produce high levels of anti-Gal antibodies (i.e. recognise terminal alpha-galactosyl epitopes). This discovery is currently being exploited for the making of rapid diagnostic tools and a potential protective glycovaccine model against CL. We hope that these tools can soon be applied in other CL-endemic countries, including refugee settings.
1. Improved planning and delivery of integrated programmes;
2. Increased and sustained access to NTD drugs;
3. Harmonised inter-sectoral approach; and
4. Strong and generalisable evidence base for integrated elimination and control of NTDs.
The development of Trypanosoma brucei within the tsetse vector is accompanied by the expression of several stage-specific families of GPI-anchored surface glycoproteins. We recently discovered that saliva from T.brucei-infected tsetse flies is enriched with Brucei Alanine-Rich Proteins (BARP), VSG and a novel family of GPI-anchored surface glycoproteins. The latter are phylogenetically grouped within the Clade IV of family 50 of trypanosome surface proteins and are encoded by five paralogs, whose products are over 90% identical in sequence. Immunofluorescence and transcript analysis showed that Clade IV proteins are expressed on the surface of metacyclic trypanosomes and also on epimastigotes and pre-metacyclic forms although in lower abundance. This expression pattern opposes that of BARP, which is highly expressed in the epimastigote stage and diminishes during differentiation to metacyclics. Because Clade IV proteins are almost identical in sequence and are heavily expressed in the metacyclic stage, we named them Metacyclic Invariant.
This study aims to determine if the addition of lymphatic stimulating activities to community-based home-care for lymphoedema can improve outcomes for people affecetd by moderate to late stage disease.
Primary Objective: To evaluate and develop MMDP services in Nigeria to be responsive to patient and provider perspectives using community based participatory research approaches in a participatory action research cycle
Formative research question: To what extent are the support needs of people affected by NTDs being met?
Intervention research question: How can new programme strategies be adapted to meet outstanding need?
Can the micro-stratification of lymphatic filariasis (LF) transmission assessment surveys positive case and clinical case data be used to identify, map and monitor transmission hotspots as part of an enhanced endgame surveillance strategy?
Can targeted molecular xenomonitoring detect ongoing transmission [to the same extent as human surveillance] in defined LF transmission hotspots?
This proof of concept study will take place over a 10-month period. They aim to compare the feasibility and acceptability of mobile gynecological clinics versus traditional, static health posts. The primary research question, Where urogenital schistosomiasis is endemic, can a static health outpost versus a mobile clinic deliver better diagnosis and treatmnet of FGS, HIV, HPV, and cervical cancer in an acceptable and cost-effective manner to women (14-30 years), will be answered through the following activities:
Development of a consortium on FGS bringing together high-profile researchers, policy makers, program implementers, and health professionals
Training of health professionals (nurses, physicians, community health workers) with follow up sessions to raise awareness and diagnostic capabilities through colposcopic imagery. Health workers in remote areas will utilize telehealth to transmit images for quality checks by a specialist. The team will measure the % correlation between field results and telemedicine results to determine feasibility.
Precision mapping in select districts to determine areas with the highest schistosomiasis prevalence through parasitological surveys
Pilot test mobile service delivery for FGS, HIV, HPV, and other common gynecological issues in two of the four districts. This will include a cost analysis to make a business case for scalability.
To develop and pilot a standardised analytical framework for the spatial and temporal analysis of routinely collected gender disaggregated NTD programme data. This will allow increased understanding and spatial visualisation of the influence of gendered programmatic inputs, external geographic and social factors on the equity of programmatic outputs, particularly access to mass administration of medicines (MAM).
This social science study will address the following:
Formative question: What are the strengths and weaknesses of the four models for case identification, confirmation and referral currently being implemented in Liberia for NTDs?
Intervention question: What is the optimal model for implementing case identification, confirmation and referral of NTD cases requiring case management, in terms of equity, effectiveness, economy and efficiency within the health system?"
The question of how to conduct post-elimination surveillance is a high priority for the NTD community, given that most NTD programs scale back or shut down completely once elimination as a public health problem is achieved. Few solutions exist and this proposal provides an interesting and useful case study for surveillance moving forward. The study team plans to target 1708 pregnant women as a proxy for measuring LF resurgence in a post-elimination context. As a comparison group, they plan to conduct a prevalence survey of 427 households (1708 participants) in the same community to compare LF prevalence found in each methodology. Each participant at the health facility’s residence will be geo-referenced to understand the coverage area. They also plan to conduct interviews with patients and health workers, a time-motion study, and a cost analysis to assess the additional burden on health care workers and the health system. The study will occur in 14 facilities in one district of Malawi where LF was highly endemic prior to the launch of the program.