London School of Tropical Medicine and Hygiene (LSTMH)
Quality and quantity of post-epilation trichiatic lashes: a cohort study
To understand the nature (quality and quantity) of post epilation lashes and their visual significance in unoperated minor trachomatous trichiasis (TT) cases and case with post-operative trichiasis
ClearTrachoma: Evaluation of a novel molecular rapid diagnostic device for the detection of Chlamydia trachomatis in trachoma-endemic areas
The primary aim of this study is a first evaluation (384 samples) of the DjinniChip in ocular clinical samples in a trachoma-endemic region in-country, but initially in the controlled environment of a research laboratory setting. The second aim is to determine the DjinniChips resilience and usability by evaluating its performance with a concentration series of positive control swabs in various environmental conditions (hot, dry, dusty, humid).
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.
Trachomatous Trichiasis and Mental Health: a comparative impact study
This study aims to understand the relationship between trachomatous trichiasis (TT) and mental health disorders over an 18-month study period, by answering the following questions:
- What is the impact of the blinding stage of trachoma (Trachomatous Trichiasis) on common mental disorders such as depression, anxiety and suicidality?
- Will the validation of the 5-Question Stigma Indicators (5-QSI) generic stigma tool help to measure and monitor stigma in trachomatous trichiasis patients in Ethiopia
- What are the drivers for mental disorders in TT patients
- Is there a difference in depression, anxiety and suicidality prevalence between TT cases accepting vs declining TT surgery; and un-operated vs postoperative TT cases? The research team will be trained on good clinical practice through the WHO Mental Health Gap Action Programme (mhGAP). Following interviews, any patient with TT will be referred for surgery and patients found with a mental health disorder will be referred for care. If a negative impact of blinding trachoma on mental health is noted, the researchers plan to use the results of the study to advocate for additional funding for the trachoma program and highlight the need to address mental health in Ethiopia.
Long term outcome of the two most commonly used surgical procedures to treat trachomatous trichiasis (TT): PLTR vs BLTR
Ascertain whether the difference in outcome (measured in rate of post-operative trachomatous trichiasis, or TT), between the posterior lamellar tarsal rotation (PLTR) and bilamellar tarsal rotation (BLTR) is sustained at four years or whether they give different results from what has been found at 1 year.
Field testing the use of 3D photographs of trachomatous trichiasis to train trachoma field graders
To evaluate 3D photographs of trachomatous trichiasis (TT) in the training and assessment of trachoma graders.
Determine whether current or historic C. trachomatis (Ct) infection can be detected, and whether it is associated with clinical signs of ‘trachomatous inflammation – follicular’ (TF) in Vanuatu and Kiribati
Determine the utility of infection testing as a tool for operational surveillance and impact assessment in trachoma-endemic environments.
The TUMIKIA Project aims to determine whether combining school- and community-based deworming is more effective at controling and eliminating soil-transmitted helminths (STH or intestinal worms) in Kenya than school-based deworming alone.
The two-year trial will provide the drug albendazole to all residents from 150 communities in Kwale County, Kenya. There are three study groups:
- Base: annual school-based deworming (ages 2-14)
- Increased coverage: annual school- and community-based deworming (ages 2-99)
- Increased coverage and frequency: bi-annual school- and community-based deworming (ages 2-99)
TUMIKIA stands for 'Tuangamize Minyoo Kenya Imarisha Afya,' which means “eradicate worms in Kenya to improve health,” in Swahili.
Post-MDA LF Surveillance Modeling: Developing Stratified Risk Maps
The purpose of this project is to create maps that utilize LF risk and prevalence data to predict risk of recrudescence, and to stratify this risk into 3-4 distinct groups. Such maps could subsequently be used to design and simulate the performance of different surveillance strategies.
Preliminary study findings:
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The intensity of transmission was quantified by the basic reproductive number (R0).
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A map of predicted prevalence of microfilaraemia, developed through Bayesian geostatistical modelling, was linked to mathematical models of the transmission dynamics of lymphatic filariasis.
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The models predict a marked geographical heterogeneity in the intensity of lymphatic filariasis transmission in Sub-Saharan Africa.
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Further control efforts may be required in areas of higher intensity of transmission.
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Conversely, interruption of transmission might be achieved earlier in areas of low intensity of transmission.
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The results suggest that intensity of transmission at baseline (R0) and bednet use are the best indicators for the level of surveillance required sub-nationally post-MDA.
For Girls and Women Genital Schistosomiasis (FGS) Morbid -sub-study
A pilot study on the burden of female genital schistosomiasis nested within the ongoing MORBID study set to identify meaningful and measurable targets for detecting the control of schistosomiasis-related morbidity in Africa.
This pilot sub-study is designed to answer the following questions
I. What is the burden of FGS in a S.haematobium endemic area in Malawi?
II. Are the current diagnostic tools available adequate to assess the true burden of FGS
III. What are some specific morbidity reduction goals for FGS that control programs should be aiming for?"
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.
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.
Characterising the spatial distribution of schistosomiasis prevalence in school-age children to develop optimal survey designs for informing sub-implementation unit decisions (Cote d'Ivoire)
The primary research question for the field work in Cote d'Ivoire is: what is the fine scale prevalence of S. haematobium and S. mansoni in 3 districts among children 5-14 years old?
Whole genome sequencing of ocular Chlamydia trachomatis in Amhara region, Ethiopia, an area with persistent hyperendemic trachoma.
This study will address the characteristics of the ocular chlamydia trachomatis population structures within Amhara, a setting which has experienced repeated rounds of antibiotic for trachoma, and whether those circulating populations are different than known sequenced strains.
The Neglected Mind-Skin Link: Promoting mental health and wellbeing of people affected by skin NTDs: Formative piloting of the WHO Guide on Mental Health and NTD Integration
This study is designed as a proof-of-concept to test the feasibility and acceptability of a proposed intervention package outlined in a soon to be published WHO manual on NTDs and mental health. The primary output of this study is to adapt a model of intervention from the soon to be published WHO guide on Mental Health and NTDs. The team aims to achieve this output through:
- Screening 300 individuals for symptoms of depression and anxiety, refer where necessary, and sample 30 of those individuals for participation in qualitative interviews.
- Conducting peer-led focus group discussions (separate groups for leprosy and LF) to better understand the needs, priorities, and barriers related to affected individuals’ mental wellbeing and quality of life.
- Conducting a workshop with health leaders, community health workers, nurses, service users, family/caregivers, and experts to develop a feasible and applicable theory of change that aligns with WHO guidelines.
- Conducting in depth interviews with key stakeholders to assess the developed model’s feasibility and accessibility Conducting quantitative measures for feasibility and acceptability to assess the stepped-care approach model which involves: improved screening, referral, uptake of service, knowledge uptake following training, and an assessment of whether supervision was carried out. They also plan to triangulate health information data to determine uptake of services.
- Conducting follow-up FGDs with those 30 individuals after a one-month period to understand their experience with primary health center mental health services.
Integration of LF morbidity management and disability prevention (MMDP) into community health services: exploring the coverage and equity of community health worker-driven LF MMDP burden assessment and service uptake in Côte d’Ivoire.
This study will test the reliability of community health worker-led (CHW) MMDP burden estimates by having CHWs first estimate MMDP burden, followed by a rigorous population-based survey to get a representative estimate of MMDP burden for the district. Six months later, these cases will be followed up to see whether they accessed the MMDP services and assess the quality of care. The study will examine the accuracy of the CHW estimates, CHWs’ ability to diagnose properly, social biases of health care workers that may prevent equitable care delivery, and the cost comparison of the CHW method vs. population-based survey. In addition, the team plans to conduct an evaluation of the quality of MMDP service provision, including available psychosocial support, at all facilities in the selected health district. Programs need a feasible and reliable method for coming up with MMDP burden estimates for LF and strategies to ensure that people have access to care and utilize that care. This study addresses the two pillars of WHO dossier development for MMDP and will provide the Ministry of Health with essential information to plan and adapt their program to accommodate MMDP services.
Understanding areas of increased trachoma risk (hotspots) through the implementation of a post validation trachoma surveillance strategy
To determine if there is evidence of on-going or recent transmission in the “hotspot” communities of increased risk two years after they were identified during the pre-validation surveys (clinical, antibody and infection data).
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.
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
Investigation of communities at increased risk of trachoma recrudescence & a model post-elimination surveillance strategy
Primary research question
Is there evidence of on-going or recent ocular Ct transmission in communities of northern Ghana felt to be at increased risk of recrudescence, at least two years since they were identified with Ct infection and or high anti-Pgp3 seroprevalence during pre-validation trachoma surveillance surveys?
Secondary research questions
What is the geographical extent of the boundaries of any persistent Ct infection and on-going transmission in the post-elimination setting?
What is the community-level (anti-Pgp3) prevalence of seropositivity for the multiplex bead array (MBA) (and possibly ELISA) as compared to the lateral flow assay (LFA)?
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.
Through funding from the Wellcome Trust to develop a global atlas of podoconiosis. We aim to advance new knowledge on the geographical distribution and spatial epidemiology of the disease.
i. Conduct national cross-sectional surveys in selected countries to validate the environmental predictive model developed using the mapping data in Ethiopia.
ii. Create evidence consensus maps, develop risk maps and ground-truthing work and delineate the spatial distribution and geographical limits of podoconiosis globally.
iii. Estimate the global burden of podoconiosis by quantifying the number affected, the population at risk and DALYs attributable.
iv. Estimate how much it will cost to control or eliminate podoconiosis globally.
Relationships among clinical signs (Follicular Trachoma) and infection and antibody
The purpose of this study is to analyze the relationships among clinical signs (follicular trachoma) and the prevalence of infection and antibody and to determine whether it may be appropriate to consider one or more alternative indicators for deciding whether trachoma programs can stop MDA.
Exploring alternative indicators for trachoma endpoint decision-making (Uganda)
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.
Field validation of sampling strategies for integrating STH surveys into Transmission Assessment Surveys (Ghana)
Test STH-TAS,Understand the age prevalence of LF Antibody in different setting.
Characterizing the spatial distribution of schistosomiasis prevalence in school age children to develop the optimal survey designs for sub-implementation unit decisions
What is the optimal sampling strategy for SCH impact assessments to enable sub-implementation unit decisions?
Characterising the spatial distribution of schistosomiasis prevalence in school-age children, following ≥5 rounds of preventive chemotherapy, to develop optimal survey designs for informing sub-implementation unit decisions
How is the epidemiological distribution of Schistosoma haematobium in school aged children (5 to 14 years) after multiple rounds of preventive chemotherapy across three districts in Togo.