Tanzania Ministry of Health (MOH)
Equitable access to Mass Drug Administration for trachoma elimination: an ethnographic study to understand factors associated with low coverage in Kenya and Tanzania
Main objectives are firstly to identify and understand better the factors behind low and unequal MDA coverage and compliance in trachoma endemic areas in Tanzania and Kenya with nomadic populations, secondly to prioritize factors in terms of amenability to intervention. The researcher will then use the evidence generated to design specific interventions that could improve the reach and impact of campaigns of Zithromax MDA in both countries. While there are contextual differences between nomadic societies throughout Africa, research among the Masai in Tanzania and Kenya should inform programme services in other settings with nomadic populations. Particular attention will be given to gender-sensitivity; that is, interventions that will improve access and use by women as well as men.
To evaluate strategies to improve the sensitivity of the TAS for detecting evidence of recent lymphatic filariasis transmission in an evaluation unit (EU). The TAS Strengthening Study in Tanzania is designed to assess additional indicators that may be added to the current TAS platform in order to strengthen the resulting stopping or surveillance decisions. A comprehensive analysis will be conducted to understand the correlation between antigen and antibody in adults and children with the mosquito data. A spatial analysis looking at microfoci of infection will also be conducted. Because the EU is also endemic for onchocerciasis, the new Ov16 monoplex RDT was used in the field. The Wb123 and Ov16 antibodies were assessed via ELISA in the NIMR lab in Tanga and the results will soon be compiled. Xenomonitoring work to assess Culex and Anopheles mosquitoes, as well as black flies, is underway.
Preliminary Findings and Lessons Learned
The ultimate goal of this study is to strengthen the existing TAS platform so that the programs can be more confident with their stopping and surveillance decisions. In order to strengthen the existing TAS platform we need to better understand which target population(s) and diagnostic indicator(s) are best-suited for identifying areas with persistent transmission that is not expected to cease on its own, knowing that the answer may vary according the primary vector and stage of the program. In the selected sites a community-based TAS was conducted using the standard sampling of 6-7 year olds while a community TAS (individuals >8 years) was conducted concurrently. All samples were tested via FTS and DBS (for Wb123 ELISA). In these same communities a molecular xenomonitoring study will take place and the mosquitoes will be tested for filarial DNA to relate back to the human specimens. To date human sampling has been completed in all sites and laboratory analysis of the specimens is complete. Mosquito collection has been completed in Haiti and Tanzania and the PCR analysis has been completed in Haiti and is planned for Tanzania (pending the arrival of a new PCR machine). In American Samoa xenomonitoring has been delayed due to weather conditions and arbovirus outbreaks; work is expected to commence spring 2018.
Does infection data add evidence to the understanding of trachoma prevalence in low endemic areas?
- To evaluate strategies for the elimination of trachoma by evaluating potential makers that show interruption of transmission of C. trachomatis
- To determine the prevalence of ocular chlamydial infection among children aged 1 – 9 years old in Mpwapwa and Kalambo District, Tanzania
- To determine the associated risk factors of ocular Chlamydia infection among children aged 1 – 9 years old in Mpwapwa and Kalambo District, Tanzania
- To determine the usability of antibody test to detect Chlamydia antigen pgp3 using lateral flow assay
- To examine the longevity of the antibody response to trachoma antigens in a high and low-prevalence setting
Trachomatous Trichiasis Management in Tanzania: Investigation of the productivity of case finding and referral of patients to trichiasis surgery services
One of important pillar of Trachoma elimination as a public health problem is to manage through epilation and surgery trachomatous trichiasis (TT) to reach in endemic district less than 0.1% of TT prevalence or less than 0.2% prevalence in adults of 15 years and older. However, surveys in 3 districts of Tanzania where numbers of TT surgeries were performed showed an unexpected higher prevalence despite intervention. This mixed methods study will help to address the main question as to why trachoma impact surveys demonstrating unexpectedly high TT prevalence in communities where TT surgical intervention is ongoing and how could this intervention/burden gap be addressed? The aim is to look at the case finding techniques effectiveness in all the communities and factors that affect TT referral and quality surgical services.
Trachomatous Trichiasis Management in Tanzania: Investigation of the productivity of case finding and referral of patients to trichiasis surgery services
One of important pillar of Trachoma elimination as a public health problem is to manage through epilation and surgery trachomatous trichiasis (TT) to reach in endemic district less than 0.1% of TT prevalence or less than 0.2% prevalence in adults of 15 years and older. However, surveys in 3 districts of Tanzania where numbers of TT surgeries were performed showed an unexpected higher prevalence despite intervention. This mixed methods study will help to address the main question as to why trachoma impact surveys demonstrating unexpectedly high TT prevalence in communities where TT surgical intervention is ongoing and how could this intervention/burden gap be addressed? The aim is to look at the case finding techniques effectiveness in all the communities and factors that affect TT referral and quality surgical services.
Trachomatous Trichiasis Management in Tanzania: Investigation of the productivity of case finding and referral of patients to trichiasis surgery services
One of important pillar of Trachoma elimination as a public health problem is to manage through epilation and surgery trachomatous trichiasis (TT) to reach in endemic district less than 0.1% of TT prevalence or less than 0.2% prevalence in adults of 15 years and older. However, surveys in 3 districts of Tanzania where numbers of TT surgeries were performed showed an unexpected higher prevalence despite intervention. This mixed methods study will help to address the main question as to why trachoma impact surveys demonstrating unexpectedly high TT prevalence in communities where TT surgical intervention is ongoing and how could this intervention/burden gap be addressed? The aim is to look at the case finding techniques effectiveness in all the communities and factors that affect TT referral and quality surgical services.
(1) Is it possible to eliminate schistosomiasis as a public health problem on Unguja in three years and to interrupt transmission in five years? (2) Is it possible to control schistosomiasis throughout Pemba (prevalence <10%) in three years and to eliminate it as a public health problem in five years? (3) What are the costs, successful strategies, barriers, etc. associated with three different interventions (MDA, vector control, and behavior change)?
Exploring alternative indicators for trachoma endpoint decision-making (Tanzania)
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.
Does infection data add evidence to understanding of trachoma prevalence in low endemic areas?
To investigate the utility of an antibody test as a tool for surveillance during the elimination phase of trachoma programmes
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.
Field validation of sampling strategies for integrating STH surveys into Transmission Assessment Surveys (Tanzania)
Test STH-TAS
Geospatial methods of clustering leprosy case data for effective rollout or implementation of both PEP and new case detection initiatives
To what extent can various geospatial and statistical clustering techniques be applied to leprosy case data to identify clusters and inform detection and prevention interventions (i.e. rollout of PEP) through the establishment of recommended best practices?
Equitable access to Mass Drug Administration for trachoma elimination: an ethnographic study to understand factors associated with low coverage in Kenya and Tanzania
Main objectives are firstly to identify and understand better the factors behind low and unequal MDA coverage and compliance in trachoma endemic areas in Tanzania and Kenya with nomadic populations, secondly to prioritize factors in terms of amenability to intervention. The researcher will then use the evidence generated to design specific interventions that could improve the reach and impact of campaigns of Zithromax MDA in both countries. While there are contextual differences between nomadic societies throughout Africa, research among the Masai in Tanzania and Kenya should inform programme services in other settings with nomadic populations. Particular attention will be given to gender-sensitivity; that is, interventions that will improve access and use by women as well as men.
Does infection data add evidence to the understanding of trachoma prevalence in low endemic areas?
- To evaluate strategies for the elimination of trachoma by evaluating potential makers that show interruption of transmission of C. trachomatis
- To determine the prevalence of ocular chlamydial infection among children aged 1 – 9 years old in Mpwapwa and Kalambo District, Tanzania
- To determine the associated risk factors of ocular Chlamydia infection among children aged 1 – 9 years old in Mpwapwa and Kalambo District, Tanzania
- To determine the usability of antibody test to detect Chlamydia antigen pgp3 using lateral flow assay
- To examine the longevity of the antibody response to trachoma antigens in a high and low-prevalence setting
Trachomatous Trichiasis Management in Tanzania: Investigation of the productivity of case finding and referral of patients to trichiasis surgery services
One of important pillar of Trachoma elimination as a public health problem is to manage through epilation and surgery trachomatous trichiasis (TT) to reach in endemic district less than 0.1% of TT prevalence or less than 0.2% prevalence in adults of 15 years and older. However, surveys in 3 districts of Tanzania where numbers of TT surgeries were performed showed an unexpected higher prevalence despite intervention. This mixed methods study will help to address the main question as to why trachoma impact surveys demonstrating unexpectedly high TT prevalence in communities where TT surgical intervention is ongoing and how could this intervention/burden gap be addressed? The aim is to look at the case finding techniques effectiveness in all the communities and factors that affect TT referral and quality surgical services.
Geospatial methods of clustering leprosy case data for effective rollout or implementation of both PEP and new case detection initiatives
To what extent can various geospatial and statistical clustering techniques be applied to leprosy case data to identify clusters and inform detection and prevention interventions (i.e. rollout of PEP) through the establishment of recommended best practices?
Development and validation of dried urine spot method for detection of Schistosoma circulating antigens from a resource limited archetype in Tanzania
1. What are the optimal conditions for developing a simple and efficient DUS collection method that yields reliable results in diagnosing schistosomiasis using the Schistosoma CCA cassette test in resource-limited settings?
2. What are the optimal conditions for developing a simple and efficient DUS-based Schistosoma circulating antigens extraction method for detection in the Schistosoma CCA cassette test method?
3. Does the DUS-based Schistosoma CCA cassette test method give reproducible results?
4. Is the DUS-based Schistosoma CCA cassette test method produce clinically valid result?
5. What are the optimal storage conditions for DUS for maximum Schistosoma circulating antigen stability in resource-limited environments?
Assessing the utility of female genital schistosomiasis symptoms and risk factors checklist and efficacy of praziquantel on genital lesions associated with urogenital schistosomiasis in adolescent girls and women in Maswa District, Tanzania
1. What is the specificity and sensitivity of the FGS symptoms and risk factors checklist in identifying women with suggestive symptoms of FGS compared to urine filtration test and colposcopy?
2. Does treatment with praziquantel lead to regression or healing of genital lesions related to FGS in adolescent girls and women?
Does infection data add anything to our understanding of trachoma prevalence in low endemic areas?
Does infection data add anything to our understanding of trachoma prevalence in low endemic areas?