U.K. Foreign Commonwealth and Development Office (FCDO)

This project intends to assess the effectiveness of using the Community Directed Intervention (CDI) approach as a vehicle for delivery of mass drug administration (MDA) campaigns against targeted NTDs namely, schistosomiasis and soil-transmitted helminths (STH) such as Ascaris lumbricoides (roundworms), Trichuris trichiura (whip worms) and Ancylostoma sp. (hookworms) in selected districts of Malawi. The idea is to take advantage of the logistical setup, organizational strength and high degree of efficiency of the national NTD programme to improve delivery of the current MDA efforts to control selected and highly prioritized NTDs of schistosomiasis and STH and to enhance community ownership of the interventions in selected rural and remote communities by using the CDI approach. The primary research question is: Can the CDI approach be effectively used to deliver MDA to control NTDs at community level in rural Malawian districts?

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.

Urban dwellers have frequently been included as "hard to reach" when examining MDA coverage and uptake. Poor coverage in urban settings is a key factor that prevents programs in some settings from achieving success. This research study proposes a community-based participatory action research (CBPAR) strategy to better understand the reasons why this population isn’t reached and/or their decision not to participate in onchocerciasis and lymphatic filariasis MDAs. The results will help identify last mile strategies for urban populations and will generate a technical toolkit for how to conduct rapid participatory research in areas that require novel outreach methods amongst hard-to-reach populations. This form of social science methodology has not been used frequently within the NTD community and this proposal offers an opportunity to build the evidence base for these methods within the context of hard to reach populations.

The researchers plan to conduct a number of activities in order to determine the effectiveness of the participatory approach in targeting urban populations as compared to the standard mobilization and delivery approach.

1. Rapid ethnographic interviews, a new technique aimed at rapidly collecting and analyzing qualitative data, to gather community feedback regarding barriers in accessing treatment
2. An intervention development workshop with community leaders, health workers, researchers, and the ministry of health
3. Deliver the newly designed strategy in Za-Kpota district and compare coverage in urban settings to Ouinhi district
4. Finalize a rapid participatory approach toolkit and conduct a time-motion study of the approach to improve the business case to the MoH for uptake 5. Surveys and individual interviews with key stakeholders to determine acceptability, appropriateness, and feasibility of the proposed approach and toolkit

The researchers propose taking a novel approach to increase coverage and reach previously neglected populations by engaging non-compliant individuals in devising a more effective strategy through a technique called knowledge co-production. The researchers plan to address the following questions:

1. Can an intervention package co-produced with systematically non-compliant individuals result in increased MDA coverage between the 2019 and 2020 LF MDA rounds?
2. Who and where are the systematic non-compliers in Leogane and Gressier?
3. What are the reasons motivating systematic non-compliance?
4. Is MDA non-compliance associated with hotspots of LF transmission?

The researchers plan the following activities:

1. A household cluster survey with 1300 individuals of all ages. This will define coverage in the past MDA and identify non-compliant individuals. In addition, ‘hidden’ non-compliers (NCs) will be located by a networking approach (respondent-driven sampling [RDS]).
2. All NCs will then be eligible to be selected into groups of 10 by age (18-25; 26-50; >50), sex (M, F) and demography (urban/rural). These 12 groups will each work with the national health team to devise new approaches to the non-compliance issue. These will be put into place for the 2020 MDA and then assessed by the co-production strategy groups. After the 2020 MDA a second survey will occur to assess impact.
3. The relationship between non-compliance and hotspots will be assessed using spatial analysis and defined serologically (FTS and DBS for antibodies) in collaboration with CDC.

The study will take place in the context of a larger clinical trial (FIRM-UP) that includes 4000 women affected by schistosomiasis. For the current study, the team will develop the following “work packages” to better understand community awareness of FGS, clinical diagnosis, and how to provide enhanced training:

• Work Package 1: design and implement a community-based awareness campaign, using community surveys, focus group discussions, and in-depth interviews, to determine uptake and acceptability of FGS services. This will be followed with an end-line survey to assess change in the indicators following the campaign.
• Work Package 2: establish a diagnostic package with digital colposcopy (using smartphones to capture images) and on-site microscopy.
• Work Package 3: provide a refresher training for FIRM-UP study workers, organize a colposcopy and digital imaging workshop, and extended training for staff coming from other endemic regions in Madagascar. An open-source learning platform (‘Moodle’) will be developed to exchange training and learning materials.

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?"

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).

Intervention: The primary aim of this project is to determine if the introduction of a Chronic Disease Self-Management curriculum into existing Hope Clubs in Léogâne, Haiti will result in improvements in symptoms of depression, self-rated health, chronic disease self-efficacy, social support, and disability.

Formative: What are the barriers that prevent people with LF from participating in Hope Clubs?

This social science study will address the following:

Formative question: What were the successes and challenges of the LF MMDP pilot in the Upper East region for increasing the capacity of health workers of all levels and improving the ability of patients to manage LF morbidity?

Intervention question: Can a modified capacity strengthening package, developed based on the formative research results, be effective at increasing the capacity of health workers of all levels and improving the ability of patients to manage LF morbidity?

Research questions: Does an innovative community referral linkage improve VL case finding in hard-to-reach areas of Northwest Ethiopia? Does innovative community referral linkage improve patient adherence to VL treatment? Does innovative community referral linkage improve VL patient’s treatment outcomes? Does an electronic referral linkage system improve back and forth communication and feedback between the treatment centre and community?

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. 

1. Do existing programs or activities address integrated MMDP for patients living with LF and Leprosy?
2. What is the impact of integrated MMDP in Luangwa district on access to healthcare?

• Is mobile outreach with a doxycycline test and treat strategy (TTd) an effective strategy in reducing onchocerciasis prevalence and intensity of infection amongst hard-to-reach nomadic groups in Massangam health area (HA)?
• What is the variation in prevalence of onchocerciasis and intensity of infection (community microfilaria load (CML)) in the different age and sex groups of hard-to-reach nomad community in the Massangam HA?
• What was the coverage of ivermectin mass drug administration in the nomad population with respect to the last round of ivermectin MDA?
• What is the cost of the mobile outreach strategy in this context, per person screened and treated?

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

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.

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.

Non-compliance is a primary barrier to attaining elimination goals. This study aims to utilize data captured in MDA registers to address non-compliance in the Ahanta West District of Ghana, which has been identified as a hotspot of LF transmission with >1% microfilaria (mf) prevalence after 15-16 rounds of MDA. On the basis of information identified in the register, this study proposes to deploy two strategies:

1. Engage and Treat individuals who were ill, missed treatment, or were unable to participate during the last MDA, and
2. Test and Treat for individuals who might be systemically non-compliant or afraid of adverse events. The use of MDA registers to assist in locating non-compliant individuals is novel and would provide valuable evidence for other programs and represents an alternative strategy for countries struggling with the end game. It may also help provide insight as to whether systematically non-compliant individuals truly serve as a reservoir for LF in areas designated as hotspots. Qualitative data collection will aid in understanding reasons for systematic non-compliance and may lead to changes in social mobilization strategies.

The study aims to identify the most effective approaches for case management and delivery of surgical services for IDPs and migrants suffering from LF and/or trachoma in security compromised areas. Barriers to reaching morbidity patients will be assessed, in addition to determinants of the institutionalizatoin of NTD morbidity management within the national health system. Research aims will be addressed through the following key activities: document review and direct inspection protocols to determine health facilities' ability to provide MMDP services; active case finding including creation of WhatsApp groups and SMS messaging to help keep track of patients and refer them to care; key informant interviews with health workers and community leaders to assess behavior change communication strategies for raising awareness among affected individuals; one-on-one interviews and focus group discussions with patients to understand barriers to care; and stakeholder engagement to increase buy-in and identify ways to operationalize MMDP services within national program.

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.

This study aims to integrate screening and preventive treatment with praziquantel for FGS into routine HIV and reproductive health care visits for women. A pilot study will be conducted in four health facilities with a target sample size of 4800 women over a six-month period. Trainings will be conducted for health workers and the team will use a participatory design process with key stakeholders to ensure that barriers to integration in the health system and community participation are addressed. A scale-up report will be written with stakeholder engagement and all training materials that were developed will be instantly available for use in other clinics in Cote d’Ivoire. Delivery of praziquantel to the four facilities in the pilot study will utilize existing drug-procurement and delivery systems to ensure sustainability.

Haiti, like many other countries, has made considerable progress in the elimination of lymphatic filariasis. To date, 118 out of 140 communes have passed TAS and stopped MDA. However, little is understood about why some communes have persistent transmission despite five or more rounds of MDA. The proposed study aims to identify alternative approaches to MDA that may help to increase access, uptake, and coverage, particularly for individuals who typically do not comply with MDAs. This cluster-randomized design will test a novel approach (door to door strategy) against the standard health post-based delivery method. Additionally, the study aims to identify non-compliant individuals and better understand their reasons for non-participation. Furthermore, a cost analysis will be undertaken as part of this study to understand the potential implications for the country program should the door-to-door strategy prove effective in reaching higher numbers of people.

To develop and pilot test an innovative standardized diagnostic algorithm for female genital schistosomiasis and other common causes of genital ulcerative and inflammatory disease that is feasible to use in Zambian government clinics

• Formative component: What is the capacity of the integrated morbidity management and disability prevention (MMDP) programme to incorporate a stigma reduction intervention for people with lower limb lymphoedema, and what are the barriers and facilitators to this?
• Intervention component: Is the stigma reduction intervention effective in increasing demand and access to services within an integrated MMDP programme for people with lower limb lymphoedema?

This study aims to understand and address several issues: lack of knowledge among health care workers (HCW) and community health workers (CHW) about FGS, knowledge and stigma at the community level, the potential for integrating FGS into existing sexual and reproductive health (SRH) education, and the potential for improving equity of MDAs for women of reproductive age.

Formative research will be used to develop HCW training modules, social mobilization and sensitization messaging, and to assess baseline knowledge. The team plans to conduct cross-sectional community surveys, focus groups with CHWs, and interviews with health workers that measure KAPs. In the intervention phase, the team plans to incorporate FGS material into existing SRH programs, including an online/social media platform used to teach teenage girls about HIV and STIs. They are also planning community outreach activities that coincide with the planned MDAs and are planning to field test the community-based drug delivery outlined in Kenya’s “Breaking Transmission” strategy. Testing and treatment for FGS will be improved at health facilities. Radio messaging using crafted behavior change messaging will be deployed.

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:

1. Development of a consortium on FGS bringing together high-profile researchers, policy makers, program implementers, and health professionals
2. 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.
3. Precision mapping in select districts to determine areas with the highest schistosomiasis prevalence through parasitological surveys
4. 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.

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.

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.

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).

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:

1. What is the impact of the blinding stage of trachoma (Trachomatous Trichiasis) on common mental disorders such as depression, anxiety and suicidality?
2. 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
3. What are the drivers for mental disorders in TT patients
4. 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.

Ghana aims to eliminate onchocerciasis by 2025. Currently, all data points for mass drug administrations are collected on paper. Paper-based data collection does not allow for rapid evaluation and course correction throughout the implementation of the MDA. This study proposes a collaboration between the monitoring and evaluation division of the Ghana Health Service and the Clinical Informatics Research Unit at the University of Southampton. The study aims to answer the primary research question: Can community-driven electronic data collection, and near real-time provision of source data and interactive visualizations better support decision-makers on approaches to evaluating and managing MDAs for onchocerciasis?

The success of MDA programs requires effective planning, community engagement, and delivery by community drug distributors. This proposal seeks to assess barriers and facilitators of effective coverage. Using in depth interviews, focus group discussions, and surveys, they will investigate factors related to acceptance, availability, and accessibility of MDA from the perspectives of drug distributors, healthcare workers, community leaders, the NTD program, and community members. Using the findings from the formative phase, an intervention package will be developed and implemented during MDA, followed by an evaluation of the impact of the intervention on coverage.

This project is part of a larger series of four studies that use a mixed methods approach to understand why particular districts that have undergone 5+ years of MDA are failing or are likely to fail transmission assessment surveys (TAS). Other studies include 169.1D Ghana, 169.2U Burkina Faso, and 177U Nepal. This study in Uttar Pradesh also provides a second opportunity to deploy the rapid ethnographic approach that will be first tested in Nepal. Team members from HERD Nepal will be traveling to India to train their team on the technique and assist with roll out.

To sustain the gains of active community drug distributors (CDDs) by enhancing their performance through intervention at the individual, community and primary health care center levels to reach NTD elimination and control goals.

To improve compliance and reduce the coverage-compliance gap in mass drug administration through enhanced and tailored social mobilization.

To analyze the relationships between the currently used indicator for impact assessments - prevalence of the clincial sign TF - and the prevalence of infection and antibody among 1-9 year old children in hyperendemic districts prior to mass drug administration

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.

Formative: What is the capacity of the Mozambican health system in general, and the NTD programme more specifically, to provide MMDP/DMDI services for people affected by leprosy, LF and konzo, and what are some of the barriers and facilitators to access these services?

Intervention: Which strategies are currently in place to provide quality healthcare for persons with disabilities, especially those that are caused by leprosy, LF and konzo, and how are MMDP/DMDI services organized vis-à-vis other disease control programs/health service delivery platforms?

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.

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?

What is the most appropriate method to evaluate the presence of W. bancrofti transmission in urban conurbations to establish if MDA is necessary for LF elimination?

To evaluate 3D photographs of trachomatous trichiasis (TT) in the training and assessment of trachoma graders.

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?

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.

To determine the viability of utilizing the polio program’s Vaccination Tracking System (VTS) to generate more accurate population, drug requirement and coverage estimates in NTD programs

To strengthen the capacity of the 5 African university departments hosting the Malaria Capacity Development Consortium (MCDC) programme

Helping increase and sustain the scale-up of preventive chemotherapy campaigns in West and Central Africa

Does community-based treatment of podoconiosis lymphoedema reduce the frequency of attacks of acute dermatolymphangioadenitis?

What are the most strategic approaches to building capacity for gender equity analysis in health systems?

What are the differences at 1 year post-baseline in the prevalence of trachoma and Ct infection in villages randomized to an enhanced antibiotic treatment regimen characterized by a routine community-wide MDA followed by two rounds of treatment targeted to children 6 months to 9 years in quick succession (1-2 weeks apart) compared to villages randomized to annual standard-of-care community-wide MDA?

What are the best approaches to develop sustainable and equitable approaches to human resources for health, health financing and governance in post conflict health systems?

Primary Research Question: What are the factors shaping the implementation of NTD control programme in Nigeria?

Secondary Research Questions: 

1. Does the DHIS2 tool provide a reliable estimate of treatment coverage?

2. What improvements or adaptations are required to the tool or processes around use of the tool? 

3. Can the tool be scaled up regardless of funder and location? 

4. Does the tool enhance government ownership of the data and the MDA programme in general?

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?

What is the comparative effect of enhancing the existing MMDP services with or without community-based components in significantly reducing the burden of Acute Attacks (AA), Hydrocele, and Mental Health (MH) issues among people affected by LF?

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?"

What is the effect of community health clubs on prevention and control of Schistosomiasis among fishing communities in Mayuge district?

1. What is the number of eligible SAC who were given, and who swallowed MEB/PZQ during the last MDA?
2. What is the number of eligible SAC that have never swallowed MEB/PZQ in the last three rounds of MDA?
3. Where are the eligible SAC who have never swallowed MEB/PZQ located?
4. What is the individual, social, cultural and health factors that interfere with MDA implementation?
5. What is the status of stress, anxiety, depression and motivation of health workers towards MDA, before and during the pandemic?
6. What are the challenges mitigating successful MDA implementation during the pandemic?
 

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?
 

1. What is the level of knowledge of lymphatic filariasis and its symptoms among refugees?
2. What is the prevalence of LF symptoms among refugees?
3. What are the explanatory factors for health care use among refugees?
4. What factors explain access to health care for lymphatic filariasis in refugees?
 

 i. To what extent has armed-conflict impacted treatment uptake (therapeutic coverage) for onchocerciasis in Benue and Taraba States?
ii. How can displaced community members still access and adhere to treatment uptake for onchocerciasis?
iii. What are the psychosocial services that can be provided to address traumatic experiences and facilitate uptake of treatment for onchocerciasis?
iv. What are the challenges that might hinder uptake of treatment and ways to improve it?

1- What is the effect of linking NTD control programs with traditional healers in an effort to detect additional cases of schistosomiasis, Onchocerciasis, and Lymphatic filariasis in two rural health districts in Cameroon: Bafia (Center region) and Bankim (Adamaoua region).
2- Will the traditional healers properly use the screening tools after training by NTD control program personnel?
3- Will the screening tools used by the traditional healers show clinical effectiveness so the prevalence of schistosomiasis, Onchocerciasis, and Lymphatic filariasis during our intervention?
 

Can OvMANE1 chimeric antigen specifically recognize O. volvulus antigens in human body fluids?

1. Can we identify and characterize protein-based biomarkers for schistosomiasis and schistosomiasis induced bladder pathologies using urine samples?

2. Can we identify urine antibodies to, or antigens of, S. bovis and determine their utility for diagnosis and risk of schistosomiasis haematobium and schistosomiasis-associated bladder pathologies?

3. Can we validate the identified biomarkers for consistency and reliability and inclusion in an RDT?

Will the rational selection of targets for onchocerciasis diagnosis lead to the generation of more robust, specific, and sensitive diagnostic tools?

How effective and reliable are aptamers when implemented in functional 3D µPAD, for a multiplex detection of malaria and schistosomiasis from blood samples?

1. What is the positivity rate of STH among pregnant mothers attending the ANC?
2. What is the difference in the STH burden in women who receive DOT and those who receive standard of care?
3. How acceptable is the DOT strategy in administering mebendazole among health care providers?
4. What is the information gap on STH preventive measures experienced by expectant mothers attending ANC clinics in Kilifi county?
 

- Can the co-endemicity of S. mansoni and S. haematobium in the north region of Cameroon induce a modification of the genetic structure of the parasites?
- Can the co-endemicity of S. mansoni and S. haematobium in the north region of Cameroon has an impact to the control of the disease through preventive chemotherapy?
 

1. Will the traps collect a similar daily number of host-seeking S.damnosum females than the HLC?
2. Will the physiological stage and infectivity rates of the blackflies collected by the traps be similar to those of the vector collectors?
3. Could the development of a standard and effective trap support the decision to stop MDAs by facilitating xenomonitoring of onchocerciasis?
 

We seek to find out if there are some specific miRNAs that are distinctive to FGS and could be used in prognosis and also grade the different stages of the disease progression.

1. Why are communities not accepting the intervention in spite of the presence of the infections in their communities?
2. What are the causes for lack of cooperation from school teachers, and how can these be addressed?
3. What are the factors responsible for lack of communication between the stakeholders responsible for integrated control programs in the state?
4. How are the health workers remunerated, and how can the remuneration be scaled-up to encourage their active participation and success of the program?
5. How can capacity for supervision, monitoring and evaluation of the integrated program be strengthened in the state?
 

1. What is the integrated knowledge of skin NTDs among affected and unaffected households in rural endemic communities?
2. What are community perceptions on stigma, stigma drivers and strategies to prevent stigma against women with skin NTDs in selected rural endemic communities?
3. How do women with skin NTDs cope with stigma in rural endemic communities?
4. What is the health service utilization patterns of women with skin NTDs in selected rural endemic communities?
5. What is the effect of community-level multi-component intervention on health seeking, de-stigmatization and social integration of women with skin NTDs in rural endemic communities?

1. What are the community health system barriers that affect the manner in which morbidity management and disability prevention services can be made accessible to hydrocele patients from migrant and mobile fishing populations?
2. What processes and actors at community level are crucial for the integration of morbidity management and disability prevention services so as to make them accessible to hydrocele patients from migrant and mobile fishing populations?
3. What community health system strategies can be used to increase the uptake of morbidity management and disability prevention services among hydrocele patients from migrant and mobile fishing populations?
 

1. What are the supply-side health systems enablers and constraints to equitable delivery of NTD program interventions for Onchocerciasis & LF in hard-to-reach rural areas?

2. Which demand-side (socioeconomic and disability status) factors hinder equitable access to NTD program interventions for Onchocerciasis & LF in hard-to-reach rural areas?

3. What is the prevalence of disability among health facility attendees vs. persons affected by NTDs within the community in hard-to-reach rural areas?

4. What factors hinder disability-inclusion for NTD program interventions for Onchocerciasis & LF in hard-to-reach rural areas?

1. What are the temporal trends in onchocerciasis in the study communities from the commencement of interventions until the interruption of CDTi due to COVID-19?
2. What is the impact of a 12-month interruption of CDTi on such trends?
3. What is the difference between the expected and empirical trends?
4. What are the best mitigation strategies and how can they safely be implemented to minimize the impact of the interruption and/or to accelerate progress towards EOT?
 

1.What are the perceptions of community members in school deworming exercise?
2. What are the operational difficulties health workers and teachers encounter in school deworming exercise?
3. What are the barriers affecting school deworming exercise among community members?
4. What strategies can be identified to improve coverage in school deworming exercise?
 

1. What are the roots of stigma and social isolation of people living with LF?
2. What are the perceptions of people unaffected with LF, community and religious leaders, and health workers in these communities about LF?
3. Will educational interventions using various media platforms contribute to alleviating the purported social isolation by LF patients?
 

What strategic innovative alternatives could be developed for the control of onchocerciasis?

1. Is the multiplex peptide microarray effective in diagnosing schistosomiasis, lymphatic filariasis, trachoma and the STHs (roundworm, whipworm and hookworm) in Zimbabwe?
2. Is the peptide microarray effective in screening Chagas disease, guinea worm disease, sleeping sickness and visceral leismaniasis?
 

1. Can Community-Led Total Sanitation (CLTS) and WASH improve the control of schistosomiasis and soil transmitted helminthiasis among school children in a rural area?

2. Can Community-Led Total Sanitation (CLTS) facilitate the achievement of open defecation free (ODF) status in a rural community which to improve the control of schistosomiasis and soil transmitted helminthiasis among school children in a rural area?
 

1. Which combination of clinical, demographical, and behavioral variables best predict urogenital schistosomiasis diagnosis in individuals living in communities around the Mapé dam?

2. How this combination of clinical, demographical, and behavioral variables can help to establish a diagnostic score for urogenital schistosomiasis diagnosis in individuals living in communities around the Mapé dam?
 

1. What social factors contribute to non-compliance in community directed treatment with Ivermectin?
2. Are there programmatic factors that can contribute for non-compliance and impact the program?
 

Can we identify diagnostic markers of Schistosoma mansoni in environmental water samples?

1. How sensitive and specific are the antigens in the urine of onchocerciasis patients?
2. What are the structures of the onchocerca specific antigens?
 

Does the SmCTF-RDT have high sensitivity to be potentially used in the screening, disease surveillance and routine diagnosis of schistosomiasis for people in co-endemic areas in Zambia?

Could the dynamics of schistosome populations be different in children subjected to MDA of PZQ and presenting different worm burdens?

1. What are the barriers and facilitators of access to Preventive Chemotherapy among the physically disabled in Osun State viz a viz tailor-made sensitization, mobilization, and proper drug distribution to meet their peculiarity?

2. What is the capacity of the health system and NTD programme of the state to provide these services?

3. What strategies can be adapted or developed to improve access to drugs among these demography?
 

1. What is the perception of Trachoma among women who refused to have the Trachoma Trichiasis surgery in North Pokot Sub County in West Pokot County, Kenya?

2. What are the social based barriers associated with Trachoma Trichiasis Surgery refusals among women in North Pokot Sub County of West Pokot County, Kenya?

3. What are the institutional based barriers associated with Trachoma Trichiasis Surgery refusals among women in North Pokot Sub County of West Pokot County, Kenya?
 

· Is LF associated with any disease related stress in affected Ghanaian communities?
· What are the predictors of LF related stress and depressive mental illness in LF endemic communities in Ghana?
· Is LF disease related stress independent of gender, disease stage, and age in affected Ghanaian communities?
· What is the impact of lymphatic filariasis on quality of life?
 

Will assessing key functions of the existing integrated disease surveillance and response systems improve neglected tropical diseases surveillance and response at the sub-national level in Kenya?

1. What cultural and household factors influence the uptake of PC among people living in selected communities?

2. How do the communities perceive or feel about the interventions they receive?

3. What are the barriers impeding the implementation of preventive chemotherapy for helminthic-NTDs in the study area?

4. What other health-service related factors affect the delivery of preventive chemotherapy intervention for helminthic-NTDs?

A formative study to quantify and describe implementation challenges in integrating NTD data into a data warehouse using the national DHIS2 platform and make recommendations for program improvements

To identify and describe multilevel barriers to equitable and effective implementation and delivery of Schistosomiasis interventions and make recommendations.

How could surveillance and treatment efforts be optimized to control and eliminate NTDs in Ghana?

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

What is the diagnostic potential of Ov-17-IRP and Ov-MANE-1 antigens for diagnosis of individual patients or for mapping or monitoring onchocerciasis elimination programs?

To determine the current prevalence and morbidity of Male Genital Schistosomiasis (MGS) due to S. haematobium and the potential risk of HIV transmission through viral load shedding in semen, particularly of fishermen in schistosomiasis-endemic areas along shores of Lake Malawi in Mangochi district.

Use of molecular xenomonitoring, an entomological method to assess the impact of MDA on LF transmission and characterize the vector role of mosquitoes in maintaining transmission in selected endemic areas in order to improve vector control strategies and reach elimination

1. What is the baseline prevalence of STH in the Baka community?
2. What is the level of knowledge of the Baka people with respect to STH
3. What is the impact of health education on reinfection rates and parasite loads of STHs in the Baka community?
 

To screen pregnant women visiting ANC for helminth infections.

Evaluate the field applicability of a real time Recombinase Polymerase Amplification assay for the rapid diagnosis of Schistosoma haematobium infection among school children in Ashanti region, Ghana
 

To assess equitable access to PCT distribution and use, identify its barriers and facilitators to recommend possible solutions for equitable access to PCT at South Omo, Southern Ethiopia

A field evaluation of urine dipstick developed for monitoring active onchocerciasis.
 

To assess the risk of emergence of schistosomiasis in the communities of indigenous people 8 years after modification of their environment for rubber cultivation in North of Gabon.
 

To what extent does stigma affect social participation and mental wellbeing among men and women affected/disabled by lymphatic filariasis or leprosy in Jaunpur in Uttar Pradesh and Bokaro in Bihar?