Development and validation of an agent-based model to promote evidence-based control of Taenia solium cysticercosis

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PROJECT SUMMARY Taenia solium, the pork tapeworm, is a leading cause of acquired epilepsy in low and middle income countries. Endemic transmission occurs primarily in rural areas where pigs are allowed to roam freely and consume human feces. Control and/or elimination of T. solium transmission is possible through application of anti-parasitic treatment to human tapeworm carriers or pigs, vaccination of pigs, or other social-behavioral interventions (e.g., sanitation, corralling). The critical question that policy-makers now face is which intervention strategies should be recommended for different endemic settings – specifically, what intervention combinations, frequencies, durations, and target populations are optimal for achieving a given control outcome? Infectious disease models are excellent tools for answering these questions, as they can be deployed to test a wide range of strategies in a variety of settings prior to investing massive resources in prospective trials. While prior models for T. solium transmission have been previously developed, no existing model has been validated with data from prospective trials, and none incorporate a spatial framework that can account for clustered transmission patterns observed in endemic areas. These limitations have severely limited the utility of prior models. This proposal specifically addresses these limitations to ensure that the delivered model can be directly applied to improve control and elimination for T. solium. The objective of the proposed research is to develop a definitive T. solium simulation model called CystiMASON, which will build on our group’s prior modeling experience (CystiSim and CystiAgent models), and address the shortcomings of previous T. solium models. To achieve this goal, we propose a series of field and laboratory experiments that will define environmental and biological parameters critical to CystiMASON accuracy (Aim 1). These experiments will increase the precision of model parameters and reduce uncertainty in model outcomes. As data from these studies are generated, they will be integrated into the successive version of CystiMASON, which will be calibrated and validated using a repository of data from prospective trials conducted in Peru (Aim 2). Finally, we will use data available from prospective trials conducted in Zambia to validate CystiMASON to a sub-Saharan African setting and compare the accuracy of CyistMASON in this endemic setting with other available models (Aim 3). After the completion of this research, the final CystiMASON model will be a key resource for policy-makers who seek to evaluate strategies for the control or elimination of cysticercosis in Latin America and sub-Saharan Africa.