Operationalizing One Health Interventions in Tanzania

地方性牲畜人畜共患病是造成人类发热性疾病和牲畜生产力损失的重要原因。尽管这类疾病在低收入和中等收入国家具有重大的社会影响，但仍被广泛忽视。虽然这些感染中有许多是可以治疗的，但缺乏强有力的诊断检测意味着许多病例仍未得到诊断，这也限制了获得有效治疗的机会。此外，预防和控制措施往往具有挑战性，因为这些疾病跨越人类和动物种群。该建议旨在解决设计和开发干预措施以减轻人畜共患疾病影响的几个现有障碍和制约因素，重点关注可能产生即时和长期影响的干预措施领域。我们的项目将侧重于同一健康干预研究的关键领域，以便在坦桑尼亚贫穷的牲畜饲养社区预防和控制人畜共患疾病：(i)通过医疗部门提供干预措施，以改善人畜共患疾病病例的临床管理；以社区为主导的方法，制定潜在的行为和牲畜管理干预措施；（三）兽医服务提供者可实施的控制动物种群感染的干预措施。该项目直接建立在坦桑尼亚早期ZELS研究的基础上，这些研究已显示出明显的应用潜力和影响。我们的研究将集中在畜牧业社区，这些社区人畜共患病感染风险最大，人畜共患病干预可能产生最大的社会和经济影响。先前的研究还表明，小型反刍动物（山羊和绵羊）的发病率高于牛。因此，对于动物干预措施，我们将集中精力建立针对小型反刍动物及其相关传播途径的干预能力。这项工作将涉及相关的研究活动，以制定针对布鲁氏菌病和Q热（由伯纳氏克希菌感染引起）的疾病特异性干预措施，以及有可能减少多种病原体影响的社区主导战略。医疗部门的干预措施将解决发热性疾病人畜共患原因误诊的普遍问题。研究将包括验证现有的人类布鲁氏菌病诊断测试，作为在坦桑尼亚全国推广的第一步，并开展一项卫生保健利用情况调查，以对牧区的卫生保健可用性作出可靠的估计。这些研究活动的明确目的是支持坦桑尼亚布鲁氏菌病控制国家战略的制定。以社区为基础的活动将涉及新颖的参与性行动研究，使社区共同研究人员与学术研究人员一起制定和实施减少传染病风险的行为干预措施。动物干预措施将侧重于伯纳蒂胞杆菌疫苗试验，以调查在流行环境中减少当地品种山羊的病毒脱落的安全性和有效性。这项研究将产生关于脱落和感染模式的基线纵向研究，这将为传播模型的开发提供信息，并将与经济模型相结合，以评估一系列潜在的干预策略。除了开发针对特定病原体的干预措施外，我们的研究活动还将有助于加强“同一个健康”干预措施的跨学科能力，这些干预措施可应用于更广泛的人畜共患病。我们与总理办公室的坦桑尼亚“一种健康”协调台的伙伴关系将确保这项研究的结果将通过一系列利益攸关方讲习班直接为坦桑尼亚“一种健康”战略计划提供信息，以支持知识交流和与决策者的有效沟通。

Endemic livestock zoonoses are important causes of human febrile illness and livestock productivity losses. Despite having major societal impacts in low- and middle-income countries, this group of diseases remains widely neglected. Although many of these infections can be treated, a lack of access to robust diagnostic tests means that many cases remain undiagnosed, which also limits access to effective treatment. Furthermore, prevention and control measures are often challenging as these diseases span both human and animal populations. This proposal aims to address several existing barriers and constraints to the design and development of interventions to mitigate zoonotic disease impact, focussing on areas of interventions that have the potential for both immediate and longer-term impact. Our project will focus on key areas of One Health intervention research to prevent and control zoonotic diseases in poor livestock-keeping communities in Tanzania: (i) interventions delivered through the medical sector to improve clinical management of cases of human zoonotic diseases; (ii) community-led approaches to develop potential behavioural and livestock management interventions; and (iii) interventions to control infection in animal populations that could be implemented by veterinary service providers. The project builds directly from earlier ZELS research in Tanzania that have demonstrated clear potential for application and impact. Our research will focus in pastoral livestock-keeping communities, which have the greatest risk of zoonotic infections and where the greatest social and economic impact of zoonoses interventions is likely to be. Previous research has also demonstrated that rates of disease are higher for small ruminants (goats and sheep) than cattle. Therefore, for animal interventions, we will concentrate on establishing capacity for interventions targeted at small ruminants and associated transmission pathways.The work will involve linked research activities to develop disease-specific interventions against brucellosis and Q fever (caused by infection with Coxiella burnetii), alongside community-led strategies that have potential to reduce impacts across multiple pathogens. Medical-sector interventions will address the common problem of mis-diagnosis of zoonotic causes of febrile illness. Research will involve verification of existing human brucellosis diagnostic tests as a first step towards roll out across Tanzania and a healthcare utilisation survey to generate robust estimates of healthcare availability in pastoral areas. These research activities are explicitly designed to support the development of the National Strategy for Brucellosis Control in Tanzania. Community-based activities will involve novel participatory action research that engages community co-researchers alongside academic researchers to develop and implement behavioural interventions to reduce infectious disease risks. Animal interventions will focus on a C. burnetii vaccine trial to investigate safety and effectiveness at reducing shedding in local-breed goats in endemic settings. This study will generate baseline longitudinal on shedding and infection patterns that will inform development of transmission models and will be integrated with economic models to evaluate a range of potential intervention strategies. In addition to developing pathogen-specific interventions, our research activities will contribute to strengthening interdisciplinary capacity for One Health interventions that can be applied to a wider range of zoonoses. Our partnership with the Tanzanian One Health Coordination Desk (OHCD) in the Prime Minister's Office will ensure that the findings from this research will directly inform the Tanzanian One Health Strategic Plan through a series of stakeholder workshops to support knowledge exchange and effective communication with policymakers.