mework for Optimising Control at the Local Level: Coordinated strategies for Neglected Tropical Diseases and Malaria (FOCAL-NTD)

疾病控制规划需要了解目标疾病的地理分布，以便确定最需要控制干预措施的地方。在疾病风险在一个地理区域内大致恒定（即在空间上同质）的情况下，方案能够在人口中均匀地分配干预措施。然而，疾病风险往往变化很大（即空间异质性），特别是在寄生虫与人类宿主之间的关系取决于周围环境的寄生虫病情况下。在这些情况下，“一揽子”干预方法不足以从一个地区消除疾病，因为资源浪费在没有疾病风险的地区，并且没有充分集中精力完全消除疾病“热点”。这个项目的目的是制定一个框架，使疾病控制工作能够更有效地有针对性。除了考虑个别疾病外，该框架还将鼓励多种疾病共同流行地区的控制方案之间的协调，从而加速这些方案同时实现其控制/消除目标。该项目将重点关注三种被忽视的热带病和疟疾合并感染，以展示正在制定的框架的灵活性。这些被忽视的热带病是非洲人类锥虫病（HAT，由采采蝇传播）、血吸虫病（由中间宿主蜗牛在淡水中传播）和淋巴丝虫病（LF，由蚊子传播）。将利用来自流行国家（包括马拉维和乌干达）的项目合作者提供的数据绘制每一种疾病的地方一级风险地图。这些地图将把疾病/媒介/中间宿主信息与有关疾病的危险因素信息结合起来。地理参考风险因素可包括那些影响疾病病媒/中间宿主的存在和/或密度，或影响一个人与病媒/中间宿主接触的可能性的因素。以血吸虫病为例，这可能包括村庄到最近的淡水水源的距离、影响中间宿主/寄生虫生存和繁殖能力的因素（例如海拔、温度、植被）以及该地区已实施的控制活动的信息等因素。收集地方一级疾病风险数据的传统方法使用调查队收集信息，而在发展中国家的农村地区进行调查往往昂贵、耗时且后勤困难。除了根据以前收集的信息绘制风险图外，还将探索获取地方一级疾病相关数据的替代方法。将考虑两种方法。首先，将开发更有效的空间抽样方法，以确定应该调查哪些地点。这些方法将是“灵活的”，因为采样地点的选择将迭代地完成，并且将战略性地选择，以减少研究地区疾病风险估计地理分布的不确定性。第二种方法侧重于利用社区成员收集与疾病相关的信息，而不是专门的调查小组。社区成员越来越多地参与发展中国家的疾病控制活动，事实证明，这提高了干预措施的覆盖面和可接受性。该项目将探索社区成员如何通过开发基于移动电话的监测和报告工具，更直接地为疾病控制活动作出贡献。马拉维和乌干达的社区成员将接受培训，分别报告预防性治疗覆盖面（血吸虫病和血吸虫病）和病媒控制（疟疾和血吸虫病）等信息。

Disease control programmes require knowledge of the geographical distribution of the target disease in order to establish where control interventions are most needed. In instances where the disease risk is approximately constant across a geographical area (i.e. spatially homogeneous), programmes are able to evenly distribute interventions amongst the population. However, disease risk can often be very variable (i.e. spatially heterogeneous), particularly in the case of parasitic diseases in which the relationship between the parasite and the human host is dependent on the surrounding environment. In these instances a 'blanket' intervention approach isn't sufficient to eliminate a disease from an area, as resources are wasted in areas where there is no disease risk, and are not adequately focused to completely remove disease 'hotspots'. The aim of this project is to develop a framework that enables disease control efforts to be targeted more effectively. In addition to considering individual diseases, the framework will encourage coordination between control programmes in areas where multiple diseases are co-endemic, thus accelerating these programmes simultaneously towards their control/elimination goals. This project will focus on three neglected tropical diseases (NTDs) and coinfections with malaria in order to demonstrate the flexibility of the framework being developed. These NTDs are Human African Trypanosomiasis (HAT, transmitted by tsetse flies) schistosomiasis (transmitted in freshwater by an intermediate host snail) and lymphatic filariasis (LF, transmitted by mosquitoes). Local level risk maps for each of these diseases will be produced using data provided by project collaborators from endemic countries, including Malawi and Uganda. These maps will combine disease/vector/intermediate host information with information on the risk factors of the diseases in question. Geographically referenced risk factors could include those that influence the presence and/or density of the disease's vector/intermediate host, or influence how likely a person is to come into contact with the vector/intermediate host. Using the example of schistosomiasis, this may include factors such as the distance of the village to the nearest freshwater source, factors influencing the intermediate host/parasite ability to survive and breed (e.g. altitude, temperature, vegetation) and information on control activities have been implemented in the area. Traditional methods of collecting local level disease risk data use survey teams to collect information, with surveys often being expensive, time-consuming and logistically difficult to undertake in rural areas of developing countries. In addition to developing risk maps based on previously collected information, alternative methods for obtaining local level disease-related data will be explored. Two approaches will be considered. Firstly, more efficient spatial sampling methods for determining which sites should be surveyed will be developed. These methods will be 'flexible' in the sense that the selection of sites to sample will be done iteratively, and will be selected strategically in order to reduce the uncertainty in the estimated geographical distribution of disease risk in the study area. The second approach focuses on using community members to collect disease-related information, as opposed to a dedicated survey team. Community members are becoming increasingly involved in disease control activities in developing countries, and this has been shown to improve intervention coverage and acceptability. This project will explore ways in which community members can more directly contribute to disease control activities through the development of mobile phone-based surveillance and reporting tools. Community members in Malawi and Uganda will be trained to report information such as preventive therapy coverage (for schistosomiasis and LF) and vector control (malaria and HAT) respectively.