Evaluating Re-active Surveillance Strategies for Malaria Elimination in Swaziland

描述（由申请人提供）：我的目标是通过临床护理和以病人为导向的疟疾研究，改善儿童的健康，在儿科传染病方面有一个有价值的职业。我之所以被疟疾所吸引，是因为这种疾病给全球儿童带来了巨大的负担，也因为最近人们对消除疟疾的兴趣提出了一些令人兴奋的问题，即各国如何才能阻断传播。我对反应性监测特别感兴趣，这是一种策略，通过对指示病例周围的社区成员进行筛查，作为识别和瞄准持续传播的无症状携带者的一种方法。基于我的奖学金研究（重点是监测消除疟疾），并基于现有基础设施和与斯威士兰国家疟疾控制规划的合作，我提出以下具体目标：1)比较合并PCR与快速诊断试验（RDT）对疟疾继发感染的检测效果；2)在反应性监测中确定与继发感染检测相关的流行病学因素；3)利用RDT、PCR、流行病学数据和疟疾血清学建立预测热点位置的模型并进行测试。这些发现将有助于指导反应性监测的最佳做法，澄清应使用哪种诊断检测、何时调查指示病例以及在这些调查期间应筛查社区中的哪些人。改进对热点地区的预测还将使各国能够预测潜在的疫情，将有限的资源用于剩余的重点地区，并最终阻断疟疾传播。

DESCRIPTION (provided by applicant): My goal is to have a rewarding career in pediatric infectious diseases by improving the health of children through clinical care and patient oriented malaria research. I became drawn to malaria because of the tremendous global burden of this disease in children and because recent interest in malaria elimination has brought forth exciting questions on how countries can interrupt transmission. I am particularly interested in re-active surveillance, a strategy whereby community members around index cases are screened as a way to identify and target asymptomatic carriers that perpetuate transmission. Building on my fellowship research which focused on surveillance for malaria elimination, and building on existing infrastructure and collaboration with the Swaziland National Malaria Control Program, I propose the following specific aims: 1) Compare pooled PCR to rapid diagnostic test (RDT) for improved detection of secondary malaria infections, 2) Identify epidemiological factors associated with the detection of secondary infections in re-active surveillance, and 3) Build and test a model for predicting the location of hot spots utilizing RDT, PCR, epidemiological data, and malaria serology. These findings will help guide best practices for re-active surveillance, clarifying which diagnostic test to use, when to investigate an index case, and who in the community should be screened during these investigations. Improved prediction of hot spots will also enable countries to anticipate potential outbreaks, target limited resources to remaining foci, and ultimately interrupt malaria transmission. The proposed project will also enable me to collect the preliminary data necessary for a subsequent R01 submission to test the effectiveness of focal interventions targeting hot spots identified by these surveillance methods (e.g. screening and treatment, mass drug administration, or intensive indoor residual spraying). To perform these cluster-randomized clinical trials would be the culmination of many positive and productive research, programmatic, and clinical experiences that I have had in the past. However, in order to achieve this career goal and the aims of my K23, there are two major areas where I require additional training, mentoring, and experience: 1) Advanced skills in clinical and epidemiologic research, and 2) Expertise in malaria diagnostic and surveillance laboratory assays. In this proposal, I present a detailed career development plan that includes mentorship in these areas, a Master's in Clinical Research, and practical laboratory experience at UCSF and in Swaziland. The skills and experience acquired from this training will enable me to independently design a clinical trial and compete successfully for R01 funding. I have assembled a highly experienced and well-resourced mentorship team that is committed to the proposed project and my career development. Furthermore, I already have a track record of productivity with my mentors and collaborators. I have full and enthusiastic support from UCSF, my home institution, which has a rich and enduring tradition of excellence in biomedical science, clinical and translational research, and global health. The training and research opportunities available at UCSF and through my mentorship team will no doubt prepare me for a successful career as an independent malaria researcher, addressing clinical and epidemiologic challenges of malaria elimination, and ultimately contributing to improved health of children and larger populations currently threatened by malaria.