Research Activities in Support of Malaria Prevention and Control in Uganda (PMI)

摘要 疟疾仍然是最重要的全球卫生挑战之一，估计有30亿人面临疟疾的风险。 感染，每年导致约2.5亿病例和100万人死亡，其中大部分 疾病负担集中在撒哈拉以南非洲。自2005年在乌干达成立以来，美国 总统的疟疾倡议在扩大已证实有效的疟疾的覆盖面方面取得了巨大的成功 控制干预措施。尽管有这些改进，但乌干达的疟疾负担仍然很重，没有 这是发病率和死亡率下降的明显证据。仍然非常需要有系统地 评估当前疟疾控制干预措施的有效性，并调查新的干预措施。这个 拟议的计划旨在扩大疾病控制和预防中心的网络 向目标非洲国家提供研究和技术援助的合作机构， 特别注重推进疟疾控制工作的研究。乌干达疟疾监测项目 (UMSP)成立于2001年，目的是建立一个多地点监测系统 抗疟疾药物的疗效和安全性、与疟疾有关的发病率和死亡率，以及设施建设-- 以疟疾管理为基础，目标是在疟疾控制方面取得可持续进展。作为回应 对于这一声明，UMSP建议进行以下四项独立的研究，以帮助指导疟疾 乌干达的政策决策：1)我们将使用中断的时间序列进行干预研究 研究设计以检验一系列干预措施包括基于实验室的治疗这一假设 决策、静脉注射青蒿琥酯以及标准化剂量和给药将改善患者的预后 与目前对患有复杂疟疾住院的儿童的做法相比。2)我们将进行一次临床 磺胺多辛体内清除无症状疗效的实验研究 孕妇寄生虫血症作为评估间歇预防性治疗效果的手段 怀有SP的孕妇。3)我们将在乌干达的多个地点进行随机临床试验，以比较 蒿甲醚-鲁米芬净和双氢青蒿素-哌喹治疗慢性阻塞性肺疾病的疗效和安全性 不复杂的恶性疟疾。4)我们将前瞻性地评估重点疟疾控制的覆盖率 干预措施(包括杀虫剂处理的蚊帐、室内残留喷洒杀虫剂和青蒿素-- 基于联合疗法)和测量疟疾传播、感染和疾病的多个指标 乌干达的网站。统计技术将被用来估计变化的覆盖水平的影响 对我们的结果衡量标准进行控制干预。

Abstract Malaria remains one of the most important global health challenges, with an estimated 3 billion people at risk of infection, leading to approximately 250 million cases and 1 million deaths each year, with a majority of the disease burden concentrated in sub-Saharan Africa. Since its establishment in Uganda in 2005, the U.S. President's Malaria Initiative has been highly successful in expanding the coverage of proven effective malaria control interventions. Despite these improvements, the burden of malaria remains very high in Uganda with no clear evidence of reductions in morbidity and mortality. There remains a great need to systematically evaluative the effectiveness of current malaria control interventions and investigate new interventions. The proposed program is intended to expand the Centers for Disease Control and Prevention network of collaborating institutes for both research and technical assistance to targeted African countries, with a particular focus on research to advance malaria control efforts. The Uganda Malaria Surveillance Project (UMSP) was established in 2001 with the purpose of creating a multi-site surveillance system for monitoring antimalarial drug efficacy and safety, malaria related morbidity and mortality, and building capacity for facility- based management of malaria with the goal of providing sustainable progress in malaria control. In response to this announcement, UMSP is proposing the following four separate research studies to help guide malaria policy decision making in Uganda: 1) We will perform an intervention study using an interrupted time series study design to test the hypothesis that a package of interventions including laboratory-based treatment decision making, IV artesunate, and standardized dosing and administration will improve patient outcomes compared to current practices for children hospitalized with complicated malaria. 2) We will perform a clinical trial to measure the in vivo efficacy of sulfadoxine-pyrimethamine (SP) for the clearance of asymptomatic parasitemia in pregnant women as a means of evaluating the effectiveness of intermittent preventive therapy with SP in pregnancy. 3) We will perform randomized clinical trials at multiple sites in Uganda to compare the efficacy and safety of artemether-lumefantrine and dihydroartemisinin-piperaquine for the treatment of uncomplicated falciparum malaria. 4) We will prospectively assess the coverage of key malaria control interventions (including insecticide treated bed nets, indoor residual spraying of insecticide, and artemisinin- based combination therapy) and measure metrics of malaria transmission, infection, and disease at multiple sites in Uganda. Statistical techniques will be used to estimate the impact of changing coverage levels of control interventions on our outcome measures.