Integrated Primary Prevention & Chemotherapy: Urogenital Schistosomiasis Control

描述（由申请人提供）：泌尿生殖道血吸虫病（UGS）是一种寄生虫感染，影响超过1.1亿人，其中300万人生活在加纳。尽管大规模药物管理（MDA），流行率仍然很高。MDA没有解决环境暴露于寄生虫或在缺乏水和卫生基础设施的情况下发生的危险行为的问题;因此，MDA无法将患病率降低到5- 15%以下。迫切需要破坏多宿主病毒生命周期的策略，从而防止再感染。我们的目标是开发一套公共卫生工程干预措施，通过结合水基础设施、教育和化疗来中断寄生虫排泄、水污染和感染，从而降低撒哈拉以南非洲农村地区的血吸虫感染发病率。我们将确定安装威尔斯和水上娱乐区，结合教育和化疗，对加纳8个农村城镇的艾滋病感染率的影响，并与4个没有任何基础设施的对照城镇进行比较。我们的中心假设是，这种干预措施的组合将显着 与单独化疗相比，减少了感染。临床试验的基本原理是，一旦疗效得到证明，我们的计划可以扩大到区域和国家规模。鉴于我们关于工程基础设施的好处的强有力的初步数据，我们的假设将通过追求四个具体目标来检验：（1）测量S的横截面患病率。第0年（基线）的血吸虫感染;（2）测量S.（3）评估每项单独控制措施的成本效益;（4）进行年度知识、态度和实践（KAP）调查，以确定在有和没有干预措施的情况下影响行为改变的具体因素。我们期待S。通过一揽子干预措施，解决反复暴露于有害物质的问题，使每年的嗜血杆菌发病率< 1%。我们的项目是创新的，因为它将导致在西非农村社区一级可持续的感染初级预防。我们的研究是重要的，因为它将量化和文件的好处，累积作为一个全面的，综合的方法来预防UGS，这应该增加社区和国家愿意采取和维持这一揽子干预措施的结果。

DESCRIPTION (provided by applicant): Urogenital schistosomiasis (UGS) is a parasitic infection that afflicts >110 million people, 3 million of whom live in Ghana. Prevalence remains high despite mass drug administration (MDA). MDA does not address the issues of environmental exposure to the parasite or risky behaviors that occur in the absence of water and sanitation infrastructure; thus, MDA is unable to reduce prevalence below 5-15%. There is a critical need for strategies that disrupt the multi-host schistosome lifecycle and thereby prevent reinfection. Our goal is to develop a public health engineering intervention package that reduces the incidence of Schistosoma haematobium infection in rural sub-Saharan Africa by combining water infrastructure, education and chemotherapy to interrupt parasite excretion, water contamination, and infection acquisition. We will determine the effect of installing wells and water recreation areas, combined with education and chemotherapy, on the rate of schistosome infection in 8 rural Ghanaian towns as compared with 4 control towns that will not receive any infrastructure. Our central hypothesis is that this combination of interventions will significantly reduce schistosome infection compared to chemotherapy alone. The rationale for the clinical trial is that, once efficacy is demonstrated, our program can be expanded to the regional and national scale. Given our strong preliminary data regarding the benefits of engineered infrastructure, our hypothesis will be tested by pursuing four specific aims: (1) measure the cross-sectional prevalence of S. haematobium infection in year 0 (baseline); (2) measure the incidence of infection with S. haematobium in the presence of various control measures (infrastructure, chemotherapy, education); (3) Assess the cost-effectiveness of each individual control measure; and (4) conduct annual knowledge, attitudes, and practices (KAP) surveys to identify specific factors that influence behavior change in the presence and absence of interventions. We expect S. haematobium incidence to be < 1% per year through a package of interventions that address the issue of repeated schistosome exposure. Our project is innovative, as it will lead to the sustainable primary prevention of infection at the community scale in rural West Africa. Our research is significant because it will quantify and document benefits that accrue as a result of a comprehensive, integrated approach to UGS prevention, which should increase communal and national willingness to adopt and sustain this package of interventions.