Implementation Science to Optimize Malaria Vector Control and Disease Management

描述(申请人提供)：疟疾是发展中国家面临的最大健康挑战之一。世界卫生组织的数据表明，疟疾每年造成100多万人死亡，其中90%以上发生在撒哈拉以南非洲。现有许多预防疟疾的战略，包括使用驱虫蚊帐和室内滞留喷洒以控制病媒，以及各种诊断战略和药物疗法，用于预防和治疗。然而，考虑到当地卫生保健提供系统以及病媒控制基础设施的限制，决策者往往难以确定干预措施的最佳组合。因此，这项提议的中心目标是通过一种实施科学方法改善疟疾控制成果，这种方法将保健提供实验和决策支持建模结合起来，以促进病媒控制和疾病管理战略的联合优化。我们提出了三个具体目标：(1)在坦桑尼亚进行病媒控制和疾病管理策略的随机实验，以阐明哪些干预策略组合在现实世界环境中最有效，使用执行科学方法；(2)使用从卫生服务实验中获得的分析见解来完善现有的决策支持模型，其中包括病媒控制和疾病管理；以及(3)开发在坦桑尼亚其他地区和撒哈拉以南非洲其他国家复制决策支持工具的方法。实现这些综合的具体目标将为设计和执行多管齐下的疟疾控制战略提供一个框架，这些战略最有可能在业务环境中持续有效。我们将在现场实验的基础上，随着时间的推移测试媒介和疾病管理干预措施的不同组合的有效性。然后，我们将把实验结果与决策支持建模结合起来，以改进一种新的工具，使决策者能够联合优化媒介和疾病管理策略。该工具足够灵活，可以在开发新疗法和干预措施时纳入它们。这项建议是在与坦桑尼亚的关键合作伙伴合作过程中提出的，因此利用了一系列积极和充满活力的专业关系。通过这些国家内的伙伴关系，我们可以直接接触到地方和国家两级的关键决策者。此外，我们以前在非洲各地的工作提供了一个强大的平台，可以在主要研究地点以外的地区开展未来的复制工作。

DESCRIPTION (provided by applicant): Malaria is one of the greatest health challenges facing the developing world. World Health Organization data indicate that malaria causes over 1 million deaths per year, with over 90% of those deaths occurring in sub-Saharan Africa. A number of strategies are available to prevent malaria, including the use of insecticide treated nets and indoor residual spraying for vector control and a variety of diagnostic strategies and drug therapies for both prophylaxis and treatment. However, it is often difficult for decision-makers to determine the best combination of interventions, given the constraints within local health care delivery systems, as well as in vector control infrastructure. Thus, the central objective of this proposal is to improve malaria control outcomes through an implementation science approach that integrates health delivery experiments and decision support modeling to promote joint optimization of vector control and disease management strategies. We propose three specific aims: (1) perform randomized experiments of vector control and disease management strategies in Tanzania to elucidate which intervention strategy combinations are most effective in real world settings, using an implementation science approach; (2) use analytical insights from the health delivery experiments to refine an existing decision support model that includes both vector control and disease management; and (3) develop approaches for replicating the decision support tool in other parts of Tanzania and other countries in sub-Saharan Africa. Accomplishing these combined specific aims will provide a framework for designing and implementing multi-pronged malaria control strategies that have the best chances for sustained effectiveness in an operational setting. We will test the effectiveness of different combinations of vector and disease management interventions over time based on field experiments. We will then use the experimental results in conjunction with decision support modeling to improve a new tool that will allow decision-makers to jointly optimize vector and disease management strategies. The tool is flexible enough to incorporate new therapies and interventions as they are developed. This proposal has been developed in a collaborative process with critical partners in Tanzania and, thus, leverages an active and vibrant set of professional relationships. Through these in-country partnerships, we have direct access to key decision-makers at both the local and national levels. In addition, our previous work across Africa provides a strong platform from which to launch future replication in areas beyond the primary study site.