Evaluating Re-active Surveillance Strategies for Malaria Elimination in Swaziland

评估斯威士兰消除疟疾的反应性监测策略

• 批准号: 8662187
• 负责人: Michelle Sang Hsiang
• 金额: $ 13.15万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-06-01 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8662187
• 关键词: Address; Antibodies; Antigens; Antimalarials; Area; Biological Assay; Blood; Case Study; Child; Child health care; Childhood; Clinical; Clinical Research; Clinical Trials; Collaborations; Commit; Communicable Diseases; Communities; Country; Data; Detection; Development Plans; Diagnostic; Diagnostic tests; Disease; Disease Outbreaks; Effectiveness; Enzyme-Linked Immunosorbent Assay; Epidemiologic Studies; Epidemiological Factors; Epidemiology; Fellowship; Funding; Future; Goals; Health care facility; Home environment; Hot Spot; Infection; Institution; Intervention; Investigation; Laboratories; Location; Malaria; Measures; Mentors; Mentorship; Microscopy; Modeling; Parasites; Pharmaceutical Preparations; Plasmodium falciparum; Population; Prevalence; Probability; Productivity; Public Health; Questionnaires; Randomized Clinical Trials; Research; Research Infrastructure; Research Personnel; Research Training; Residual state; Resources; Rewards; Risk; Risk Factors; Science; Serologic tests; Southern Africa; Spottings; Surface Antigens; Surveillance Methods; Surveillance Program; Swaziland; Testing; Time; Training; Translational Research; Travel; Uncertainty; base; burden of illness; career; career development; clinical care; density; design; effective intervention; experience; global health; high risk; improved; indexing; interest; member; novel; patient oriented; programs; response; scale up; screening; secondary infection; skills; surveillance data; surveillance strategy; transmission process

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.

描述（由申请人提供）：我的目标是通过临床护理和以患者为导向的疟疾研究来改善儿童的健康，从而在儿科传染病领域拥有一份有价值的职业。我之所以对疟疾感兴趣，是因为这种疾病给全球儿童带来了巨大的负担，而且最近对消除疟疾的兴趣引发了关于各国如何阻止传播的令人兴奋的问题。我对反应性监测特别感兴趣，这是一种对指示病例周围的社区成员进行筛查的策略，以此来识别和针对使传播永久化的无症状携带者。基于我的奖学金研究，重点是监测消除疟疾，并以现有基础设施和与斯威士兰国家疟疾控制计划的合作为基础，我提出了以下具体目标：1) 将聚合 PCR 与快速诊断测试 (RDT) 进行比较，以改进继发性疟疾感染的检测，2) 确定与检测反应性疟疾继发感染相关的流行病学因素。 监测；3) 建立并测试利用 RDT、PCR、流行病学数据和疟疾血清学预测热点位置的模型。这些发现将有助于指导反应性监测的最佳实践，阐明使用哪种诊断测试、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。改进热点预测还将使各国能够预测潜在的疫情爆发，将有限的资源用于剩余的疫源地，并最终阻断疟疾传播。 拟议的项目还将使我能够收集后续 R01 提交所需的初步数据，以测试针对这些监测方法（例如筛查和治疗、大规模药物管理或密集室内滞留喷洒）确定的热点的重点干预措施的有效性。进行这些整群随机临床试验将是我过去所拥有的许多积极且富有成效的研究、计划和临床经验的结晶。然而，为了实现这一职业目标和我的 K23 目标，我需要在两个主要领域进行额外的培训、指导和经验：1) 临床和流行病学研究方面的高级技能，2) 疟疾诊断和监测实验室检测方面的专业知识。在这份提案中，我提出了一份详细的职业发展计划，其中包括这些领域的指导、临床研究硕士学位以及加州大学旧金山分校和斯威士兰的实际实验室经验。从这次培训中获得的技能和经验将使我能够独立设计临床试验并成功竞争R01资助。 我组建了一支经验丰富、资源充足的导师团队，致力于拟议的项目和我的职业发展。此外，我已经与我的导师和合作者建立了生产力记录。我得到了我的家乡加州大学旧金山分校的全力和热情支持，该机构在生物医学科学、临床和转化研究以及全球健康方面拥有丰富而持久的卓越传统。加州大学旧金山分校以及我的导师团队提供的培训和研究机会无疑将为我作为一名独立疟疾研究员的成功职业生涯做好准备，解决消除疟疾的临床和流行病学挑战，并最终为改善目前受到疟疾威胁的儿童和更多人口的健康做出贡献。