Implementation Science to Optimize Malaria Vector Control and Disease Management

描述（由申请人提供）：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%以上的死亡发生在撒哈拉以南非洲。有许多预防疟疾的战略，包括使用经杀虫剂处理的蚊帐和室内滞留喷洒以控制病媒，以及用于预防和治疗的各种诊断战略和药物疗法。然而，考虑到地方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，本提案的中心目标是通过将卫生服务实验和决策支持建模相结合的实施科学方法来改善疟疾控制结果，以促进媒介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)在坦桑尼亚开展媒介控制和疾病管理策略的随机实验，利用实施科学方法阐明哪些干预策略组合在现实环境中最有效；(2)利用卫生服务实验的分析见解，完善现有的包括病媒控制和疾病管理的决策支持模型；(3)制定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实施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取得持续成效。我们将根据现场试验，在一段时间内测试病媒和疾病管理干预措施不同组合的有效性。然后，我们将把实验结果与决策支持建模结合起来，改进一种新工具，使决策者能够共同优化病媒和疾病管理策略。该工具具有足够的灵活性，可以将开发出来的新疗法和干预措施纳入其中。该提案是在与坦桑尼亚重要合作伙伴的合作过程中制定的，因此利用了一套积极和充满活力的专业关系。通过这些国内伙伴关系，我们可以直接接触地方和国家两级的关键决策者。此外，我们之前在非洲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。

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. PUBLIC HEALTH RELEVANCE: Malaria is one of the greatest health challenges facing the developing world. This project evaluates malaria control interventions under real world conditions. By harnessing new insights from decision science and implementation science, we are helping decision-makers to jointly optimize vector and disease management strategies. In so doing, we will provide a clear mechanism for improving malaria outcomes.