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

疟疾仍然是最重要的全球健康挑战之一，估计有30亿人处于感染风险中，每年导致约2.5亿例病例和100万例死亡，其中大部分疾病负担集中在撒哈拉以南非洲。自2005年在乌干达设立以来，美国总统疟疾倡议在扩大已证明有效的疟疾控制干预措施的覆盖面方面取得了巨大成功。尽管取得了这些进展，但乌干达的疟疾负担仍然很重，没有明显证据表明发病率和死亡率有所下降。仍然非常需要系统地评价当前疟疾控制干预措施的有效性，并调查新的干预措施。拟议的方案旨在扩大疾病控制和预防中心的合作机构网络，向目标非洲国家提供研究和技术援助，特别侧重于促进疟疾控制工作的研究。乌干达疟疾监测项目于2001年设立，目的是建立一个多地点监测系统，监测抗疟药物的效力和安全性、与疟疾有关的发病率和死亡率，并建设以设施为基础的疟疾管理能力，以便在疟疾控制方面取得可持续的进展。作为对这一宣布的回应，UMSP提议进行以下四项独立的研究，以帮助指导乌干达的疟疾政策决策：1）我们将使用中断时间序列研究设计进行干预研究，以检验一系列干预措施（包括基于实验室的治疗决策，静脉注射青蒿琥酯，与目前对因复杂疟疾住院的儿童的做法相比，标准化的剂量和管理将改善患者的预后。2)我们将进行一项临床试验，以测量磺胺嘧啶-乙胺嘧啶（SP）清除孕妇无症状寄生虫血症的体内疗效，作为评估妊娠期SP间歇性预防性治疗有效性的一种手段。3)我们将在乌干达的多个地点进行随机临床试验，比较蒿甲醚-苯芴醇和双氢青蒿素-哌喹治疗无并发症恶性疟疾的疗效和安全性。4)我们将前瞻性地评估关键疟疾控制干预措施的覆盖范围（包括经杀虫剂处理的蚊帐、杀虫剂室内滞留喷洒和青蒿素类复方疗法），并衡量乌干达多个地点的疟疾传播、感染和疾病指标。统计技术将被用来估计不断变化的控制干预措施的覆盖水平对我们的成果措施的影响。 公共卫生相关性：这项建议的目的是进行一系列研究，以评价乌干达目前使用的各种疟疾预防和控制干预措施的效力和效果。预计这些研究的结果将有助于指导疟疾政策决策，并最大限度地发挥疟疾预防和控制干预措施的影响。

DESCRIPTION (provided by applicant): 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. PUBLIC HEALTH RELEVANCE: The purpose of this proposal is to conduct a series of research studies to evaluate the efficacy and effectiveness of various malaria prevention and control interventions currently in use in Uganda. It is anticipated that the results of these studies will help guide malaria policy decision making and maximize the impact of malaria prevention and control interventions.