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

摘要 疟疾仍然是最重要的全球健康挑战之一，估计有30亿人面临疟疾风险。 感染，每年导致大约2.5亿例病例和100万例死亡，其中大多数人 疾病负担集中在撒哈拉以南非洲。自2005年在乌干达成立以来，美国 总统疟疾倡议在扩大已证明有效的疟疾覆盖面方面非常成功 控制干预。尽管取得了这些进展，但乌干达的疟疾负担仍然很高， 发病率和死亡率下降的明显证据。仍然非常需要系统地 评估当前疟疾控制干预措施的有效性，并调查新的干预措施。的 拟议的计划旨在扩大疾病控制和预防中心的网络， 与各研究所合作，向目标非洲国家提供研究和技术援助， 特别注重研究，以推动疟疾控制工作。乌干达疟疾监测项目 （UMSP）成立于2001年，目的是建立一个多站点监测系统， 抗疟药物的功效和安全性、疟疾相关的发病率和死亡率，以及设施能力建设， （c）加强对疟疾的基础管理，目标是在疟疾控制方面取得可持续进展。响应 根据这一声明，UMSP提出了以下四项独立的研究，以帮助指导疟疾 乌干达的政策决策：1）我们将使用中断的时间序列进行干预研究 一项研究设计，旨在检验一套干预措施（包括实验室治疗） 决策，静脉注射青蒿琥酯，标准化的剂量和管理将改善患者的结果 与目前对患有复杂疟疾的住院儿童的做法相比。2)我们将进行临床 测定磺胺嘧啶-乙胺嘧啶（SP）清除无症状性 孕妇寄生虫血症作为评价间歇性预防治疗有效性的一种手段 怀孕期间的SP 3)我们将在乌干达的多个地点进行随机临床试验， 蒿甲醚-苯芴醇和双氢青蒿素-哌喹治疗糖尿病的有效性和安全性 单纯性恶性疟4)我们将前瞻性地评估重点疟疾防治的覆盖面 干预措施（包括驱虫蚊帐、杀虫剂室内滞留喷洒和青蒿素- 基于联合疗法），并测量疟疾传播、感染和疾病的指标， 乌干达的网站将使用统计技术来估计不断变化的 控制干预对我们结果的影响。

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.