Implementation of ring strategy for community-engaged control of neurocysticercosis

项目总结 脑囊虫病(NCC)是一种常见的神经系统疾病，是人类可预防的癫痫的主要原因之一。 亚洲、非洲和拉丁美洲。它是由中枢神经感染猪带绦虫(猪肉 绦虫)。虽然最近在制定控制措施方面取得了很大进展 在传播方面，这些战略的程序性采用已经远远落后。迫切需要 进行合理的执行研究，以确保采取最有效和最实际的战略。完毕 在过去的7年里，我们开发、优化和测试了一种名为环治疗的有针对性的方法，该方法需要 这种人畜共患疾病的人和猪宿主之间具有很强的空间聚集性。监视 以及检测猪的感染(囊虫病)，这种感染在屠宰时出现在肉中，在猪的舌头中可见 生猪，导致附近家庭治疗带绦虫病(人类肠道感染)。该策略提供了一种 一种简单实用的监测方法，能够有效地治疗那些有最高风险的人 感染了带绦虫病。在两年多的头对头随机分组试验中，环治疗实现了 减少寄生虫传播的稳健水平与大规模治疗相同(69.3%比64.7%， )，但只使用了药物的一小部分(1791剂对11,186剂)。然而，一些人 环处理仍然存在必须解决的障碍，才能采用控制程序。 在这个为期5年的项目中，我们使用实施研究综合框架(CFIR)来开发 可采用的环处理方法作为小麦白粉菌的控制程序。我们首先使用形成性评价 利益相关者制定干预协议，然后通过与Iteration进行的试点研究来完善这些协议 评估。然后，我们将环状治疗的实施评估为政府运营和社区参与 遵循CRE-AIM框架(成本、覆盖范围、采用、实施和 维护)。我们还评估了整合一种新的尿液筛查方法的实用性和有效性 囊虫病环状治疗干预。最后，我们给出了一系列教学和应用的实现 为受训人员提供研究培训机会，以提高秘鲁实施研究的能力。

PROJECT SUMMARY Neurocysticercosis (NCC) is a common neurologic disease and a leading cause of preventable epilepsy in Asia, Africa, and Latin America. It is caused by central nervous infection with Taenia solium (the pork tapeworm). While there has been considerable recent progress in developing interventions to control transmission, programmatic adoption of these strategies has lagged far behind. There is an urgent need for sound implementation research to ensure that the most effective and practical strategies can be adopted. Over the past 7 years we developed, optimized, and tested a targeted approach known as ring treatment that takes advantage of the strong spatial clustering between human and pig hosts of this zoonotic disease. Surveillance and detection of pig infection (cysticercosis), which is visible in meat at time of slaughter and in the tongues of live pigs, leads to treatment for taeniasis (human intestinal infection) in nearby homes. This strategy provides a simple and practical method for surveillance leading to efficient treatment of those humans at highest risk of being infected with taeniasis. In a head-to-head cluster randomized trial over 2 years, ring treatment achieved the same robust level of reduced parasite transmission as mass treatment (69.3% vs. 64.7% reduction, respectively) but did so using only a small fraction of the drug (1791 vs. 11,186 doses). However, a number of barriers exist that must still be solved for ring treatment to adopted a control program. In this 5-year project, we use the Consolidated Framework for Implementation Research (CFIR) to develop an adoptable approach for ring treatment as a control program for T. solium. We first use formative evaluation with stakeholders to develop intervention protocols, then refine these protocols through a pilot study with iterative evaluation. We then evaluate ring treatment implementation as a government run and community-engaged program in a 3 year trial, following the cRE-AIM framework (cost, reach, adoption, implementation, and maintenance). We also evaluate the utility and effectiveness of integrating a new urine screening assay for cysticercosis in ring treatment intervention. Finally, we provide a series of didactic and applied implementation research training opportunities for trainees to advance capacity for implementation research in Peru.