Identifying gaps between LLIN use and vector exposure to improve malaria control

项目摘要/摘要 疟疾影响着全球30亿人。尽管疟疾发病率在过去的几年里显著下降 15年来，最近的证据表明，我们传统的控制工具正在减弱。经处理的长效杀虫剂 蚊帐(LLIN)是最广泛使用的预防疟疾的工具，并为降低疟疾发病率做出了重大贡献，但最近的研究表明，LLIN的效果要么不如以前，要么不如人 没有像报道的那样使用它们。严格评估媒介暴露的时间和地点如何与实际使用LLIN相交，对于重新掌握疟疾控制的主动权至关重要。然而， 缺乏LLIN使用的可靠衡量标准是一个重大挑战。当前的测量工具，如自我报告 使用，是主观的，无法解释使用中的时间变化。为了解决这些限制，我发明了 LLIN使用的电子监控器。SMARTnet使用标准LLIN中嵌入的传感器来持续评估 它是否以98%的准确率展开。我们已经完成了成功的可行性、可接受性和现场试验 智能网络。这一项目主要理由是持续监测联合使用的各个LLIN 通过量化暴露于疟疾，病媒将允许进行比以前更可靠的分析 LLIN如何在实践中减少媒介暴露。这项K23方案的研究目标是发展高产 改善疟疾控制的干预措施--确定个人接触媒介的风险与 个人使用LLIN。为了促进这项工作，我可以接触到乌干达480人的纵向队列。 我们的方法利用了这个队列中每两周收集一次的密集昆虫学监测。此外，我们将在每个睡眠空间部署智能网络，以覆盖多个 好几年了。将通过追求三个具体目标来确定高产干预措施：1)量化疟疾风险暴露 向量并确定与较高风险相关的因素；2)量化LLIN的使用并确定与以下因素相关的因素 依从性差，3)确定LLIN使用和媒介暴露之间的不匹配，制定解决这些差距的干预措施，然后系统地确定减少媒介-人之间的最高产量干预措施 使用病媒暴露的模型进行接触。我的长期职业目标是建立一个独立的研究 开发改进疟疾控制的创新方法的职业。这份K23提案是对我之前的建议的补充 在疟疾昆虫学、流行病学和传染病模型方面的指导和培训经验。总之，拟议的研究活动和补充培训旨在产生强有力的 对未来工作的规划。我将从这个奖项中脱颖而出，为申请NIH R01做好准备 在不同的传播环境中采取的方法，以发展我们的高产干预措施的业务研究 确定并扩大范围，从减少媒介与人的接触到减少实际疟疾发病率。这 K23奖提供了我目前的经历和实现我成为 发明、部署和测试改进疟疾预防的创新方法的国际领导者。

PROJECT SUMMARY/ABSTRACT Malaria affects three billion people worldwide. Despite remarkable reductions in malaria incidence over the last 15 years, recent evidence shows that our traditional control tools are weakening. Long-lasting insecticide-treated bednets (LLINs) are the most widely used tool for malaria prevention and have contributed significantly to decreases in malaria incidence, but recent studies suggest that LLINs are either less effective than before or people are not using them as reported. A rigorous assessment of how the timing and location of vector exposure intersects with real-life use of LLINs could be vitally important to regain the initiative in malaria control. However, the lack of a reliable measure of LLIN use presents a major challenge. Current measurement tools, like self-reported use, are subjective and unable to account for temporal variations in use. To address these limitations, I invented an electronic monitor of LLIN use. SmartNet uses sensors embedded in a standard LLIN to continuously assess whether it is unfurled with 98% accuracy. We have completed successful feasibility, acceptability and field trials of SmartNet. The central rationale for this project is that continuous monitoring of individual LLIN use combined with quantified exposure to malaria vectors will allow a more robust analysis than has previously been possible of how LLINs reduce vector exposure in practice. The research goal of this K23 proposal is to develop high-yield interventions for improving malaria control by identifying gaps between individual risk of vector exposure and individual LLIN use. To facilitate this work, I have access to a longitudinal cohort of 480 individuals in Uganda. Our approach leverages intensive entomology surveillance already being gathered every two weeks in this cohort. Additionally, we will deploy SmartNets over every sleeping space to cover every individual over multiple years. High-yield interventions will be identified by pursuing three specific aims: 1) quantify exposure to malaria vectors and identify factors associated with higher risk, 2) quantify LLIN use and identify factors associated with poor adherence and 3) identify mismatches between LLIN use and vector exposure, develop interventions addressing these gaps and then systematically determine the highest-yield interventions for reducing vector-human contact using a model of vector exposure. My long-term career goal is to establish an independent research career developing innovative approaches for improving malaria control. This K23 proposal supplements my prior experience with mentorship and training in malaria entomology and epidemiology and infectious disease modelling. Together, the proposed research activities and complementary training are designed to lead to a robust program of future work. I will emerge from this award prepared for a strong NIH R01 application to apply this approach in different transmission settings, to develop operational studies of the high-yield interventions we identify and to expand the scope from reducing vector-human contact to reducing actual malaria incidence. This K23 award provides the crucial link between my current experience and achieving my career goal of becoming an international leader inventing, deploying and testing innovative approaches for improving malaria prevention.