Malaria Operations Research to Improve Malaria Control and Reduce Morbidity and Mortality in Western Kenya

项目总结 本申请是疾控中心疟疾分部和利物浦热带学院之间的第四次、为期5年的合作 医学(LSTM)。在肯尼亚西部开展的活动是在两国之间长期合作的框架下进行的 肯尼亚医学研究所(KEMRI)、CDC和LSTM，并受益于LSTM在 肯尼亚。研究战略遵循国家研究组织的5个目标。第一个目标涉及在 2020/21年度流行病学(1.1)和昆虫学监测(1.2)平台，跟踪疟疾防治进展情况 在2021/22年引入全人口干预措施后的减少传播目标。维护 低传播状态，这需要从现有的定期、地区级监测转向以下系统 监测本身成为一种干预手段，可以近乎实时、快速地检测到个别地理位置的病例 通报和焦点调查。我们将支持肯尼亚卫生部实现数字化的目标 使用可扫描的软件在纸质健康登记簿上收集的数据(1.1.5)。这将是 包括记录门诊(1.1.6)和社区卫生部门使用病例负担数据的登记表 作为综合社区病例管理(ICCM)(1.1.7)的一部分的工作人员，以及产前诊所登记 在第一次产前就诊期间捕获疟疾感染流行率。这是一种新的跟踪方法 种群中无症状的寄生虫库(1.1.8)。结合在一起，这第一次允许可持续的，日常的， 近实时监测，跟踪实现疟疾传播减少目标的进展情况。我们还将进行 追踪疟疾流行率和干预覆盖率的持续疟疾指标家庭调查(CMIS)(1.1.9) 和昆虫学监测(1.2)，两者都使用能够应对挑战的自适应采样框架 这与疟疾传播的快速变化有关。作为第二个目标的一部分，我们将在全国范围内实施 针对疟疾传播的干预措施，从2021/22年开始。新颖或改进的最佳组合 将在2020/21年度与疾控中心密切合作制定干预措施。这可能包括增强的案例- 使用ICCM的数字支持的质量改进方法进行管理，加强病媒控制 幼虫来源管理和经杀虫剂处理的胡椒基丁醚(PBO)蚊帐，以及通过 双氢青蒿素-哌喹和伊维菌素瞄准无症状寄生虫库(2.1)。第三 目标涉及评估当前部署的抗疟疾药物用于预防的安全性有效性(3.2.1) 在抗疟疾药物耐药性增加的背景下，疟疾的治疗(3.2和3.3)。我们将与 美国疾病控制与预防中心在亚特兰大的实验室用于耐药性的分子监测。第四个目标是最大化地实现 通过支持在KEMRI的CGHR创建一个知识中心作为证据，对公共卫生的影响 综合和信息交流，以加强全球疟疾控制政策的翻译(4)。目标5 涉及通过提供实习机会加强肯尼亚合作伙伴的研究能力(5.1)和 硕士、博士和博士后奖学金和研究领导力指导(5.1)。

Project summary This application is for the fourth, 5-year CoAG between CDC’s Malaria Branch and the Liverpool School of Tropical Medicine (LSTM). Activities take place in western Kenya under the umbrella of the long-term collaboration between the Kenya Medical Research Institute (KEMRI), CDC, and LSTM and benefit from LSTM’s existing infrastructure in Kenya. The research strategy follows the 5 objectives of the NOFO. The first objective involves the expansion in 2020/21 of the epidemiological (1.1) and entomological surveillance (1.2) platform to track progress towards malaria transmission reduction targets following the introduction of population-wide interventions in 2021/22. To maintain low transmission status, this requires a shift from the existing periodic, district-level surveillance to systems where surveillance itself becomes an intervention and can detect individual geo-located cases near real-time for rapid notification and foci investigation. We will support the Kenyan Ministry of Health (MoH) with their goal to digitise the data collected on their paper-based health registers using software that makes them scannable (1.1.5). This will include registers that capture case-burden data used in out-patient departments (1.1.6) and by community health workers as part of integrated community case management (ICCM) (1.1.7), and antenatal clinic registers that capture malaria infection prevalence during first antenatal clinic visits. This is a novel method to track the asymptomatic parasite reservoir in populations (1.1.8). Combined, this allows, for the first time, sustainable, daily, near real-time surveillance to track progress towards malaria transmission reduction targets. We will also conduct continuous malaria indicator household surveys (cMIS) to track malaria prevalence and intervention coverage (1.1.9) and entomological monitoring (1.2), both using adaptive sampling frameworks that can respond to challenges related to rapid changes in malaria transmission. As part of the second objective, we will implement population-wide interventions targeting malaria transmission, starting in 2021/22. The optimal combination of novel or improved interventions will be developed in close collaboration with CDC in 2020/21. This is likely to include enhanced case- management using digitally supported quality improvement approaches of ICCM, enhanced vector control with larval source management and insecticide-treated piperonyl butoxide (PBO) nets, and mass drug administration with dihydroartemisinin-piperaquine and ivermectin targeting the asymptomatic parasite reservoir (2.1). The third objective involves assessing the safety effectiveness of currently deployed antimalarials for the prevention (3.2.1) and treatment (3.2 and 3.3) of malaria in the context of increasing antimalarial drug resistance. We will liaise with CDC’s laboratories in Atlanta for the molecular monitoring of drug resistance. The fourth objective aims to maximise the public health impact by supporting the creation of a knowledge centre at the KEMRI’s CGHR for evidence synthesis and information exchange to enhance the translation of global malaria control policies (4). Objective 5 involves the strengthening of research capacity of the partners in Kenya by the provision of internships (5.1) and MSc, PhD and post-doctoral studentships and research leadership mentoring (5.1).