Interrupting transmission of soil-transmitted helminths: cluster randomised trial evaluating alternative treatment strategies in Kenya

阻断土源性蠕虫的传播：评估肯尼亚替代治疗策略的整群随机试验

基本信息

批准号：
MR/N00597X/1
负责人：
Rachel Pullan
金额：
$ 130.96万
依托单位：
London School of Hygiene & Tropical Medicine
依托单位国家：
英国
项目类别：
Research Grant
财政年份：
2015
资助国家：
英国
起止时间：
2015 至无数据
项目状态：
已结题

来源：
https://gtr.ukri.org/projects?ref=MR%2FN00597X%2F1
关键词：
Interrupting transmission soil transmitted helminths

项目摘要

Some 1.45 billion people are estimated to be infected worldwide with intestinal worms, also known as soil-transmitted helminths (STH). Chronic and intense STH infections can contribute to malnutrition and iron-deficiency anaemia, and also can adversely affect physical and mental growth in childhood. Globally, STH result in 4.98 million years lived with disability each year. Fortunately, however, the global community is increasingly committed to tackling these infections, with many countries now successfully implementing geographically-targeted programmes that provide mass treatment to school-aged children delivered through schools. However, whilst school-based deworming has many important benefits for treated children, recent mathematical modelling suggests that treating only school-aged children will rarely stop transmission of these parasites, except in very low transmission settings, and that alternative approaches to treatment, including extending coverage and frequency of treatment, are required. To effectively deliver such expanded treatment, there is an associated need to evaluate the impact and cost-effectiveness of using community health workers to treat adult populations. We plan to evaluate the impact of school- versus community-based treatment in reducing the transmission of STH species. A range of quantitative and qualitative assessments will evaluate the costs, cost-effectiveness, acceptability and feasibility of the different strategies and delivery systems. The study will be conducted in two contrasting settings in Kenya - south coastal and western regions - where an estimated 20% of the population are infected with STH. In order to maximize public health relevance, the study will be nested within the ongoing national school-based deworming programme, which is currently treating 4.6 million preschool and school children annually. The study drugs will be donated by GlaxoSmithKline and the full costs of delivery through schools and communities will be covered by the Children's Investment Fund Foundation, with additional input from the Government of Kenya. Cofunding for some of the trial activities are already funded by the Bill & Melinda Gates Foundation. There is tremendous interest in conducting this study. The Government of Kenya, other national governments, funders and international policy makers are seeking clear policy and technical guidance as to the optimal approach to interrupt STH transmission. At the same time, countries are increasingly using community health workers (CHW; community members who provide basic health and medical care to their community, often on a volunteer basis) to deliver a wide range of health interventions, and there is a need to evaluate the benefits of using CHWs to deliver STH treatment. The proposed study, the first of its kind in Africa, will address these policy information gaps. Our proposed study is demand-led at the country level, with partners in Kenya supporting delivery and committed to scaling-up the new strategy, once demonstrated to be beneficial. Not only will the findings inform policy and practice in Kenya and other STH endemic countries, they may also lead to new WHO guidelines on the community control of STH and ultimately have demonstrable benefits for the impoverished communities affected by STH.

据估计，全球约有 14.5 亿人感染肠道蠕虫，也称为土源性蠕虫 (STH)。慢性和严重的 STH 感染会导致营养不良和缺铁性贫血，还会对儿童时期的身心发育产生不利影响。在全球范围内，STH 每年导致 498 万岁的人生活残疾。然而幸运的是，国际社会越来越致力于解决这些感染问题，许多国家现在成功实施了有针对性的计划，通过学校为学龄儿童提供大规模治疗。然而，虽然基于学校的驱虫对接受治疗的儿童有许多重要的好处，但最近的数学模型表明，仅治疗学龄儿童很少会阻止这些寄生虫的传播，除非在传播率非常低的情况下，并且替代治疗方法，包括延长需要治疗的覆盖范围和频率。为了有效地提供这种扩大的治疗，需要评估使用社区卫生工作者治疗成年人口的影响和成本效益。我们计划评估学校治疗与社区治疗在减少 STH 物种传播方面的影响。一系列定量和定性评估将评估不同策略和交付系统的成本、成本效益、可接受性和可行性。这项研究将在肯尼亚两个截然不同的环境中进行——南部沿海和西部地区——估计那里有 20% 的人口感染了 STH。为了最大限度地提高公共卫生相关性，该研究将纳入正在进行的国家学校驱虫计划中，该计划目前每年治疗 460 万学前儿童和在校儿童。研究药物将由葛兰素史克捐赠，通过学校和社区提供的全部费用将由儿童投资基金基金会承担，肯尼亚政府还提供额外投入。比尔及梅琳达·盖茨基金会已经为一些试验活动提供了共同资助。人们对开展这项研究抱有极大的兴趣。肯尼亚政府、其他国家政府、资助者和国际政策制定者正在寻求明确的政策和技术指导，以找到阻断某种东西传播的最佳方法。与此同时，各国越来越多地利用社区卫生工作者（CHW；通常以志愿者的形式向社区提供基本卫生和医疗保健的社区成员）来提供广泛的卫生干预措施，因此有必要评估使用社区卫生工作者提供 STH 治疗的好处。拟议的研究是非洲首个此类研究，将解决这些政策信息差距。我们拟议的研究是在国家层面以需求为主导的，肯尼亚的合作伙伴支持实施，并致力于在新战略被证明有益后扩大其规模。研究结果不仅将为肯尼亚和其他 STH 流行国家的政策和实践提供信息，还可能导致世卫组织制定关于 STH 社区控制的新指南，并最终为受 STH 影响的贫困社区带来明显的好处。

项目成果

期刊论文数量（10）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Assessment of the required performance and the development of corresponding program decision rules for neglected tropical diseases diagnostic tests: Monitoring and evaluation of soil-transmitted helminthiasis control programs as a case study.

DOI：
10.1371/journal.pntd.0009740
发表时间：
2021-09
期刊：
PLoS neglected tropical diseases
影响因子：
3.8
作者：
Levecke B;Coffeng LE;Hanna C;Pullan RL;Gass KM
通讯作者：
Gass KM

Patterns of individual non-treatment during multiple rounds of mass drug administration for control of soil-transmitted helminths in the TUMIKIA trial, Kenya: a secondary longitudinal analysis.

DOI：
10.1016/s2214-109x(20)30344-2
发表时间：
2020-11
期刊：
The Lancet. Global health
影响因子：
0
作者：
Oswald WE;Kepha S;Halliday KE;Mcharo C;Safari T;Witek-McManus S;Hardwick RJ;Allen E;Matendechero SH;Brooker SJ;Njenga SM;Mwandawiro CS;Anderson RM;Pullan RL
通讯作者：
Pullan RL

Domains of transmission and association of community, school, and household sanitation with soil-transmitted helminth infections among children in coastal Kenya.

肯尼亚沿海儿童土源性蠕虫感染的传播领域以及社区、学校和家庭卫生条件与相关性。

DOI：
10.1371/journal.pntd.0007488
发表时间：
2019
期刊：
PLoS neglected tropical diseases
影响因子：
3.8
作者：
Oswald WE
通讯作者：
Oswald WE

Patterns and Drivers of Household Sanitation Access and Sustainability in Kwale County, Kenya.

DOI：
10.1021/acs.est.0c05647
发表时间：
2021-05-04
期刊：
Environmental science & technology
影响因子：
11.4
作者：
Legge H;Halliday KE;Kepha S;Mcharo C;Witek-McManus SS;El-Busaidy H;Muendo R;Safari T;Mwandawiro CS;Matendechero SH;Pullan RL;Oswald WE
通讯作者：
Oswald WE

Domains of transmission and association of community, school, and household sanitation with soil-transmitted helminth infections among children in coastal Kenya

肯尼亚沿海儿童土源性蠕虫感染的传播领域以及社区、学校和家庭卫生设施与土源性蠕虫感染的关联