Evaluating Re-active Surveillance Strategies for Malaria Elimination in Swaziland

评估斯威士兰消除疟疾的反应性监测策略

• 批准号: 8862355
• 负责人: Michelle Sang Hsiang
• 金额: $ 13.15万
• 依托单位: UT SOUTHWESTERN MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-06-01 至 2017-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8862355
• 关键词: Address; Antibodies; Antigens; Antimalarials; Area; Biological Assay; Blood; Case Study; Child; Child health care; Childhood; Clinical; Clinical Research; Clinical Trials; Collaborations; Communicable Diseases; Communities; Country; Data; Detection; Development Plans; Diagnostic; Diagnostic tests; Disease; Disease Outbreaks; Effectiveness; Enzyme-Linked Immunosorbent Assay; Epidemiologic Studies; Epidemiological Factors; Epidemiology; Fellowship; Funding; Future; Goals; Health care facility; Home environment; Hot Spot; Infection; Institution; Intervention; Investigation; Laboratories; Location; Malaria; Measures; Mentors; Mentorship; Microscopy; Modeling; Parasites; Pharmaceutical Preparations; Plasmodium falciparum; Population; Prevalence; Probability; Productivity; Public Health; Questionnaires; Randomized Clinical Trials; Research; Research Infrastructure; Research Personnel; Research Training; Residual state; Resources; Rewards; Risk; Risk Factors; Science; Serologic tests; Southern Africa; Spottings; Surface Antigens; Surveillance Methods; Surveillance Program; Swaziland; Testing; Time; Training; Translational Research; Travel; Uncertainty; base; burden of illness; career; career development; clinical care; density; design; effective intervention; experience; global health; high risk; improved; indexing; interest; malaria transmission; member; novel; patient oriented; programs; response; scale up; screening; secondary infection; skills; surveillance data; surveillance strategy; transmission process

DESCRIPTION (provided by applicant): My goal is to have a rewarding career in pediatric infectious diseases by improving the health of children through clinical care and patient oriented malaria research. I became drawn to malaria because of the tremendous global burden of this disease in children and because recent interest in malaria elimination has brought forth exciting questions on how countries can interrupt transmission. I am particularly interested in re-active surveillance, a strategy whereby community members around index cases are screened as a way to identify and target asymptomatic carriers that perpetuate transmission. Building on my fellowship research which focused on surveillance for malaria elimination, and building on existing infrastructure and collaboration with the Swaziland National Malaria Control Program, I propose the following specific aims: 1) Compare pooled PCR to rapid diagnostic test (RDT) for improved detection of secondary malaria infections, 2) Identify epidemiological factors associated with the detection of secondary infections in re-active surveillance, and 3) Build and test a model for predicting the location of hot spots utilizing RDT, PCR, epidemiological data, and malaria serology. These findings will help guide best practices for re-active surveillance, clarifying which diagnostic test to use, when to investigate an index case, and who in the community should be screened during these investigations. Improved prediction of hot spots will also enable countries to anticipate potential outbreaks, target limited resources to remaining foci, and ultimately interrupt malaria transmission. The proposed project will also enable me to collect the preliminary data necessary for a subsequent R01 submission to test the effectiveness of focal interventions targeting hot spots identified by these surveillance methods (e.g. screening and treatment, mass drug administration, or intensive indoor residual spraying). To perform these cluster-randomized clinical trials would be the culmination of many positive and productive research, programmatic, and clinical experiences that I have had in the past. However, in order to achieve this career goal and the aims of my K23, there are two major areas where I require additional training, mentoring, and experience: 1) Advanced skills in clinical and epidemiologic research, and 2) Expertise in malaria diagnostic and surveillance laboratory assays. In this proposal, I present a detailed career development plan that includes mentorship in these areas, a Master's in Clinical Research, and practical laboratory experience at UCSF and in Swaziland. The skills and experience acquired from this training will enable me to independently design a clinical trial and compete successfully for R01 funding. I have assembled a highly experienced and well-resourced mentorship team that is committed to the proposed project and my career development. Furthermore, I already have a track record of productivity with my mentors and collaborators. I have full and enthusiastic support from UCSF, my home institution, which has a rich and enduring tradition of excellence in biomedical science, clinical and translational research, and global health. The training and research opportunities available at UCSF and through my mentorship team will no doubt prepare me for a successful career as an independent malaria researcher, addressing clinical and epidemiologic challenges of malaria elimination, and ultimately contributing to improved health of children and larger populations currently threatened by malaria.

描述（由申请人提供）：我的目标是通过通过临床护理和以患者为导向的疟疾研究来改善儿童的健康，在儿科传染病方面拥有有意义的职业。由于这种疾病在儿童中的全球负担巨大，我之所以被疟疾吸引，是因为最近对疟疾消除的兴趣引起了人们对国家如何中断传播的激动人心的问题。我对重新活跃监视特别感兴趣，该战略将围绕索引案件的社区成员筛选为识别和目标无症状的载体的一种方式，以使传播永存。在我的奖学金研究基础上，重点是消除疟疾的监视，并基于现有的基础设施和与斯威士兰国家疟疾控制计划的合作，我提出了以下具体目的：1）将PCR汇集的PCR与快速诊断测试（RDT）进行比较，以改善与次要疟疾感染相关的检测，2）鉴定相关的疾病，2）2）鉴定次要的疾病。2）监视和3）构建和测试一个模型，用于预测使用RDT，PCR，流行病学数据和疟疾血清学的热点位置。这些发现将有助于指导重新主动监视的最佳实践，澄清要使用的诊断测试，何时调查索引案例以及在这些调查中应筛选社区中的谁。改进的热点预测还将使各国能够预测潜在的爆发，以有限的资源为目标，以剩余的焦点以及最终中断疟疾的传播。 拟议的项目还将使我能够收集随后的R01提交所需的初步数据，以测试针对这些监视方法鉴定的热点的焦点干预措施的有效性（例如，筛查和治疗，大众药物管理，或密集的室内残留室内残留喷雾）。进行这些聚类的临床试验将是我过去经历过的许多积极和生产性研究，程序化和临床经验的高潮。但是，为了实现这一职业目标和我的K23的目标，在两个主要领域，我需要额外的培训，指导和经验：1）临床和流行病学研究的高级技能，以及2）疟疾诊断和监视实验室分析方面的专业知识。在此提案中，我提出了一项详细的职业发展计划，其中包括在这些领域的指导，临床研究的硕士以及在UCSF和Swaziland的实践实验室经验。从这项培训中获得的技能和经验将使我能够独立设计临床试验并成功竞争R01资金。 我组建了一个经验丰富且资源丰富的指导团队，该团队致力于拟议的项目和我的职业发展。此外，我已经与导师和合作者拥有生产力的记录。我得到了UCSF，我的家庭机构的全力支持，它具有丰富而持久的生物医学科学，临床和转化研究以及全球健康的传统。 UCSF以及通过我的指导团队提供的培训和研究机会无疑将使我为成功的职业生涯做好准备，以应对独立的疟疾研究人员，应对消除疟疾的临床和流行病学挑战，并最终为改善儿童的健康和当前受疟疾威胁的较大人群的健康做出贡献。