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Farrell S, Coffeng L, Truscott J, et al., 2017, INSIGHTS FROM MATHEMATICAL MODELS OF SOIL TRANSMITTED HELMINTH (STH) TRANSMISSION INTO POLICY FOR THEIR CONTROL AND ELIMINATION BY MASS DRUG ADMINISTRATION (MDA), 66th Annual Meeting of the American-Society-of-Tropical-Medicine-and-Hygiene (ASTMH), Publisher: AMER SOC TROP MED & HYGIENE, Pages: 565-565, ISSN: 0002-9637
O'Brien CW, Anderson R, Ayzenberg B, et al., 2017, Employers' Viewpoint on Clinical Education., J Allied Health, Vol: 46, Pages: 131-137
ISSUE: This qualitative study gathered the opinions of healthcare employers to better understand the importance, benefits, obstacles, and evolving issues related to allied health (AH) clinical education from the employers' perspective, with the goal to identify opportunities to strengthen and improve clinical-educational partnerships. METHOD: Member deans of the Association of Schools of Allied Health Professions (ASAHP) provided names and contact information of employers that routinely educate their students. Interviews were scheduled with employers who responded to Clinical Education Task Force (CETF) invitation. Twenty-one interviews were conducted by CETF members in early 2016 and analyzed utilizing qualitative software. OUTCOMES: Themes included benefits of working with students and hiring trainees, and obstacles of time and effort required to host students. A trend was noted in gaps between educational preparation and clinical performance. Recent changes highlighted increased technology and regulation, while anticipated changes included more focus on learning on site, longer clinical experiences, and payment for clinical education. CONCLUSION: Collaboration between educators and employers is essential to ensure that curriculum and outcomes match the needs of the field and effectively prepare students as entry-level clinicians.
Sarkar R, Rose A, Mohan VR, et al., 2016, Study design and baseline results of an open-label cluster randomized community-intervention trial to assess the effectiveness of a modified mass deworming program in reducing hookworm infection in a tribal population in southern India, Contemporary Clinical Trials Communications, Vol: 5, Pages: 49-55, ISSN: 2451-8654
Introduction: Hookworm infection is a leading cause of iron deficiency anemia and malnutrition inresource-poor settings. Periodic mass deworming with anthelminthic drugs remains the cornerstone ofhookworm control efforts worldwide. Reinfection following treatment occurs, reflecting the humanhost's inability to acquire immunity following exposure to an untreated reservoir of infection. Thiscluster randomized trial will evaluate the effectiveness of a modified, population-based, massdeworming strategy in reducing hookworm infection in an endemic southern Indian population.Methods: Forty five tribal villages were randomized into three groups: one received annual treatment;the second received two rounds of treatment at 1-month intervals; and the third received four rounds oftreatment e two rounds 1 month apart at the beginning, followed by another two after 6 months. Stoolsamples collected through cross-sectional parasitological surveys pre- and post-intervention, and at 3-monthly intervals for a period of 1 year were tested for presence of hookworm ova. Long-term effectivenessof treatment will be assessed through another survey conducted 2 years after the last treatmentcycle.Results: From a population of 11,857 individuals, 8681 (73.2%) were found to be eligible and consented toparticipate, out-migration being the primary reason for non-participation. Baseline stool samples wereobtained from 2082 participants, with 18.5% having hookworm infection, although majority were lowintensity infections (<2000 eggs per gram of feces).Discussion: This study will help identify the optimal mass deworming strategy that can achieve thegreatest impact in the shortest period of time, particularly in settings where long-term program sustainabilityis a challenge
Truscott JE, Turner HC, Farrell SH, et al., 2016, Soil-Transmitted Helminths: Mathematical Models of Transmission, the Impact of Mass Drug Administration and Transmission Elimination Criteria, ADVANCES IN PARASITOLOGY, VOL 94: MATHEMATICAL MODELS FOR NEGLECTED TROPICAL DISEASES: ESSENTIAL TOOLS FOR CONTROL AND ELIMINATION, PT B, Vol: 94, Pages: 133-198, ISSN: 0065-308X
Vegvari C, Hadjichrysanthou C, Cauët E, et al., 2016, How Can Viral Dynamics Models Inform Endpoint Measures in Clinical Trials of Therapies for Acute Viral Infections?, PLOS One, Vol: 11, ISSN: 1932-6203
Acute viral infections pose many practical challenges for the accurate assessment of the impact of novel therapies on viral growth and decay. Using the example of influenza A, we illustrate how the measurement of infection-related quantities that determine the dynamics of viral load within the human host, can inform investigators on the course and severity of infection and the efficacy of a novel treatment. We estimated the values of key infection-related quantities that determine the course of natural infection from viral load data, using Markov Chain Monte Carlo methods. The data were placebo group viral load measurements collected during volunteer challenge studies, conducted by Roche, as part of the oseltamivir trials. We calculated the values of the quantities for each patient and the correlations between the quantities, symptom severity and body temperature. The greatest variation among individuals occurred in the viral load peak and area under the viral load curve. Total symptom severity correlated positively with the basic reproductive number. The most sensitive endpoint for therapeutic trials with the goal to cure patients is the duration of infection. We suggest laboratory experiments to obtain more precise estimates of virological quantities that can supplement clinical endpoint measurements.
Vegvari C, Cauët E, Hadjichrysanthou C, et al., 2016, Using Clinical Trial Simulators to Analyse the Sources of Variance in Clinical Trials of Novel Therapies for Acute Viral Infections., PLOS One, Vol: 11, ISSN: 1932-6203
BACKGROUND: About 90% of drugs fail in clinical development. The question is whether trials fail because of insufficient efficacy of the new treatment, or rather because of poor trial design that is unable to detect the true efficacy. The variance of the measured endpoints is a major, largely underestimated source of uncertainty in clinical trial design, particularly in acute viral infections. We use a clinical trial simulator to demonstrate how a thorough consideration of the variability inherent in clinical trials of novel therapies for acute viral infections can improve trial design. METHODS AND FINDINGS: We developed a clinical trial simulator to analyse the impact of three different types of variation on the outcome of a challenge study of influenza treatments for infected patients, including individual patient variability in the response to the drug, the variance of the measurement procedure, and the variance of the lower limit of quantification of endpoint measurements. In addition, we investigated the impact of protocol variation on clinical trial outcome. We found that the greatest source of variance was inter-individual variability in the natural course of infection. Running a larger phase II study can save up to $38 million, if an unlikely to succeed phase III trial is avoided. In addition, low-sensitivity viral load assays can lead to falsely negative trial outcomes. CONCLUSIONS: Due to high inter-individual variability in natural infection, the most important variable in clinical trial design for challenge studies of potential novel influenza treatments is the number of participants. 100 participants are preferable over 50. Using more sensitive viral load assays increases the probability of a positive trial outcome, but may in some circumstances lead to false positive outcomes. Clinical trial simulations are powerful tools to identify the most important sources of variance in clinical trials and thereby help improve trial design.
Hadjichrysanthou C, Cauët E, Lawrence E, et al., 2016, Understanding the within-host dynamics of influenza A virus: from theory to clinical implications, Journal of the Royal Society Interface, Vol: 13, ISSN: 1742-5689
Mathematical models have provided important insights into acute viral dynamics within individual patients. In this paper, we study the simplest target cell-limited models to investigate the within-host dynamics of influenza A virus infection in humans. Despite the biological simplicity of the models, we show how these can be used to understand the severity of the infection and the key attributes of possible immunotherapy and antiviral drugs for the treatment of infection at different times post infection. Through an analytic approach, we derive and estimate simple summary biological quantities that can provide novel insights into the infection dynamics and the definition of clinical endpoints. We focus on nine quantities, including the area under the viral load curve, peak viral load, the time to peak viral load and the level of cell death due to infection. Using Markov chain Monte Carlo methods, we fitted the models to data collected from 12 untreated volunteers who participated in two clinical studies that tested the antiviral drugs oseltamivir and zanamivir. Based on the results, we also discuss various difficulties in deriving precise estimates of the parameters, even in the very simple models considered, when experimental data are limited to viral load measures and/or there is a limited number of viral load measurements post infection.
Turner HC, Truscott JE, Bettis AA, et al., 2016, Analysis of the population-level impact of co-administering ivermectin with albendazole or mebendazole for the control and elimination of Trichuris trichiura, Parasite Epidemiology and Control, Vol: 1, Pages: 177-187, ISSN: 2405-6731
INTRODUCTION: Soil-transmitted helminth (STH) infections are predominately controlled by providing children with preventive chemotherapy with either albendazole or mebendazole. However, neither has a high efficacy against Trichuris trichiura. This low efficacy limits the overall effectiveness of the current STH control programmes against T. trichiura. It has been demonstrated that co-administering ivermectin with albendazole or mebendazole significantly increases the efficacy of current treatments, which may increase the overall effectiveness of control programmes. METHODS: Using a STH transmission mathematical model, we evaluated the potential impact of co-administering ivermectin with albendazole or mebendazole to treat T. trichiura within a preventive chemotherapy programme targeting children (2-15 year olds). We evaluated the impact in terms of reduction in prevalent infections, mean worm burden, and prevalence of heavy infections. RESULTS: Although the current treatment strategy reduced T. trichiura worm burden and prevalence of heavy infections, due to their poor efficacy the long term impact of preventive chemotherapy for children was smaller compared to the other STH. Co-administering ivermectin increased the projected impact of the preventive chemotherapy programme in terms of all three of the explored metrics, practically in high transmission settings. Furthermore, ivermectin co-administration greatly increased the feasibility of and timeframe for breaking transmission. CONCLUSIONS: Co-administering ivermectin notably increased the projected impact of preventive chemotherapy in high transmission settings and increased the feasibility for breaking transmission. This has important implications for control programmes, some of which may be shifting focus from morbidity control to interruption of transmission, and some of which may be logistically unable to provide preventive chemotherapy twice a year as recommended. However, the benefit of co-administerin
Turner HC, Truscott JE, Anderson RM, 2016, Cost-effectiveness of community-wide treatment for helminthiasis, Lancet Global Health, Vol: 4, Pages: E156-E156, ISSN: 2214-109X
Turner HC, Truscott JE, Fleming FM, et al., 2016, Cost-effectiveness of scaling up mass drug administration for the control of soil-transmitted helminths: a comparison of cost function and constant costs analyses., Lancet: Infectious Diseases, Vol: 16, Pages: 838-846, ISSN: 1473-3099
BACKGROUND: The coverage of mass drug administration (MDA) for neglected tropical diseases, such as the soil-transmitted helminths (STHs), needs to rapidly expand to meet WHO's 2020 targets. We aimed to compare use of a cost function to take into account economies of scale to the standard method of assuming a constant cost per treatment when investigating the cost and cost-effectiveness of scaling up a STH MDA programme targeting Ascaris lumbricoides. METHODS: We fitted a cost function describing how the costs of MDA change with scale to empirical cost data and incorporated it into a STH transmission model. Using this cost function, we investigated the consequences of taking into account economies of scale on the projected cost-effectiveness of STH control, by comparison with the standard method of assuming a constant cost per treatment. The cost function was fitted to economic cost data collected as part of a school-based deworming programme in Uganda using maximum likelihood methods. We used the model to investigate the total reduction in the overall worm burden, the total number of prevalent infection case-years averted, and the total number of heavy infection case-years averted. For each year, we calculated the effectiveness as the difference between the worm burden or number of cases and the number in absence of treatment. FINDINGS: When using the cost function, the cost-effectiveness of STH control markedly increased as the programme was scaled up. By contrast, the standard method (constant cost per treatment) undervalued this and generated misleading conclusions. For example, when scaling up control in the projected district from 10% to 75% coverage of at-risk school-age children, the cost-effectiveness in terms of prevention of heavy burden infections was projected to increase by over 70% when using the cost function, but decrease by 18% when assuming a constant cost per treatment. INTERPRETATION: The current exclusion of economies of scale in most economic
Dunn JC, Turner HC, Tun A, et al., 2016, Epidemiological surveys of, and research on, soil-transmitted helminths in Southeast Asia: a systematic review, Parasites & Vectors, Vol: 9, ISSN: 1756-3305
Soil-transmitted helminth (STH) infections of humans fall within the World Health Organization’s (WHO) grouping termed the neglected tropical diseases (NTDs). It is estimated that they affect approximately 1.4 billion people worldwide. A significant proportion of these infections are in the population of Southeast Asia. This review analyses published data on STH prevalence and intensity in Southeast Asia over the time period of 1900 to the present to describe age related patterns in these epidemiological measures. This is with a focus on the four major parasite species affecting humans; namely Ascaris lumbricoides, Trichuris trichiura and the hookworms; Necator americanus and Ancylostoma duodenale. Data were also collected on the diagnostic methods used in the published surveys and how the studies were designed to facilitate comparative analyses of recorded patterns and changes therein over time. PubMed, Google Scholar, EMBASE, ISI Web of Science, Cochrane Database of Systematic Reviews and the Global Atlas of Helminth Infections search engines were used to identify studies on STH in Southeast Asia with the search based on the major key words, and variants on, “soil-transmitted helminth” “Ascaris” “Trichuris” “hookworm” and the country name. A total of 280 studies satisfied the inclusion criteria from 11 Southeast Asian countries; Brunei, Cambodia, Indonesia, Lao People’s Democratic Republic (Lao PDR), Malaysia, Myanmar, Philippines, Singapore, Thailand, Timor-Leste and Vietnam. It was concluded that the epidemiological patterns of STH infection by age and species mix in Southeast Asia are similar to those reported in other parts of the world. In the published studies there were a large number of different diagnostic methods used with differing sensitivities and specificities, which makes comparison of the results both within and between countries difficult. There is a clear requirement to standardise the m
Shuford KV, Turner HC, Anderson RM, 2016, Compliance with anthelmintic treatment in the neglected tropical diseases control programmes: a systematic review, Parasites & Vectors, Vol: 9, ISSN: 1756-3305
Preventive chemotherapy (PCT) programmes are used to control five of the highest burden neglected tropical diseases (NTDs): soil-transmitted helminth infections (hookworm, ascariasis, and trichuriasis), lymphatic filariasis, schistosomiasis, onchocerciasis, and trachoma. Over the past decade, new resource commitments for the NTDs have enabled such programmes to intensify their control efforts, and for some diseases, to shift from goals of morbidity control to the interruption of transmission and elimination. To successfully eliminate the parasite reservoir, these programmes will undoubtedly require prolonged, high treatment coverage. However, it is important to consider that even when coverage levels reach an acceptable proportion of the target population, there may be a considerable gap between coverage (those who receive the drug) and compliance (those who actually consume the drug)—a topic of fundamental and perhaps underestimated importance. We conducted a systematic review of published literature that investigated compliance to PCT programmes for NTD control and elimination. Databases searched included PubMed/Medline, Web of Knowledge (including Web of Science), OVID, and Scopus. Data were collected on compliance rates, reasons for non-compliance, as well as the heterogeneity of compliance definitions and calculations across programmes and studies. A total of 112 studies were selected for inclusion. The findings of the review revealed substantial heterogeneity across compliance terms and definitions; an imbalance of available studies for particular disease areas and countries; and finally, a lack of longitudinal compliance studies to properly investigate the role of systematic non-compliance. The lack of consistency among reporting of compliance data can result in under- or over-estimating compliance in a population, and therefore has serious implications for setting and reaching elimination targets. Reframing of the guidelines on compliance definitions c
Easton AV, Oliveira RG, O'Connell EM, et al., 2016, Multi-parallel qPCR provides increased sensitivity and diagnostic breadth for gastrointestinal parasites of humans: field-based inferences on the impact of mass deworming, Parasites & Vectors, Vol: 9, ISSN: 1756-3305
BackgroundAlthough chronic morbidity in humans from soil transmitted helminth (STH) infections can be reduced by anthelmintic treatment, inconsistent diagnostic tools make it difficult to reliably measure the impact of deworming programs and often miss light helminth infections.MethodsCryopreserved stool samples from 796 people (aged 2–81 years) in four villages in Bungoma County, western Kenya, were assessed using multi-parallel qPCR for 8 parasites and compared to point-of-contact assessments of the same stools by the 2-stool 2-slide Kato-Katz (KK) method. All subjects were treated with albendazole and all Ascaris lumbricoides expelled post-treatment were collected. Three months later, samples from 633 of these people were re-assessed by both qPCR and KK, re-treated with albendazole and the expelled worms collected.ResultsBaseline prevalence by qPCR (n = 796) was 17 % for A. lumbricoides, 18 % for Necator americanus, 41 % for Giardia lamblia and 15 % for Entamoeba histolytica. The prevalence was <1 % for Trichuris trichiura, Ancylostoma duodenale, Strongyloides stercoralis and Cryptosporidium parvum. The sensitivity of qPCR was 98 % for A. lumbricoides and N. americanus, whereas KK sensitivity was 70 % and 32 %, respectively. Furthermore, qPCR detected infections with T. trichiura and S. stercoralis that were missed by KK, and infections with G. lamblia and E. histolytica that cannot be detected by KK. Infection intensities measured by qPCR and by KK were correlated for A. lumbricoides (r = 0.83, p < 0.0001) and N. americanus (r = 0.55, p < 0.0001). The number of A. lumbricoides worms expelled was correlated (p < 0.0001) with both the KK (r = 0.63) and qPCR intensity measurements (r = 0.60).ConclusionsKK may be an inadequate tool for stool-based surveillance in areas where hookworm or Strongyloides are common or where intensity of helmi
Basanez M-G, Anderson RM, 2016, ADVANCES IN PARASITOLOGY Mathematical Models for Neglected Tropical Diseases: Essential Tools for Control and Elimination, Part B PREFACE, Publisher: ELSEVIER ACADEMIC PRESS INC
Anderson RM, Turner HC, Farrell SH, et al., 2016, Studies of the Transmission Dynamics, Mathematical Model Development and the Control of Schistosome Parasites by Mass Drug Administration in Human Communities, ADVANCES IN PARASITOLOGY, VOL 94: MATHEMATICAL MODELS FOR NEGLECTED TROPICAL DISEASES: ESSENTIAL TOOLS FOR CONTROL AND ELIMINATION, PT B, Editors: Basanez, Anderson, Publisher: ELSEVIER ACADEMIC PRESS INC, Pages: 199-246
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Anderson RM, 2016, The Impact of Vaccination on the Epidemiology of Infectious Diseases, VACCINE BOOK, 2ND EDITION, Editors: Bloom, Lambert, Publisher: ACADEMIC PRESS LTD-ELSEVIER SCIENCE LTD, Pages: 3-31, ISBN: 978-0-12-802174-3
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Spratt BG, Anderson RM, 2015, Special feature on evolution and genetics in medicine, Proceedings of the Royal Society B: Biological Sciences, Vol: 282, ISSN: 0962-8452
Hollingsworth TD, Adams ER, Anderson RM, et al., 2015, Quantitative analyses and modelling to support achievement of the 2020 goals for nine neglected tropical diseases, Parasites & Vectors, Vol: 8, ISSN: 1756-3305
Quantitative analysis and mathematical models are useful tools in informing strategies to control or eliminatedisease. Currently, there is an urgent need to develop these tools to inform policy to achieve the 2020 goals forneglected tropical diseases (NTDs). In this paper we give an overview of a collection of novel model-based analyseswhich aim to address key questions on the dynamics of transmission and control of nine NTDs: Chagas disease,visceral leishmaniasis, human African trypanosomiasis, leprosy, soil-transmitted helminths, schistosomiasis, lymphaticfilariasis, onchocerciasis and trachoma. Several common themes resonate throughout these analyses, including: theimportance of epidemiological setting on the success of interventions; targeting groups who are at highest risk ofinfection or re-infection; and reaching populations who are not accessing interventions and may act as a reservoirfor infection,. The results also highlight the challenge of maintaining elimination ‘as a public health problem’ whentrue elimination is not reached. The models elucidate the factors that may be contributing most to persistence ofdisease and discuss the requirements for eventually achieving true elimination, if that is possible. Overall thiscollection presents new analyses to inform current control initiatives. These papers form a base from which furtherdevelopment of the models and more rigorous validation against a variety of datasets can help to give moredetailed advice. At the moment, the models’ predictions are being considered as the world prepares for a finalpush towards control or elimination of neglected tropical diseases by 2020.
Turner HC, Truscott JE, Bettis AA, et al., 2015, An economic evaluation of expanding hookworm control strategies to target the whole community., Parasites & Vectors, Vol: 8, ISSN: 1756-3305
BACKGROUND: The WHO treatment guidelines for the soil-transmitted helminths (STH) focus on targeting children for the control of morbidity induced by heavy infections. However, unlike the other STHs, the majority of hookworm infections are harboured by adults. This untreated burden may have important implications for controlling both hookworm's morbidity and transmission. This is particularly significant in the context of the increased interest in investigating STH elimination strategies. METHODS: We used a deterministic STH transmission model and parameter estimates derived from field epidemiological studies to evaluate the impact of child-targeted (2-14 year olds) versus community-wide treatment against hookworm in terms of preventing morbidity and the timeframe for breaking transmission. Furthermore, we investigated how mass treatment may influence the long-term programmatic costs of preventive chemotherapy for hookworm. RESULTS: The model projected that a large proportion of the overall morbidity due to hookworm was unaffected by the current child-targeted strategy. Furthermore, driving worm burdens to levels low enough to potentially break transmission was only possible when using community-wide treatment. Due to these projected reductions in programme duration, it was possible for community-wide treatment to generate cost savings - even if it notably increases the annual distribution costs. CONCLUSIONS: Community-wide treatment is notably more cost-effective for controlling hookworm's morbidity and transmission than the current child-targeted strategies and could even be cost-saving in many settings in the longer term. These calculations suggest that it is not optimum to treat using the same treatment strategies as other STH. Hookworm morbidity and transmission control require community-wide treatment.
Anderson RM, Turner HC, Farrell SH, et al., 2015, What is required in terms of mass drug administration to interrupt the transmission of schistosome parasites in regions of endemic infection?, Parasites & Vectors, Vol: 8, ISSN: 1756-3305
Background: Schistosomiasis is endemic in 54 countries, but has one of the lowest coverages by mass drugadministration of all helminth diseases. However, with increasing drug availability through donation, the WorldHealth Organisation has set a goal of increasing coverage to 75 % of at-risk children in endemic countries andelimination in some regions. In this paper, we assess the impact on schistosomiasis of the WHO goals in terms ofcontrol and elimination.Methods: We use an age-structured deterministic model of schistosome transmission in a human community andthe effect of mass drug administration. The model is fitted to baseline data from a longitudinal re-infection study inKenya and validated against the subsequent re-infection data. We examine the impact on host worm burden of thecurrent treatment trend, extrapolated to meet the WHO goals, and its sensitivity to uncertainty in importantparameters. We assess the feasibility of achieving elimination.Results: Model results show that the current treatment trend, extrapolated to the WHO goals, is able to greatlyreduce host worm burdens. If coverage is continued at the same level beyond 2020, elimination is possible for lowto moderate transmission settings, where transmission intensity is defined by the basic reproduction number, R0.Low levels of adult coverage have a significant impact on worm burden in all settings. Model validation against there-infection survey demonstrates that the age-structured model is able to match post-treatment data well in termsof egg output, but that some details of re-infection among school children and young adults are not currently wellrepresented.Conclusions: Our work suggests that the current WHO treatment goals should be successful in bringing about amajor reduction in schistosome infection in treated communities. If continued over a 15 year period, they are likelyto result in elimination, at least in areas with lower transmission.
Truscott JE, Turner HC, Anderson RM, 2015, What impact will the achievement of the current World Health Organisation targets for anthelmintic treatment coverage in children have on the intensity of soil transmitted helminth infections?, Parasites & Vectors, Vol: 8, ISSN: 1756-3305
BackgroundIt is the aim of the World Health Organisation to eliminate soil-transmitted helminths (STH) as a health problem in children. To this end, the goal is to increase anthelmintic treatment coverage for soil transmitted helminths to reach 75 % in pre-school aged and school aged children by 2020 in endemic countries. In this paper, we use mathematical models to investigate the impact of achieving this goal on the burdens of Ascaris lumbricoides, Trichuris trichuria and hookworm.MethodsWe employ a deterministic fully age-structured model of STH transmission and mass drug administration to examine the changes in worm burden in response to the known and projected coverage trends in children up to 2020 and beyond. Parameters are estimated from worm expulsion data and age intensity profiles before treatment using maximum likelihood methods. Model validation is performed using reinfection studies for Ascaris and analyses are conducted to assess the sensitivity of the predicted outcomes to variation in parameter estimates including transmission intensity (R0), children’s contributions to the pool of infective stages and drug coverage levels.ResultsThe impact of the required increase in coverage trends are quite different across the three species. Ascaris burdens are reduced dramatically by 2020 with elimination predicted within studied the setting a further 10 years. For Trichuris and hookworm, however, impact is more limited, due to issues of drug efficacy (Trichuris) and distribution of worms in the population (hookworm). Sensitivity analysis indicates that results are largely robust. However, validation against Ascaris data indicates that assumptions concerning re-infection among children may have to be revised.ConclusionsThe 2020 coverage target is predicted to have a major impact on Ascaris levels by 2020. However, there is evidence from model validation that Ascaris in children is more resilient to treatment than currently assumed in the model. Broader cov
Brooker SJ, Mwandawiro CS, Halliday KE, et al., 2015, Interrupting transmission of soil-transmitted helminths: a study protocol for cluster randomised trials evaluating alternative treatment strategies and delivery systems in Kenya, BMJ Open, Vol: 5, ISSN: 2044-6055
Introduction In recent years, an unprecedented emphasis has been given to the control of neglected tropical diseases, including soil-transmitted helminths (STHs). The mainstay of STH control is school-based deworming (SBD), but mathematical modelling has shown that in all but very low transmission settings, SBD is unlikely to interrupt transmission, and that new treatment strategies are required. This study seeks to answer the question: is it possible to interrupt the transmission of STH, and, if so, what is the most cost-effective treatment strategy and delivery system to achieve this goal?Methods and analysis Two cluster randomised trials are being implemented in contrasting settings in Kenya. The interventions are annual mass anthelmintic treatment delivered to preschool- and school-aged children, as part of a national SBD programme, or to entire communities, delivered by community health workers. Allocation to study group is by cluster, using predefined units used in public health provision—termed community units (CUs). CUs are randomised to one of three groups: receiving either (1) annual SBD; (2) annual community-based deworming (CBD); or (3) biannual CBD. The primary outcome measure is the prevalence of hookworm infection, assessed by four cross-sectional surveys. Secondary outcomes are prevalence of Ascaris lumbricoides and Trichuris trichiura, intensity of species infections and treatment coverage. Costs and cost-effectiveness will be evaluated. Among a random subsample of participants, worm burden and proportion of unfertilised eggs will be assessed longitudinally. A nested process evaluation, using semistructured interviews, focus group discussions and a stakeholder analysis, will investigate the community acceptability, feasibility and scale-up of each delivery system.
Easton AV, Oliveira RG, O'Connell EM, et al., 2015, MULTI-PARALLEL QPCR PROVIDES INCREASED SENSITIVITY AND DIAGNOSTIC BREADTH ALLOWING FOR IMPROVED EVALUATION OF THE IMPACT OF DEWORMING PROGRAMS FOR SOIL-TRANSMITTED HELMINTHS (STH), Publisher: AMER SOC TROP MED & HYGIENE, Pages: 18-18, ISSN: 0002-9637
Nikolay B, Mwandawiro CS, Kihara JH, et al., 2015, A CONTEXTUAL FRAMEWORK TO ASSESS HETEROGENEITY IN IMPACT OF NATIONAL NEGLECTED TROPICAL DISEASE CONTROL PROGRAMS: EVIDENCE FROM SCHOOL-BASED DEWORMING IN KENYA, Publisher: AMER SOC TROP MED & HYGIENE, Pages: 139-139, ISSN: 0002-9637
Truscott J, Anderson R, 2015, IMPACT OF THE DESIGN OF PREVENTIVE CHEMOTHERAPY STRATEGY ON CONTROL AND ELIMINATION OF SCHISTOSOMIASIS, Publisher: AMER SOC TROP MED & HYGIENE, Pages: 162-162, ISSN: 0002-9637
Oliveira RG, Easton A, Kepha S, et al., 2015, IMMUNO-EPIDEMIOLOGY OF SOIL-TRANSMITTED HELMINTH INFECTIONS AFTER REPEATED SCHOOL-BASED DEWORMING: A COMMUNITY-WIDE CROSS SECTIONAL STUDY IN WESTERN KENYA, Publisher: AMER SOC TROP MED & HYGIENE, Pages: 138-138, ISSN: 0002-9637
Turner HC, Truscott JE, Bettis AA, et al., 2015, WHAT ARE THE BENEFITS OF COMMUNITY WIDE TREATMENT FOR THE CONTROL AND ELIMINATION OF HOOKWORM?, Publisher: AMER SOC TROP MED & HYGIENE, Pages: 17-18, ISSN: 0002-9637
Nikolay B, Mwandawiro CS, Kihara JH, et al., 2015, Understanding Heterogeneity in the Impact of National Neglected Tropical Disease Control Programmes: Evidence from School-Based Deworming in Kenya, PLOS Neglected Tropical Diseases, Vol: 9, ISSN: 1935-2735
BackgroundThe implementation of soil-transmitted helminth (STH) treatment programmes occurs invaried environmental, social and economic contexts. Programme impact will be influencedby factors that affect the reduction in the prevalence and intensity of infections followingtreatment, as well as the subsequent rate of reinfection. To better understand the heterogeneityof programme impact and its underlying reasons, we investigated the influence of contextualfactors on reduction in STH infection as part of the national school based deworming(SBD) programme in Kenya.Materials and MethodsData on the prevalence and intensity of infection were collected within the monitoring andevaluation component of the SBD programme at baseline and after delivery of two annualtreatment rounds in 153 schools in western Kenya. Using a framework that considers STHepidemiology and transmission dynamics, capacity to deliver treatment, operational feasibilityand financial capacity, data were assembled at both school and district (county) levels.Geographic heterogeneity of programme impact was assessed by descriptive and spatialanalyses. Factors associated with absolute reductions of Ascaris lumbricoides and hookworm infection prevalence and intensity were identified using mixed effects linearregression modelling adjusting for baseline infection levels.Principal FindingsThe reduction in prevalence and intensity of A. lumbricoides and hookworms varied significantlyby county and within counties by school. Multivariable analysis of factors associatedwith programme impact showed that absolute A. lumbricoides reductions varied by environmentalconditions and access to improved sanitation at schools or within the community.Larger reduction in prevalence and intensity of hookworms were found in schools locatedwithin areas with higher community level access to improved sanitation and within countieswith higher economic and health service delivery indicator scores.ConclusionsThe study identifies factors
Anderson RM, Turner HC, Truscott JE, et al., 2015, Should the Goal for the Treatment of Soil Transmitted Helminth (STH) Infections Be Changed from Morbidity Control in Children to Community-Wide Transmission Elimination?, PLOS Neglected Tropical Diseases, Vol: 9, Pages: e0003897-e0003897, ISSN: 1935-2735
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