Research on HIV, TB and malaria achievements

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Knowledge gap
Program
implementation
Impact evaluation
Evaluate new tools
Translate new
knowledge into policy
and implementation
Research on HIV, TB and malaria
achievements
• Globally, remarkable progress in control of
HIV, TB and malaria in last two decades:
millions of lives have been saved
• Progress made possible by research
contributions to improved control:
– HIV: discovery of anti-retroviral drugs;
demonstrating their impact on transmission
– TB: multidrug regimens, outcome monitoring
– Malaria: ACT, insecticide-treated bed nets
KEMRI & CDC public health and research
collaboration since 35 years
1.
2.
3.
Insecticide-treated bed net trial informing global
malaria control policy
Kisumu breastfeeding study informing PMTCT
guidelines
HPTN 052: transmission impact of ARV:
treatment as prevention
1. Lindblade et al JAMA 2004 2. Thomas et al PLoS Med 2011 3. Cohen et al. N Engl J Med 2011
Major challenges
research response
• Despite progress, elimination of HIV, TB and
malaria as public health threats still far away
• Ambitious sustainable development goals
adopted (end epidemics…)
• Priority studies for KEMRI and CDC collaboration:
– Population based studies on maximum impact of
current tools
– Clinical studies to evaluate new tools
• Other research priorities:
– New tools development, operational research, social
science research
Population based studies
impact of current tools
• HIV: population impact of
combined interventions in
particular diagnosis and treatment
• TB: impact of improved case finding
plus improved TB prevention (ART,
LTBI treatment)
• Malaria: feasibility of preelimination in high transmission
area
• NTDs: optimum delivery of MDA
% Parasitemia
100
90
80
70
60
50
40
30
20
10
0
1982 1992 2003 2006 2007 2008 2009 2010 2011 2012 20
<5 yrs
5-14 yrs
>15 yrs
Clinical studies
evaluation of new tools
• HIV: PoC diagnostics; various drug
trials (ARVs) and prevention trials (e.g.
vaginal ring)
• TB: diagnostic platform; various drug
trials (e.g. short course preventive
therapy, new TB drugs, TB-HIV
treatment), vaccine trials
• Malaria: low dose primaquine among
children to reduce transmission
• NTDs: PoC diagnostics schistosomiasis
Often multicentre, e.g. ACTG, TBTC
Conclusions
• Research relatively easy to translate into
health programs, if this translation is
considered in formulating research questions
• Major role for research in accelerating the
control of communicable diseases in highburden, low-income settings
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