Operational Research for STH
Meeting Notes
March 20, 2015
Participants
David Addiss, Children Without Worms
Roy Anderson, London Center for NTD Research
Akudo Anyanwu, Children Without Worms
Alison Bettis, London Center for NTD Research
Mark Bradley, GlaxoSmithKline
Jason Cantera, PATH
Katie Gass, NTD Support Center
Vanja Karanovic, World Food Program
Lauren Labovitz, Children Without Worms
Pat Lammie, CDC and NTD Support Center
Charles Mwandawiro, Kenya Medical Research Institute
Tala de los Santos, PATH
Helen Storey, PATH
Steve Williams, NTD Support Center and Smith College
Overview
A document was circulated which lays out the recommended activities for operational research from the STH Advisory
Committee meeting in October 2014. This will serve as the framework for today’s meeting as we look at what progress is
being made and next steps for each activity.
Updates
1. Operational research on how best to accelerate drug coverage and improve reporting in order to achieve WHO
global treatment targets for 2020 (STH AC Recommendation 3.1.3)
- Update: A protocol has been developed by the NTD Support Center to assess the use of community-based surveys
to measure school-based MDA coverage.
- Action: Looking for country partners to implement this research.
- Update: A rapid tool for monitoring coverage has been developed by the NTD Support Center and there are plans
to pilot it in a school setting.
- Related research issues:
- Understanding systematic noncompliance – and factors that motivate compliance - is critically important for
success in all NTD programs; this has not been looked at in the STH setting and should be on the agenda for
operational research in the STH field.
2. Validate in the field the utility of WHO guidelines on assessing STH drug efficacy. Develop and deploy molecular
markers to assess the potential emergence of drug resistance (STH AC Recommendation 3.2)
- Discussions are underway for research in this area; details are not available.
3. Operational research to identify and deploy new drug regimens, formulations, and drug combinations for STH
control. The results of these studies should be incorporated into ongoing epidemiologic modeling (STH AC
Recommendation 3.4)
- Update: the Swiss Tropical and Public Health Institute published the results from a study of drug combinations.
4. Operational research on the magnitude, patterns, and importance of unprogrammed deworming (STH AC
Recommendation 5.1.1)
- Update: A paper assessing unprogrammed deworming in Kibera, Kenya was published by Julie Harris and
colleagues at CDC.
- Update: The NTD Support Center is hoping to take advantage of several upcoming coverage surveys to include a
module asking about unprogrammed deworming.
o When the module is put together, it should include a question about what drugs are being used and where
they’re being accessed from.
5. Maintain and update an STH operational research matrix to assist the Committee in providing an overview of this
research. (STH AC Recommendation 6.2)
- Eric Strunz at CWW keeps an eye on the literature and will continue to update that matrix annually unless
requested more frequently.
6.
Research to refine and field-test PRC diagnostic assays as well as evaluation of programmatic costs associated with
them (STH AC Recommendation 7.1)
- Update: Since the STH Advisory Committee meeting New Orleans, additional studies of samples from Timor
showed a good distribution of the STH parasites. The comparison of PCR with Kato-Katz was excellent as far as
concordance, with more positives from PCR as expected. Quantitative PCR studies are being compared to egg
counts.
o The test is currently used for Trichuris trichiura, Ascaris lumbricoides, Strongyloides stercoralis, Necator
americanus and Ancylostoma duodenale. There is consideration for adding Schistosoma mansoni and
Ancylostoma ceylanicum (for Asia). Parasite species can be added quite easily to the PCR platform.
- Next steps: Once the current “spiking” study is complete, by the end of May, the next step would be to roll the PCR
test out in a few countries, test specimens in tandem with Kato-Katz on a much larger scale, and assess the
economics as well as the feasibility of the logistics of the PCR assay. Other issues: One of the difficulties with the
spiking study was obtaining material for the different parasites. There is concern that some of the tests might vary
in terms of effectiveness in various parts of the world because of geographically-based variation in parasite
genomes.
o If people have samples they would like to donate, Steve would like to do a study of fecal samples from
diverse geographical areas in order to look at variations at the DNA level in all of the different STH species.
Contact Steve Williams directly if interested.
7. “State of the art” review from Emory University Center for Global Safe Water on the importance of environmental
monitoring for STH control (STH AC Recommendation 7.2)
- Update: A group at Emory University has been working on a review of environmental monitoring and a manuscript
is in draft form. It will hopefully be finalized and submitted in the next few months.
8. Assess the correlation between the number of viable, fertilized eggs in the environment and human population
infection to determine if environmental monitoring can be a useful proxy, either in research or program settings, to
better understand STH transmission (STH AC Recommendation 7.2)
- Update: The Gates NTD Modeling Consortium grant was approved a few weeks ago. The investigators will meet
next week in Warwick. One day will focus on STH, on what data are available and what data we need to collect.
The results of those discussions will be open access on the web on the NTD Modeling Consortium website.
9. Continue the innovative work being done by investigators at the London Centre for NTD Research on epidemiologic
modeling of STH transmission breakpoints as well as further elucidation of R 0 for STH species and its correlation with
indicators that are measurable in field settings (STH AC Recommendation 7.3)
- The London Center for NTD is preparing a database of STH epidemiological studies and will make these available
on their website.
10. Operational research to assess - in various epidemiologic and programmatic settings - the potential rebound of STH
prevalence and intensity in persons not targeted by school-based programs as a result of the transition from
community-based LF program to school-based STH programs (STH AC Recommendation 7.4)
- Update: This operational research is underway. WHO has published the TAS-STH manual on its website.
- Action: CWW will draw attention to the new TAS-STH manual through its newsletter.
Next Steps
- The COR-NTD meeting will be held in advance of the ASTMH meeting in Philadelphia, October 22-23, 2015. Please
let David Addiss (daddiss@taskforce.org) or Pat Lammie (plammie@taskforce.org) know if you would like to use
time for breakout sessions to address critical STH-related operational research issues, or harmonize efforts or
catalyze action. Examples being considered include a session on drug resistance / assessing drug efficacy and
possibly one on STH diagnostics.
- Look forward to convening another teleconference in the next 3-4 months.