This is the 3rd, 5-year collaborative agreement between CDC's Malaria Branch and the Liverpool School of Tropical Medicine (LSTM). The proposed research strategy follows the objectives outlined in the FOA and involves 4 themes: a) Operational research (OR) related to malaria transmission reduction, b) OR to identify novel or improved interventions for children with severe malarial anaemia and pregnant women, c) Maximising the public health impact by supporting translation of global policies for the control of malaria in pregnancy to country level policies through information exchange (3.1), and d) Strengthening research capacity of the overseas partners in Kenya, Malawi and Indonesia by provision of individual level PhD and post-doctoral studentships and group courses (5.1). Malaria transmission reduction OR activities take place under the umbrella of the long-term collaboration between the Kenya Medical Research Institute (KEMRI) and CDC in Kenya. LSTM will work with CDC to provide technical support to KEMRI to build the information infrastructure needed to track malaria transmission intensity and progress towards malaria control targets, including the rational development of large-scale entomological monitoring systems in situations with declining vector densities, increased outdoor biting and vector resistance to the commonly used insecticides (1.1), support the development of enhanced semi-automated routine surveillance systems with scannable registers, and conduct continuous malaria indicator surveys for real- time monitoring of the case-burden and infection prevalence (4.1). LSTM will support CDC to develop the concept and seek funding for proof-of-principle studies that determine the safety, feasibility and effectiveness of mass-drug administration with antimalarials when combined with indoor residual spraying (2.1). It will support dose finding studies with primaquine and ivermectin that aim to identify adjunct therapies to enhance the impact of mass drug administration (MDA) (2.2), and support the economic evaluation of different interventions and surveillance methods as part of the transmission reduction activities (2.3). Studies in high risk groups includes research to improve adherence to malaria case-management guidelines in pregnancy in western Kenya (1.2) and three large multi-centre trials including one on the prevention of rebound admissions and deaths with post-discharge malaria chemoprevention in children with severe anaemia in Kenya (2.4) and two on the control of malaria in pregnancy: STOPMiP-Indonesia (2.6), STOPMIP2 in Kenya and Malawi (2.5) evaluating the safety and efficacy of intermittent preventive therapy with dihydroartemisinin-piperaquine.
The aim of the proposed collaboration is to improve the use of existing interventions and to explore new ways to reduce the burden of malaria in high risk groups such as young children and pregnant women. In addition it aims to explore the effect of different combinations of area-wide interventions to reduce malaria transmission and to evaluate surveillance tools that can measure the beneficial impact on populations in terms of health, household level wealth and quality of health service delivery. These are high priority objectives of the partner institutions in Kenya, Malawi and Indonesia and align with the objective of CDC's Division of Parasitic Diseases and Malaria of the Center for Global Health to refine malaria interventions and develop new tools to stay ahead of the curve and ensure its global investments continue to be successful.
