AFRO-NETS> Calls for Applications - Schistosomiasis Control

[Dieter Neuvians MD <neuvians@mweb.co.za>]

Calls for Applications - Schistosomiasis Control
------------------------------------------------
Source: tdr-scientists@who.int

Capability strengthening initiative to support proof of principle and 
implementation research for schistosomiasis control

Call for proposals and/or letters of intent

TDR is offering support to scientists and public health workers in 
schistosomiasis endemic countries to improve their capacity to evalu-
ate and validate new tools and methods for schistosomiasis control. 
This includes the introduction of new tools and strategies under real 
field conditions faced by many control programmes. One objective of 
the initiative is to create an infrastructure for research to evalu-
ate and adapt tools for public health interventions sensitive to lo-
cal conditions. Prior experience has demonstrated that in areas where 
disease control proved effective, research was essential to monitor, 
and modify when necessary, the control interventions.

Background and objectives

The objectives of the initiative are:

* to introduce scientists and public health workers in schistosomi-
  asis endemic countries to proof of principle (POP) research to vali-
  date new and improved tools for schistosomiasis control;

* to contribute to the incorporation of new and improved tools for 
  schistosomiasis into control programmes through a 'learning by doing' 
  approach.

For proof of principle, the strategic emphases for schistosomiasis is 
to optimize the use of praziquantel in schistosomiasis control, to 
evaluate alternative treatments for schistosomiasis, and to evaluate 
the utility of available diagnostic tests in the field. For implemen-
tation research, the goal is evaluation of these interventions and 
strategies within the context of a control programme [strategic em-
phases for schistosomiasis research].

Successful letters of intent and proposals will address one of the 
following areas of the research:

I. Efficacy and safety of praziquantel (PZQ) in combination with 
other anti-schistosomal drugs.

In areas of high schistosomiasis transmission, cure rates and egg re-
duction rates following PZQ treatment have been lower than expected 
(Gryseels et al. Tropical Medicine and International Health. 2001, 
6(11):864-73). Use of artemether in combination with PZQ has been 
recommended as a possible solution (Utzinger J. et al. International 
Journal of Parasitology. 2001, 31(14):1549-62; Xiao SH. et al. Acta 
Tropica, 2002, 82:175-81). In areas of high S. mansoni transmission, 
where PZQ has been less than optimal, oxamniquine has been effica-
cious (Stelma F. et al. Journal of Infectious Diseases, 1997, 
176:304-7). The combination of oxamniquine (OXQ) and PZQ, previously 
found to be synergistic in the treatment of schistosomiasis should be 
re-examined (Pugh RN and Teesdale CH. British Medical Journal, 1983, 
13(1):877-8). Given that OXQ is less costly that artemether, it may 
be the better option for combined treatment with PZQ in high trans-
mission areas.

Successful proposals or letters of intent will be those that will 
evaluate combined treatment of schistosomiasis in comparison with PZQ 
alone at six weeks and 12 months post-treatment. The endpoints of in-
terest are egg reduction and cure rates at those time points, as well 
as tolerability of the drug regimen.

II. Evaluation of alternative regimens for praziquantel use in the 
field

In high-burden countries, with poor health infrastructure, popula-
tion-based chemotherapy is recommended, but the distribution of 
praziquantel is hampered by several factors including shortage of 
health workers, and dosage by weight. Drug distribution channels and 
mechanisms that provide high treatment coverage for target popula-
tions should be examined. Community and/or school-based distribution 
of praziquantel may result in increased coverage and impact on inten-
sity and prevalence of infection where there is a shortage of health 
workers (Magnussen P. et al. Transactions of the Royal Society of 
Tropical Medicine and Hygiene 2001, 95:58-64). Use of height to de-
termine praziquantel dosage in school age children provides an alter-
native to weight (Hall A. et al. Transactions of the Royal Society of 
Tropical Medicine and Hygiene, 1999, 93:653-8). The standard 
praziquantel dosage for the treatment of schistosomiasis is 40 mg/kg 
body weight, even though doses of 60 mg/kg have been used in differ-
ent areas (reference). Doses higher than 40 mg/kg may be optimal in 
some situations.

Outcomes of interest would be population coverage, drug tolerability, 
re-treatment cycle, as well as egg reduction and cure rates.

Where animals are reservoir hosts of schistosomiasis and contribute 
to transmission, current means of treatment are not as efficient. 
Treatment could be improved by timed-release formulations of 
praziquantel (Jiang QW. et al. Acta Tropica, 2002, 82:115-125). Along 
with egg reduction and cure rates, incidence of infection in humans 
would be an outcome of interest.

III. Develop and evaluate new or improved tools for schistosomiasis

Triclabendazole, a broad-spectrum anti-trematode drug recommended for 
the treatment of fascioliasis has some activity against schistosomi-
asis (Mansoury ST. Journal of the Egyptian Society of Parasitology 
1997, 27(1):233-41). In areas where both infections are co-endemic, 
those with double infections could be treated for fascioliasis with 
triclabendazole to examine its effect on schistosomiasis, before spe-
cific treatment for schistosomiasis. Parameters of interest would be 
tolerability, egg reduction and cure rates.

IV. Field applicability of existing diagnostic tests for schistosomi-
asis

As new diagnostic tests for schistosomiasis come on the market, sci-
entists and public health workers in endemic countries should be able 
to evaluate them under field conditions. Research on the diagnostic 
efficiency of available tests will be supported to see how they can 
be used in different endemic settings. Antibody detection systems may 
be adequate to identify transmission hot spots in low transmission 
areas, while antigen detection systems would be of utility in other 
endemic situations (van Lieshout L. et al. Acta Tropica 2000, 
77(1):69-80). It may be that some of the new diagnostic tests can be 
used for surveillance in countries of low endemicity and others for 
operational decision making in high-burden/transmission areas.

Rapid individual and community diagnosis of urinary schistosomiasis 
is now possible, with reagent dipsticks and questionnaires, respec-
tively (Lengeler C. et al. Bulletin of the World Health Organization 
2002;80(3):235-42). This is not the same for intestinal schistosomi-
asis. This initiative will support research for the rapid diagnosis 
of intestinal schistosomiasis so as to target public health interven-
tions.

The tests will be evaluated for sensitivity and specificity in en-
demic settings, from which the diagnostic efficiency can be deter-
mined.

How to apply

Full proposals

Full proposals should be submitted using the Collaborative Research 
form <http://www.who.int/tdr/grants/forms.htm> or on request from 
TDR). Applications should be submitted by e-mail, where possible, to 
<chitsulol@who.int>, under subject title <Schistosomiasis>. Only 
those full proposals received by 15 November 2002, will be reviewed.

The deadline for full proposals is 15 Nov 2002.

Applicants from the least developed countries (LDCs) may submit an 
initial letter of intent and will receive assistance from TDR to de-
velop full proposals.

Letters of intent

The following content is suggested for the letter of intent:

* Outline of proposed research project(s): PI, title, objectives, ra-
  tionale, and overall design;
* Research team / institutions involved and collaborators;
* Relationship with any ongoing programme, research project, external 
  funding;
* Proposed budget breakdown;
* No longer than 4 pages and be submitted together with a one page 
  summary CV of the Principal Investigator and a supporting letter from 
  the Institution Director.

Applications should be submitted by e-mail, where possible, to
<chitsulol@who.int>, under subject title <Schistosomiasis-letters of 
intent>.

The deadline for letters of intent is 30 July 2002.

For further information, please contact 
L Chitsulo
mailto:chitsulol@who.int

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