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[afro-nets] Malaria Diagnostic Implementation Research

  • From: "Bruyere, Jocelyne M.D." <bruyerejm@WHO.INT>
  • Date: Fri, 27 Jan 2006 13:03:29 +0200

Call for letters of intent: Implementation research on rapid di-
agnostic testing in home management of malaria


Full version available at:

The UNICEF/UNDP/World Bank/WHO Special Programme for Research
and Training in Tropical Diseases (TDR) invites letters of in-
tent on implementation research to establish the role of rapid
diagnostic testing (RDT) in the context of home management of
malaria (HMM) in sub-Saharan Africa.


The HMM strategy has been developed in order to increase access
to prompt and effective antimalarial treatment by children with
uncomplicated malaria living in highly endemic areas in Africa.
The strategy is based on the assumption that a high proportion
of fever episodes are due to malaria, and seeks to improve a
frequent occurrence: mothers treating their children at home for
fever episodes ("hot body"), which is in most cases done inade-

In recent years, growing resistance to conventional antimalarial
drugs (chloroquine, sulphadoxine/pyrimethamine) has obliged many
countries to change treatment policy and adopt more efficacious
medicines, such as artemisinin-based combination therapies
(ACTs) as first-line antimalarial therapy. Concerns have been
raised with regard to the use of ACTs for antimalarial treatment
at the community level as these medicines are new and expensive,
and evidence-based delivery models are lacking. One particular
concern relates to the fact that malaria is a difficult disease
to diagnose by clinical examination only. Clinical diagnosis of
malaria may overestimate the true incidence of the disease and
lead to an excessive use of ACTs. This, in turn, could lead to
unnecessary expenditure, and facilitate the appearance of para-
site resistance to the new medicines. Therefore, some experts
have called for a more cautious use of ACTs, which should be re-
stricted to patients with a confirmed diagnosis of infection
with malaria parasites.

The use of RDT in the HMM strategy provides an opportunity to
improve diagnosis and administer targeted treatment only to
parasitologically confirmed malaria cases. However, RDT use also
has operational and financial implications. If it were to be
used routinely in the context of HMM, the well established HMM
strategy would be changed and additional costs incurred, which
may not necessarily be compensated by less use of the drugs.
Furthermore, the potential benefit of introducing RDT in terms
of improvement of clinical outcome in children, both treated and
not treated with ACTs, has to be proven. It is thus necessary to
carry out implementation research to establish the role of RDT
within the context of HMM with ACTs, based on the feasibility,
acceptability, risk-benefit and cost-effectiveness of its use at
the community level.

Objectives of the research

General objective: To establish the role of RDT in the context
of the HMM strategy with ACTs in sub-Saharan Africa.

Specific objectives

- To evaluate the impact of RDT-oriented administration of ACTs
for malaria on the clinical outcome of the disease (in terms of
proportion of cases with full clinical recovery and incidence of
complications) within the context of HMM.

- To establish the cost-effectiveness of RDT in the context of
the HMM strategy with ACTs.

- To perform a risk/benefit analysis of RDT in the context of
the HMM strategy with ACTs.

- To describe the operational feasibility, acceptability and
safety of RDT in the context of the HMM strategy with ACTs.

Terms of reference

The research objectives will be met through open, randomized
controlled studies (to be developed at a later stage), imple-
mented in close collaboration with the national malaria control

In the letter of intent, interested research groups should pro-
vide information on the following:

- Knowledge of the WHO/HMM strategy.

- Experience with community-based interventions and implementa-
tion research.

- Established links with a community or to a research site.

- Experience in performing clinical trials under GCP standards.

- Linkages and collaboration with the national malaria control

- Resources available to the research group (human, financial,

- Potential contribution towards capacity building of knowledge
and skills in the local context.

How to apply

Interested groups are invited to submit a letter of intent of no
more than 4 pages (size A4, font 12 pt.) outlining the follow-

1. Project title

2. Background and statement of the research question

3. Overall and specific objectives (1 page comprising items 1, 2
and 3)

4. Methods (1 page)

5. Estimated budget (1/2 page)

6. Relationship with any ongoing programme, research project,
network, external funding

7. Proposed principal investigator, research institution and
study team, describing compliance with the terms of reference
outlined above (1 page comprising items 6 and 7)

Letters of intent can be submitted in English or French (submis-
sions in French should include a summary in English). A CV of
the principal investigator, no longer than one page, should be

Letters of intent should be submitted as an e-mail MS-Word file
attachment (*.doc) addressed to mailto:pagnonif@who.int, with
copy to mailto:appiahagboglad@who.int, no later than 28 February

A short list of letters of intent will be selected for further
development into full proposals. Pending further confirmation,
TDR is planning to invite principal investigators of shortlisted
letters to participate in a proposal development workshop, to be
held from 24 to 28 April 2006 (tentative dates) in a venue that
will be notified later.

For additional information, please contact

Dr Franco Pagnoni
Manager, Home Management of Malaria
Implementation Research and Methods Unit
TDR, World Health Organization
Avenue Appia
1211-Geneva 27
Tel: +41-22-791-1811
Fax: +41-22-791-4774

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