UNDP/World Bank/WHO

Special Programme for Research and Training in Tropical Diseases (TDR)

WORKPLAN of the TASK FORCE on OPERATIONAL RESEARCH IN FILARIASIS

Rationale

The activities of the Task Force on Operational Research in Filariasis will emphasize operational research needs in the area of lymphatic filariasis. The major challenge facing the Task Force is to consolidate available new research findings based on current and planned activities and translate them into affordable, cost-effective and sustainable strategies. The Task Force recognizes that recent developments in the area of understanding the pathogenesis and identification of hidden pathology as well as development of chemotherapy strategies now place lymphatic filariasis among the list of potentially "eradicable" diseases. In order to develop the control strategies to achieve this aim the Task Force has identified 5 major thrust areas:

Objectives

An outline of the objectives, strategies and ongoing and planned activities of the Task Force on Operational Research in Filariasis is given below.

(1) Development of rapid assessment methods for epidemiological mapping of infection and disease;

(2) Assessment of chemotherapy delivery strategies by supporting studies that will help in programme design and evaluation and studies that will assess the cost and sustainability of delivery strategies;

(3) To promote chemotherapy product development especially DEC-fortified salt;

(4) To evaluate the role of supplementary interventions such as vector control and morbidity management in control programmes; and lastly,

(5) To estimate the global clinical and socioeconomic burden of the illness which will be utilized to enhance the advocacy of the control programme.

Strategies

(1) Carry out studies to develop and evaluate rapid assessment procedures to determine the prevalence of the disease in the community and infective stages in the vectors and assess the cost-effectiveness of these approaches;

(2) Carry out studies to assess the community acceptance, cost-effectiveness and impact and process of different delivery strategies with particular emphasis on annual community chemotherapy and DEC-fortified salt;

(3) To evaluate safety and efficacy of newer drug and combinations in comparisons with DEC; to assess the safety, efficacy and delivery of iodized DEC salt and ivermectin in endemic areas and also in areas where mixed infections occur.

(4) To assess the cost-effectiveness of vector control and morbidity management in the control of lymphatic filariasis;

(5) To estimate the geographical extent, patterns and socioeconomic impact of the disease and promote studies to highlight the gender differences and the impact and? extent and accessibility of sub-clinical lymphangiopathy.

Activities

(1) Phase III and Phase IV studies using ivermectin and DEC tablets and combinations or DEC-medicated salt and vector control, where appropriate, including studies with Bacillus sphaericus, polystyrene beads and improvement of sanitation.

(2) Studies to determine the effect of ivermectin and DEC individually or in combination as well as antibiotics in preventing lymphoedema and acute filarial attacks and early chronic disease in asymptomatic and symptomatic individuals.

(3) Studies to determine the potential macrofilaricidal effects of ivermectin and other drugs.

(4) Studies to determine the microfilaricidal and macrofilaricidal effects of ivermectin and DEC (or albendazole) given together.

(5) Studies to determine the potential of DEC-medicated salt for prophylaxis and prevention of acute attacks.

(6) Field evaluation of antigen detection assays and DNA-probes for detection of infection in communities and vectors and for monitoring recrudescence.

(7) Essential studies to describe specific aspects of the dynamics of filarial infections and consequent pathogenesis.

(8) Use of existing data from various endemic areas to estimate quantitative relationships among host, pathogen and vector and to develop analytic and simulation models for lymphatic epidemiology and control.

(9) Comparative analyses of the costs and effectiveness of different control strategies under different conditions.

(10) Studies of the reliability and validity of rapid assessment procedures.

(11) Develop surveillance techniques that will permit reliable estimates of incidence and prevalence of filarial infection and disease, the public health impact and trend over time, including the global health burden of lymphatic filariasis.

(12) Assessment of socio-economic burden of disease.