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Tun STT, Min MC, Aguas R, Fornace K, Htoo GN, White LJ, Parker DM. Human movement patterns of farmers and forest workers from the Thailand-Myanmar border. Wellcome Open Res 2023; 6:148. [PMID: 37990719 PMCID: PMC10660292 DOI: 10.12688/wellcomeopenres.16784.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 11/23/2023] Open
Abstract
Background: Human travel patterns play an important role in infectious disease epidemiology and ecology. Movement into geographic spaces with high transmission can lead to increased risk of acquiring infections. Pathogens can also be distributed across the landscape via human travel. Most fine scale studies of human travel patterns have been done in urban settings in wealthy nations. Research into human travel patterns in rural areas of low- and middle-income nations are useful for understanding the human components of epidemiological systems for malaria or other diseases of the rural poor. The goal of this research was to assess the feasibility of using GPS loggers to empirically measure human travel patterns in this setting, as well as to quantify differing travel patterns by age, gender, and seasonality among study participants. Methods: In this pilot study we recruited 50 rural villagers from along the Myanmar-Thailand border to carry GPS loggers for the duration of a year. The GPS loggers were programmed to take a time-stamped reading every 30 minutes. We calculated daily movement ranges and multi-day trips by age and gender. We incorporated remote sensing data to assess patterns of days and nights spent in forested or farm areas, also by age and gender. Results: Our study showed that it is feasible to use GPS devices to measure travel patterns, though we had difficulty recruiting women and management of the project was relatively intensive. We found that older adults traveled farther distances than younger adults and adult males spent more nights in farms or forests. Conclusion: The results of this study suggest that further work along these lines would be feasible in this region. Furthermore, the results from this study are useful for individual-based models of disease transmission and land use.
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Affiliation(s)
- Sai Thein Than Tun
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Myo Chit Min
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Ricardo Aguas
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Kimberly Fornace
- Centre for Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Gay Nay Htoo
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Lisa J. White
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Daniel M. Parker
- Department of Population Health and Disease Prevention, University of California, Irvine, CA, 92697, USA
- Epidemiology and Biostatistics, University of California, Irvine, CA, 92697, USA
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Aung YN, Tun STT, Vanisaveth V, Chindavongsa K, Kanya L. Cost-effectiveness analysis of G6PD diagnostic test for Plasmodium vivax radical cure in Lao PDR: An economic modelling study. PLoS One 2022; 17:e0267193. [PMID: 35468145 PMCID: PMC9037946 DOI: 10.1371/journal.pone.0267193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 04/04/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Plasmodium vivax (Pv) infections were 68% of the total malaria burden in Laos in 2019. The parasite causes frequent relapses, which can be prevented by primaquine (PMQ). Testing for glucose-6-phosphate-dehydrogenase (G6PD) deficiency is recommended before giving PMQ to avoid haemolysis. Because of the risk of haemolysis in G6PD intermediate deficiencies among females, Laos uses the PMQ 14-days regimen only in G6PD normal females. Among G6PD point-of-care tests, qualitative tests cannot differentiate between G6PD normal and intermediate females. Quantitative tests are required to differentiate between G6PD normal and intermediate deficiencies. However, the quantitative test lacks the cost-effectiveness evidence necessary for decision-making for large-scale adoption. This study examined the cost-effectiveness of quantitative G6PD test, with either supervised PMQ treatment or unsupervised PMQ treatment, against the usual unsupervised PMQ 8-weeks strategy. Supervised PMQ 8-weeks strategy without G6PD testing was also compared against the unsupervised PMQ 8-weeks strategy since the former had recently been adopted in malaria high burden villages that had village malaria volunteers. A budget impact analysis was conducted to understand the incremental cost and effect needed for a nationwide scale-up of the chosen strategy.
Methods
A decision tree model compared the cost-effectiveness of implementing four strategies at one health facility with an average of 14 Pv cases in one year. The strategies were unsupervised PMQ strategy, supervised PMQ strategy, G6PD test with unsupervised PMQ strategy, and G6PD test with supervised PMQ strategy. Disability Adjusted Life Years (DALYs) was the effect measure. Costs were calculated from a payer perspective, and sensitivity analyses were conducted. One Gross Domestic Product (GDP) per capita of Laos was set as the cost-effectiveness threshold. Budget impact analysis was conducted using the health facility wise Pv data in Laos in 2020.
Findings
Supervised PMQ strategy was extendedly dominated by G6PD test strategies. When compared against the unsupervised PMQ strategy, both G6PD test strategies were more costly but more effective. Their Incremental Cost-Effectiveness Ratios (ICER) were 96.72US$ for the G6PD test with unsupervised PMQ strategy and 184.86US$ for the G6PD test with supervised PMQ strategy. Both ICERs were lower than one GDP per capita in Laos. Following the sensitivity analysis, low adherence for PMQ 14 days made both G6PD test strategies less cost-effective. The lower the Pv case number reported in a health facility, the higher the ICER was. In the budget impact analysis, the expected budget need was only half a million US$ when the G6PD test rollout was discriminately done depending on the Pv case number reported at the health facilities. Indiscriminate roll out of G6PD test to all health facilities was most expensive with least effect impact.
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Affiliation(s)
- Yu Nandar Aung
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
- * E-mail:
| | - Sai Thein Than Tun
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Viengxay Vanisaveth
- Center for Malaria, Parasitology and Entomology, Ministry of Health, Vientiane, Lao PDR
| | | | - Lucy Kanya
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
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3
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Tun STT, Min MC, Aguas R, Fornace K, Htoo GN, White LJ, Parker DM. Human movement patterns of farmers and forest workers from the Thailand-Myanmar border. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.16784.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Human travel patterns play an important role in infectious disease epidemiology and ecology. Movement into geographic spaces with high transmission can lead to increased risk of acquiring infections. Pathogens can also be distributed across the landscape via human travel. Most fine scale studies of human travel patterns have been done in urban settings in wealthy nations. Research into human travel patterns in rural areas of low- and middle-income nations are useful for understanding the human components of epidemiological systems for malaria or other diseases of the rural poor. The goal of this research was to assess the feasibility of using GPS loggers to empirically measure human travel patterns in this setting, as well as to quantify differing travel patterns by age, gender, and seasonality. Methods: In this pilot study we recruited 50 rural villagers from along the Myanmar-Thailand border to carry GPS loggers for the duration of a year. The GPS loggers were programmed to take a time-stamped reading every 30 minutes. We calculated daily movement ranges and multi-day trips by age and gender. We incorporated remote sensing data to assess patterns of days and nights spent in forested or farm areas, also by age and gender. Results: Our study showed that it is feasible to use GPS devices to measure travel patterns, though we had difficulty recruiting women and management of the project was relatively intensive. We found that older adults traveled farther distances than younger adults and adult males spent more nights in farms or forests. Conclusion: The results of this study suggest that further work along these lines would be feasible in this region. Furthermore, the results from this study are useful for individual-based models of disease transmission and land use.
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Tun STT, Parker DM, Aguas R, White LJ. The assembly effect: the connectedness between populations is a double-edged sword for public health interventions. Malar J 2021; 20:189. [PMID: 33865392 PMCID: PMC8052750 DOI: 10.1186/s12936-021-03726-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 04/07/2021] [Indexed: 11/26/2022] Open
Abstract
Background Many public health interventions lead to disruption or decrease of transmission, providing a beneficial effect for people in the population regardless of whether or not they individually participate in the intervention. This protective benefit has been referred to as a herd or community effect and is dependent on sufficient population participation. In practice, public health interventions are implemented at different spatial scales (i.e., at the village, district, or provincial level). Populations, however defined (i.e., neighbourhoods, villages, districts) are frequently connected to other populations through human movement or travel, and this connectedness can influence potential herd effects. Methods The impact of a public health intervention (mass drug administration for malaria) was modelled, for different levels of connectedness between populations that have similar disease epidemiology (e.g., two nearby villages which have similar baseline malaria incidences and similar malaria intervention measures), or between populations of varying disease epidemiology (e.g., two nearby villages which have different baseline malaria incidences and/or malaria intervention measures). Results The overall impact of the interventions deployed could be influenced either positively (adding value to the intervention) or negatively (reducing the impact of the intervention) by how much the intervention units are connected with each other (e.g., how frequent people go to the other village or town) and how different the disease intensity between them are. This phenomenon is termed the “assembly effect”, and it is a meta-population version of the more commonly understood “herd effect”. Conclusions The connectedness of intervention units or populations is an important factor to be considered to achieve success in public health interventions that could provide herd effects. Appreciating the assembly effect can improve the cost-effective strategies for global disease elimination projects. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03726-x.
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Affiliation(s)
- Sai Thein Than Tun
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Nakhon Ratchasima, Thailand. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Daniel M Parker
- Department of Population Health and Disease Prevention, University of California, Irvine, USA.,Department of Epidemiology, University of California, Irvine, USA
| | - Ricardo Aguas
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Nakhon Ratchasima, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Lisa J White
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, Big Data Institute, University of Oxford, Oxford, UK
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Alahmadi A, Belet S, Black A, Cromer D, Flegg JA, House T, Jayasundara P, Keith JM, McCaw JM, Moss R, Ross JV, Shearer FM, Tun STT, Walker J, White L, Whyte JM, Yan AWC, Zarebski AE. Influencing public health policy with data-informed mathematical models of infectious diseases: Recent developments and new challenges. Epidemics 2020; 32:100393. [PMID: 32674025 DOI: 10.1016/j.epidem.2020.100393] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 04/25/2020] [Indexed: 12/16/2022] Open
Abstract
Modern data and computational resources, coupled with algorithmic and theoretical advances to exploit these, allow disease dynamic models to be parameterised with increasing detail and accuracy. While this enhances models' usefulness in prediction and policy, major challenges remain. In particular, lack of identifiability of a model's parameters may limit the usefulness of the model. While lack of parameter identifiability may be resolved through incorporation into an inference procedure of prior knowledge, formulating such knowledge is often difficult. Furthermore, there are practical challenges associated with acquiring data of sufficient quantity and quality. Here, we discuss recent progress on these issues.
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Affiliation(s)
- Amani Alahmadi
- School of Mathematics, Faculty of Science, Monash University, Melbourne, Australia
| | - Sarah Belet
- School of Mathematics, Faculty of Science, Monash University, Melbourne, Australia; Australian Research Council Centre of Excellence for Mathematical and Statistical Frontiers (ACEMS)
| | - Andrew Black
- School of Mathematical Sciences, University of Adelaide, Adelaide, Australia; Australian Research Council Centre of Excellence for Mathematical and Statistical Frontiers (ACEMS)
| | - Deborah Cromer
- Kirby Institute for Infection and Immunity, UNSW Sydney, Sydney, Australia and School of Mathematics and Statistics, UNSW Sydney, Sydney, Australia
| | - Jennifer A Flegg
- School of Mathematics and Statistics, University of Melbourne, Melbourne, Australia.
| | - Thomas House
- Department of Mathematics, University of Manchester, Manchester, UK; IBM Research, Hartree Centre, Sci-Tech Daresbury, Warrington, UK.
| | | | - Jonathan M Keith
- School of Mathematics, Faculty of Science, Monash University, Melbourne, Australia; Australian Research Council Centre of Excellence for Mathematical and Statistical Frontiers (ACEMS)
| | - James M McCaw
- School of Mathematics and Statistics, University of Melbourne, Melbourne, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
| | - Robert Moss
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Joshua V Ross
- School of Mathematical Sciences, University of Adelaide, Adelaide, Australia; Australian Research Council Centre of Excellence for Mathematical and Statistical Frontiers (ACEMS).
| | - Freya M Shearer
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Sai Thein Than Tun
- Big Data Institute, Nuffield Department of Medicine, University of Oxford, UK
| | - James Walker
- School of Mathematical Sciences, University of Adelaide, Adelaide, Australia
| | - Lisa White
- Big Data Institute, Nuffield Department of Medicine, University of Oxford, UK
| | - Jason M Whyte
- Centre of Excellence for Biosecurity Risk Analysis (CEBRA), School of BioSciences, University of Melbourne, Melbourne, Australia; Australian Research Council Centre of Excellence for Mathematical and Statistical Frontiers (ACEMS)
| | - Ada W C Yan
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
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Parker DM, Tun STT, White LJ, Kajeechiwa L, Thwin MM, Landier J, Chaumeau V, Corbel V, Dondorp AM, von Seidlein L, White NJ, Maude RJ, Nosten F. Potential herd protection against Plasmodium falciparum infections conferred by mass antimalarial drug administrations. eLife 2019; 8:e41023. [PMID: 30990166 PMCID: PMC6467567 DOI: 10.7554/elife.41023] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 03/25/2019] [Indexed: 11/13/2022] Open
Abstract
The global malaria burden has decreased over the last decade and many nations are attempting elimination. Asymptomatic malaria infections are not normally diagnosed or treated, posing a major hurdle for elimination efforts. One solution to this problem is mass drug administration (MDA), with success depending on adequate population participation. Here, we present a detailed spatial and temporal analysis of malaria episodes and asymptomatic infections in four villages undergoing MDA in Myanmar. In this study, individuals from neighborhoods with low MDA adherence had 2.85 times the odds of having a malaria episode post-MDA in comparison to those from high adherence neighborhoods, regardless of individual participation, suggesting a herd effect. High mosquito biting rates, living in a house with someone else with malaria, or having an asymptomatic malaria infection were also predictors of clinical episodes. Spatial clustering of non-adherence to MDA, even in villages with high overall participation, may frustrate elimination efforts.
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Affiliation(s)
- Daniel M Parker
- Department of Population Health and Disease PreventionUniversity of CaliforniaIrvineUnited States
| | - Sai Thein Than Tun
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical MedicineMahidol UniversityNakhon PathomThailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of MedicineUniversity of OxfordOxfordUnited kingdom
| | - Lisa J White
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical MedicineMahidol UniversityNakhon PathomThailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of MedicineUniversity of OxfordOxfordUnited kingdom
| | - Ladda Kajeechiwa
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical MedicineMahidol UniversityNakhon PathomThailand
| | - May Myo Thwin
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical MedicineMahidol UniversityNakhon PathomThailand
| | - Jordi Landier
- Institut de Recherche pour le DéveloppementUniversity of MontpellierMontpellierFrance
| | - Victor Chaumeau
- Centre for Tropical Medicine and Global Health, Nuffield Department of MedicineUniversity of OxfordOxfordUnited kingdom
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical MedicineMahidol UniversityNakhon PathomThailand
- Centre Hospitalier Universitaire de MontpellierMontpellierFrance
- Maladies Infectieuses et Vecteurs, Ecologie, Génétique, Evolution et Contrôle IRD 224-CNRS 5290UM1-UM2, Institut de Recherche pour le Développement (IRD)University of MontpellierMontpellierFrance
| | - Vincent Corbel
- Maladies Infectieuses et Vecteurs, Ecologie, Génétique, Evolution et Contrôle IRD 224-CNRS 5290UM1-UM2, Institut de Recherche pour le Développement (IRD)University of MontpellierMontpellierFrance
| | - Arjen M Dondorp
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical MedicineMahidol UniversityNakhon PathomThailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of MedicineUniversity of OxfordOxfordUnited kingdom
| | - Lorenz von Seidlein
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical MedicineMahidol UniversityNakhon PathomThailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of MedicineUniversity of OxfordOxfordUnited kingdom
| | - Nicholas J White
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical MedicineMahidol UniversityNakhon PathomThailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of MedicineUniversity of OxfordOxfordUnited kingdom
| | - Richard J Maude
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical MedicineMahidol UniversityNakhon PathomThailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of MedicineUniversity of OxfordOxfordUnited kingdom
- Harvard TH Chan School of Public HealthHarvard UniversityHarvardUnited States
| | - François Nosten
- Centre for Tropical Medicine and Global Health, Nuffield Department of MedicineUniversity of OxfordOxfordUnited kingdom
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical MedicineMahidol UniversityNakhon PathomThailand
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Tun STT, von Seidlein L, Pongvongsa T, Mayxay M, Saralamba S, Kyaw SS, Chanthavilay P, Celhay O, Nguyen TD, Tran TNA, Parker DM, Boni MF, Dondorp AM, White LJ. Towards malaria elimination in Savannakhet, Lao PDR: mathematical modelling driven strategy design. Malar J 2017; 16:483. [PMID: 29183370 PMCID: PMC5706414 DOI: 10.1186/s12936-017-2130-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 11/23/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The number of Plasmodium falciparum malaria cases around the world has decreased substantially over the last 15 years, but with the spread of resistance against anti-malarial drugs and insecticides, this decline may not continue. There is an urgent need to consider alternative, accelerated strategies to eliminate malaria in countries like Lao PDR, where there are a few remaining endemic areas. A deterministic compartmental modelling tool was used to develop an integrated strategy for P. falciparum elimination in the Savannakhet province of Lao PDR. The model was designed to include key aspects of malaria transmission and integrated control measures, along with a user-friendly interface. RESULTS Universal coverage was the foundation of the integrated strategy, which took the form of the deployment of community health workers who provided universal access to early diagnosis, treatment and long-lasting insecticidal nets. Acceleration was included as the deployment of three monthly rounds of mass drug administration targeted towards high prevalence villages, with the addition of three monthly doses of the RTS,S vaccine delivered en masse to the same high prevalence sub-population. A booster dose of vaccine was added 1 year later. The surveillance-as-intervention component of the package involved the screening and treatment of individuals entering the simulated population. CONCLUSIONS In this modelling approach, the sequential introduction of a series of five available interventions in an integrated strategy was predicted to be sufficient to stop malaria transmission within a 3-year period. These interventions comprised universal access to early diagnosis and adequate treatment, improved access to long-lasting insecticidal nets, three monthly rounds of mass drug administration together with RTS,S vaccination followed by a booster dose of vaccine, and screening and treatment of imported cases.
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Affiliation(s)
- Sai Thein Than Tun
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - Lorenz von Seidlein
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, Oxford, UK
| | - Tiengkham Pongvongsa
- Savannakhet Provincial Health Department, Phonsavangnuea Village, Kaysone-Phomvihan District, Savannakhet, Lao People's Democratic Republic
| | - Mayfong Mayxay
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, Oxford, UK.,Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Vientiane, Lao People's Democratic Republic.,Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao People's Democratic Republic
| | - Sompob Saralamba
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Shwe Sin Kyaw
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Phetsavanh Chanthavilay
- Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao People's Democratic Republic.,Institute of Francophonie for Tropical Medicine, Vientiane, Lao People's Democratic Republic
| | - Olivier Celhay
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Tran Dang Nguyen
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
| | - Thu Nguyen-Anh Tran
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
| | - Daniel M Parker
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, Thailand
| | - Maciej F Boni
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, Oxford, UK.,Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.,Department of Biology, Pennsylvania State University, University Park, PA, USA
| | - Arjen M Dondorp
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, Oxford, UK
| | - Lisa J White
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, Oxford, UK
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8
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Tun STT, Lubell Y, Dondorp AM, Fieldman T, Tun KM, Celhay O, Chan XH, Saralamba S, White LJ. Identifying artemisinin resistance from parasite clearance half-life data with a simple Shiny web application. PLoS One 2017; 12:e0177840. [PMID: 28531230 PMCID: PMC5439677 DOI: 10.1371/journal.pone.0177840] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 05/03/2017] [Indexed: 11/19/2022] Open
Abstract
The emergence of artemisinin-resistant Plasmodium falciparum malaria is a major threat to malaria elimination. New tools for supporting the surveillance of artemisinin resistance are critical for current and future malaria control and elimination strategies. We have developed an open-access, user-friendly, web-based tool to analyse parasite clearance half-life data of P. falciparum infected patients after treatment with artemisinin derivatives, so that resistance to artemisinin can be identified. The tool can be accessed at bit.ly/id_artemisinin_resistance.
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Affiliation(s)
- Sai Thein Than Tun
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- * E-mail:
| | - Yoel Lubell
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Arjen M. Dondorp
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Tom Fieldman
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Kyaw Myo Tun
- Defence Services Medical Academy, Yangon, Myanmar
| | - Olivier Celhay
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Xin Hui Chan
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Sompob Saralamba
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Lisa J. White
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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Thiha N, Chinnakali P, Harries AD, Shwe M, Balathandan TP, Thein Than Tun S, Das M, Tin HH, Yi Y, Babin FX, Lwin TT, Clevenbergh PA. Is There a Need for Viral Load Testing to Assess Treatment Failure in HIV-Infected Patients Who Are about to Change to Tenofovir-Based First-Line Antiretroviral Therapy? Programmatic Findings from Myanmar. PLoS One 2016; 11:e0160616. [PMID: 27505228 PMCID: PMC4978485 DOI: 10.1371/journal.pone.0160616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 07/01/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND WHO recommends that stavudine is phased out of antiretroviral therapy (ART) programmes and replaced with tenofovir (TDF) for first-line treatment. In this context, the Integrated HIV Care Program, Myanmar, evaluated patients for ART failure using HIV RNA viral load (VL) before making the change. We aimed to determine prevalence and determinants of ART failure in those on first-line treatment. METHODS Patients retained on stavudine-based or zidovudine-based ART for >12 months with no clinical/immunological evidence of failure were offered VL testing from August 2012. Plasma samples were tested using real time PCR. Those with detectable VL>250 copies/ml on the first test were provided with adherence counseling and three months later a second test was performed with >1000 copies/ml indicating ART failure. We calculated the prevalence of ART failure and adjusted relative risks (aRR) to identify associated factors using log binomial regression. RESULTS Of 4934 patients tested, 4324 (87%) had an undetectable VL at the first test while 610 patients had a VL>250 copies/ml. Of these, 502 had a second VL test, of whom 321 had undetectable VL and 181 had >1000 copies/ml signifying ART failure. There were 108 who failed to have the second test. Altogether, there were 94% with an undetectable VL, 4% with ART failure and 2% who did not follow the VL testing algorithm. Risk factors for ART failure were age 15-24 years (aRR 2.4, 95% CI: 1.5-3.8) compared to 25-44 years and previous ART in the private sector (aRR 1.6, 95% CI: 1.2-2.2) compared to the public sector. CONCLUSIONS This strategy of evaluating patients on first-line ART before changing to TDF was feasible and identified a small proportion with ART failure, and could be considered by HIV/AIDS programs in Myanmar and other countries.
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Affiliation(s)
- Nay Thiha
- International Union Against Tuberculosis and Lung Disease, Mandalay, Myanmar
- * E-mail:
| | - Palanivel Chinnakali
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Anthony D. Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Myint Shwe
- National AIDS program, Department of Health, Nay Pyi Taw, Myanmar
| | | | | | - Mrinalini Das
- Medécins sans Frontières, Doctors without borders-OCB, Mumbai, India
| | - Htay Htay Tin
- National Health Laboratory, Department of Health, Yangon, Myanmar
| | - Yi Yi
- Public Health Laboratory, Department of Health, Mandalay, Myanmar
| | | | - Thi Thi Lwin
- National Health Laboratory, Department of Health, Yangon, Myanmar
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Thida A, Tun STT, Zaw SKK, Lover AA, Cavailler P, Chunn J, Aye MM, Par P, Naing KW, Zan KN, Shwe M, Kyaw TT, Waing ZH, Clevenbergh P. Retention and risk factors for attrition in a large public health ART program in Myanmar: a retrospective cohort analysis. PLoS One 2014; 9:e108615. [PMID: 25268903 PMCID: PMC4182661 DOI: 10.1371/journal.pone.0108615] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 09/01/2014] [Indexed: 11/28/2022] Open
Abstract
Background The outcomes from an antiretroviral treatment (ART) program within the public sector in Myanmar have not been reported. This study documents retention and the risk factors for attrition in a large ART public health program in Myanmar. Methods A retrospective analysis of a cohort of adult patients enrolled in the Integrated HIV Care (IHC) Program between June 2005 and October 2011 and followed up until April 2012 is presented. The primary outcome was attrition (death or loss-follow up); a total of 10,223 patients were included in the 5-year cumulative survival analysis. Overall 5,718 patients were analyzed for the risk factors for attrition using both logistic regression and flexible parametric survival models. Result The mean age was 36 years, 61% of patients were male, and the median follow up was 13.7 months. Overall 8,564 (84%) patients were retained in ART program: 750 (7%) were lost to follow-up and 909 (9%) died. During the 3 years follow-up, 1,542 attritions occurred over 17,524 person years at risk, giving an incidence density of 8.8% per year. The retention rates of participants at 12, 24, 36, 48 and 60 months were 86, 82, 80, 77 and 74% respectively. In multivariate analysis, being male, having high WHO staging, a low CD4 count, being anaemic or having low BMI at baseline were independent risk factors for attrition; tuberculosis (TB) treatment at ART initiation, a prior ART course before program enrollment and literacy were predictors for retention in the program. Conclusion High retention rate of IHC program was documented within the public sector in Myanmar. Early diagnosis of HIV, nutritional support, proper investigation and treatment for patients with low CD4 counts and for those presenting with anaemia are crucial issues towards improvement of HIV program outcomes in resource-limited settings.
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Affiliation(s)
- Aye Thida
- The Union Office in Myanmar, International Union Against Tuberculosis and Lung Disease, Mandalay, Myanmar
- * E-mail:
| | - Sai Thein Than Tun
- The Union Office in Myanmar, International Union Against Tuberculosis and Lung Disease, Mandalay, Myanmar
| | - Sai Ko Ko Zaw
- The Union Office in Myanmar, International Union Against Tuberculosis and Lung Disease, Mandalay, Myanmar
| | - Andrew A. Lover
- Infectious Diseases Programme, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Jennifer Chunn
- Maths and Statistics Help Centre, James Cook University, Singapore
| | - Mar Mar Aye
- Medical Care Division, Department of Health, Mandalay, Myanmar
| | - Par Par
- Medical Care Division, Department of Health, Mandalay, Myanmar
| | - Kyaw Win Naing
- Medical Care Division, Department of Health, Mandalay, Myanmar
| | - Kaung Nyunt Zan
- Medical Care Division, Department of Health, Mandalay, Myanmar
| | - Myint Shwe
- National AIDS Program, Department of Health, Nay Pyi Taw, Myanmar
| | - Thar Tun Kyaw
- Disease Control Division, Department of Health, Nay Pyi Taw, Myanmar
| | - Zaw Htoon Waing
- The Union Office in Myanmar, International Union Against Tuberculosis and Lung Disease, Mandalay, Myanmar
| | - Philippe Clevenbergh
- The Union Office in Myanmar, International Union Against Tuberculosis and Lung Disease, Mandalay, Myanmar
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Zaw SKK, Tun STT, Thida A, Aung TK, Maung W, Shwe M, Aye MM, Clevenbergh P. Prevalence of hepatitis C and B virus among patients infected with HIV: a cross-sectional analysis of a large HIV care programme in Myanmar. Trop Doct 2013; 43:113-5. [PMID: 23800421 DOI: 10.1177/0049475513493416] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Co-infection with the hepatitis C virus (HCV) and/or hepatitis B virus (HBV) influences the morbidity and mortality of patients with HIV. A cross sectional analysis was of 11,032 HIV-infected patients enrolled in the Integrated HIV Care Program from May 2005 to April 2012 and Epi-info 3.5 was used to determine the serological prevalence of chronic hepatitis B and hepatitis C. The mean ± standard deviation age of patients was 36 ± 8.4 years (adult cohort) and 7 ± 3 years (paediatric cohort). The sero prevalence of hepatitis B surface antigen, hepatitis C (anti HCV antibodies) and triple infection are 8.7%, 5.3% and 0.35%, respectively. Men who have sex with men are at the highest risk of being co-infected with hepatitis B while intravenous drug users are at the highest risk of being co-infected with hepatitis C. It is important to screen for hepatitis B and C in HIV infected people in order to provide quality care for HIV patients with co-infection.
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Affiliation(s)
- Sai Ko Ko Zaw
- International Union Against Tuberculosis and Lung Disease, Mandalay, Myanmar
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