Documenting a research partnership model to eliminate visceral leishmaniasis
The positive impact of tightly integrating research with control has been documented in the campaign to eliminate visceral leishmaniasis on the Indian sub-continent. A PLOS NTD paper analysing the output of TDR’s long-term research commitments provides lessons learnt in how to make a major impact.
About 147 million people are at risk of visceral leishmaniasis (VL), also known as kala-azar in the Southeast Asian region. It is transmitted to humans through the bite of infected sandflies, affecting internal organs such as the liver and spleen. VL is fatal if not treated.
In 2005, the ministers of health of Bangladesh, India, and Nepal committed to eliminate VL by 2015 – defined as less than 1 case in 10,000 inhabitants at uphazilla, block, or district level, respectively. A 2007 World Health Assembly resolution mandated WHO to lead technical assistance, and TDR played a critical role in developing new approaches and tools through research, working closely with the countries and communities.
Since then, VL cases have reduced by more than 75% in the Indian subcontinent. In Nepal all of the 12 previously endemic districts have achieved VL elimination since 2013 and maintained the elimination status thereafter; Bangladesh is set to reach the elimination target this year, and India has only 15% of the VL-endemic blocks above the target.
What worked to create this achievement
The PLOS NTD paper focuses on the knowledge generated through research, which in turn translated to practice and public health. It analysed 3 framework strategies: detection of new cases, morbidity reduction, and prevention of infection. TDR was found to play a critical role in all 3 through the following:
- Conducted the evaluation and subsequent use of the rK39 rapid diagnostic test (RDT) as a point-of-care test to confirm VL in the national program.
- Supported the clinical research and development of miltefosine and single-dose liposomal amphotericin B, which became first-line treatment against VL.
- Engaged with in-country researchers, national programme managers, and partners to generate evidence-based interventions for early detection and treatment of VL patients.
- Evaluated the quality, community acceptance, and cost effectiveness of indoor residual spraying, insecticide-treated bed nets, insecticide-impregnated durable wall linings, insecticidal paint, and environmental management as tools for integrated vector management in reducing sandfly density.
Disease elimination challenges
There are more disease elimination campaigns underway than ever in history – for malaria, tuberculosis, HIV – the list increases regularly. These require major political, scientific and community efforts.
One of the challenges is to maintain these commitments over long time periods, and revise strategies and tools at the very end, when the per unit cost of prevention and treatment is high because there are fewer people at risk. This is as critical a period as the earlier ones.
For example, despite the success, VL remains in some highly endemic areas, and new outbreaks have occurred in other areas that have not had transmission, so the TDR research network is continuing its work.
The PLOS NTD paper offers a compelling model for these campaigns, showing how a broad network like what was created that includes local, regional, national and international support and commitments can have a major impact.
For more information, contact Dr Piero Olliaro.