Project: Impact of increased praziquantel frequency on childhood fibrosis in persistent schistosomiasis morbidity hotspots

Acronym	FibroScHot (Reference Number: RIA2017NIM-1842)
Duration	01/08/2018 - 31/07/2022
Project Topic	Severe schistosomiasis is a devastating neglected infectious disease (NID). Without control and disease management strategies, sufferers with the manifestion of periportal fibrosis can develop portal hypertension, in its severest form causing death through haematemasis. Mass Drug Administration (MDA) programmes are the corner-stone of international efforts to control schistosomiasis as a public health problem. Uganda was at the forefront of the treatment vanguard, first administering MDA in 2003. Amongst the communities first treated were those residing on the shores of Lake Albert, an area historically with high rates of periportal fibrosis. Our recent screens of school-children in these fishing communities show that despite concerted efforts and reported community treatment coverage rates of near 80%, infection intensities are very high and periportal fibrosis common place. There is a major need for alternative strategies for these hotspots if we are to meet the aims of Sustainable Development Goal 3: Ensure health lives and promote well being for all at all ages”. For rapid uptake into national and international policy these interventions need to be built upon existing control structures and be relatively easy to facilitate. In lower transmission areas MDA is targeted at school-children, combining the epidemiological knowledge that this age-group suffers the greatest burden of infection with easier implementation. We therefore propose that increasing praziquantel treatment frequency within the school-structure, in addition to annual community MDA, will be an effective disease control strategy in hotspots of schistosomiasis morbidity. At the core of this proposal is a superiority randomised intervention trial that asks the question: Does increased treatment frequency reduce the prevalence of childhood periportal fibrosis in hotspots of persistant schistosomiasis? A combination of statistical and mathematical analysis will provide the greatest evidence base from the trial for impact. The consortium members have the research and advisory networks to ensure maximum impact is achieved. Trial results will be disseminated to national, regional and international policy makers and to a multi-disciplinary neglected infectious disease (NID) research community, while communication and open access data policies will ensure a wider reach. The proposed clinical trial oversight structure is designed to leave an integrated trial platform between Makerere University School of Public Health and Ministry of Health – Vector Control Division (MoH-VCD), increasing NID clinical trial capacity within Uganda; while multi-disciplinary exploratory analysis in anthropology, parasite genomics and immunology are integrated to build capacity within the Uganda NID research network for support of future NID clinical trials.
Network	EDCTP2
Call	Targeting control and elimination of NIDs through product-focused implementation research

Project partner

Number	Name	Role	Country
1	The Chancellor, Masters and Scholars of the University of Cambridge	Coordinator	United Kingdom
3	Cambridge University Hospitals NHS Foundation Trust	Partner	United Kingdom
5	Genome Research Limited	Partner	United Kingdom
7	Kobenhavns Universitet	Partner	Denmark
9	London School of Hygiene and Tropical Medicine	Partner	United Kingdom
11	Makerere University	Partner	Uganda
13	Ministry of Health - Uganda	Partner	Uganda
15	The Royal Veterinary College University of London	Partner	United Kingdom