A5020242502- Malaria Research and Control
- Mosquito-borne diseases and control
- Global Maternal and Child Health
- Health Policy Implementation Science
- Computational Drug Discovery Methods
- Travel-related health issues
- Primary Care and Health Outcomes
- HIV/AIDS Research and Interventions
- Health Systems, Economic Evaluations, Quality of Life
- Hepatitis B Virus Studies
- Interprofessional Education and Collaboration
- HIV Research and Treatment
- HIV, Drug Use, Sexual Risk
- Pharmaceutical Quality and Counterfeiting
- Viral Infections and Outbreaks Research
- Pharmaceutical Economics and Policy
- Hemoglobinopathies and Related Disorders
- Healthcare Systems and Reforms
- Adolescent Sexual and Reproductive Health
- Vector-borne infectious diseases
- Vaccine Coverage and Hesitancy
- Parasites and Host Interactions
- Evaluation and Performance Assessment
- Hepatitis C virus research
University of North Carolina at Chapel Hill
2021-2024
Tulane University
2024
University of North Carolina System
2023
London School of Hygiene & Tropical Medicine
2014-2021
University of London
2014-2021
Malaria Consortium
2006-2010
ACCESS Health International
2009
Access to Wholistic and Productive Living Institute
2009
Saratoga Hospital
2007
Ministry of Health
2005
ObjectivesTo compare the efficacy and safety of artemisinin combination therapies for treatment uncomplicated falciparum malaria in Uganda.DesignRandomized single-blind controlled trial.SettingTororo, Uganda, an area high-level transmission.ParticipantsChildren aged one to ten years with confirmed P. malaria.InterventionsAmodiaquine + artesunate or artemether–lumefantrine.Outcome MeasuresRisks recurrent symptomatic parasitemia at 28 days, unadjusted adjusted by genotyping distinguish...
Background Drug resistance in Plasmodium falciparum poses a major threat to malaria control. Combination antimalarial therapy including artemisinins has been advocated recently improve efficacy and limit the spread of resistance, but are expensive relatively untested highly endemic areas. We compared artemisinin-based other combination therapies four districts Uganda with varying transmission intensity. Methods Findings enrolled 2,160 patients aged 6 mo or greater uncomplicated malaria....
Abstract Reports suggest non-falciparum species are an underappreciated cause of malaria in sub-Saharan Africa but their epidemiology is ill-defined, particularly highly malaria-endemic regions. We estimated incidence and prevalence PCR-confirmed Plasmodium falciparum infections within a longitudinal study conducted Kinshasa, Democratic Republic Congo (DRC) between 2015-2017. Children adults were sampled at biannual household surveys routine clinic visits. Among 9,089 samples from 1,565...
Background In Uganda, community services for febrile children are expanding from presumptive treatment of fever with anti-malarials through the home-based management (HBMF) programme, to include malaria, diarrhoea and pneumonia Integrated Community Case Management (ICCM). To understand level support available, capacity motivation health workers deliver these expanded services, we interviewed medicine distributors (CMDs), who had been involved in HBMF programme Tororo district, shortly before...
By 2008, the WHO Pesticide Evaluation Scheme (WHOPES) recommended five long-lasting insecticidal nets (LLINs) for prevention of malaria: Olyset®, PermaNet 2.0®, Netprotect®, Duranet® and Interceptor®. Field information is available both Olyset® PermaNet®, with limited data on newer LLINs. To address this gap, a field evaluation was carried out to determine acceptability durability Interceptor® A one-year prospective study conducted in eight rural returnee villages Liberia. Households were...
Abstract Background Healthcare systems in low-resource settings need simple, low-cost interventions to improve services and address gaps care. Though routine data provide opportunities guide these efforts, frontline providers are rarely engaged analyzing them for facility-level decision making. The Systems Analysis Improvement Approach (SAIA) is an evidence-based, multi-component implementation strategy that engages use of promote systems-level thinking quality improvement (QI) efforts...
The use of combinations inexpensive drugs for the treatment malaria in Africa has been proposed as an interim policy while awaiting widespread availability more effective regimens. We compared sulfadoxine-pyrimethamine plus chloroquine or amodiaquine three districts Uganda. Patients aged 6 months greater with uncomplicated falciparum were enrolled and randomized to therapy. Safety, tolerability, efficacy outcomes, adjusted by genotyping, assessed over 28 days. Of 1,105 patients enrolled,...
Abstract Background Prompt, effective treatment of confirmed malaria cases with artemisinin-based combination therapy (ACT) is a cornerstone control. Maximizing adherence to ACT medicines key ensuring effectiveness. Methods This open-label, randomized trial evaluated caregiver co-formulated artemether–lumefantrine (AL) and fixed-dose amodiaquine–artesunate (AQAS) in Sierra Leone. Children aged 6–59 months diagnosed were recruited from two public clinics, receive AL or AQAS, visited at home...
To document the feasibility of a cross-border community based integrated malaria control programme implemented by internally displaced persons in eastern Burma/Myanmar.This pilot study was conducted from February 2003 through January 2005 seven villages ethnic Karen. Interventions comprised early diagnosis Plasmodium falciparum and treatment with mefloquine artesunate, distribution long-lasting insecticide treated nets (LLITNs), educational messages. The primary outcome measure P. prevalence...
Burma records the highest number of malaria deaths in southeast Asia and may represent a reservoir infection for its neighbors, but burden disease magnitude transmission among border populations remains unknown.Plasmodium falciparum (Pf) parasitemia was detected using HRP-II antigen based rapid test (Paracheck-Pf(R)). Pf prevalence estimated from screenings conducted 49 villages participating control program, four retrospective mortality cluster surveys encompassing sampling frame more than...
Malaria is the leading cause of death in children under 5-yr age Republic Guinea. This study aimed at investigating knowledge, attitudes and practices malaria control urban rural communities Guinea order to better target future health interventions.A cross-sectional survey 200 randomly selected households was conducted an site three villages within district Forιcariah using two semi-structured questionnaires.Only 18.5% respondents were aware role mosquitoes transmission both households....
New antimalarial regimens, including artemisinin-based combination therapies (ACTs), have been adopted widely as first-line treatment for uncomplicated malaria. Although these drugs appear to be safe and well-tolerated, experience with their use in Africa is limited continued assessment of safety a priority. However, no standardized guidelines evaluating drug tolerability malaria studies exist. A system monitoring adverse events trials conducted Uganda was developed. Here the reporting...
Abstract Background Increasing reports suggest that non-falciparum species are an underappreciated cause of malaria in sub-Saharan Africa, but their epidemiology is not well-defined. This particularly true regions high P. falciparum endemicity such as the Democratic Republic Congo (DRC), where 12% world’s cases and 13% deaths occur. Methods Findings The cumulative incidence prevalence malariae ovale spp. infection detected by real-time PCR were estimated among children adults within a...
Abstract Background Access and adherence to artemisinin-based combination therapy (ACT) are key challenges effective malaria treatment. A secondary analysis of the Sierra Leone Knowledge, Attitudes, Practices (mKAP) survey was conducted investigate access ACT for treatment fever in children under-five. Methods The mKAP a nationally representative, two-stage cluster-sample survey, 2012. Thirty primary sampling units per district were randomly selected using probability proportionate size,...
Medication adherence is an essential step in the malaria treatment cascade. We conducted a qualitative study embedded within randomized controlled trial comparing to recommended dosing of two artemisinin-based combination therapies (ACT) treat uncomplicated Freetown, Sierra Leone. This explored circumstances and factors that influenced caregiver ACT prescribed for their child trial. In-depth interviews were with 49 caregivers; all recorded, transcribed, translated. Transcripts coded...
Histidine-rich protein 2- (HRP2-) based rapid diagnostic tests (RDTs) are widely used to detect Plasmodium falciparum in sub-Saharan Africa. Reports of parasites with pfhrp2 and/or pfhrp3 (pfhrp2/3) gene deletions Africa raise concerns about the long-term viability HRP2-based RDTs. We evaluated changes pfhrp2/3 deletion prevalence over time using a 2018-2021 longitudinal study 1,635 enrolled individuals Kinshasa Province, Democratic Republic Congo (DRC). Samples collected during biannual...
Abstract Hepatitis B virus (HBV) antiviral administration and adherence are essential to reach the World Health Organization’s 2030 hepatitis elimination goals. As HBV treatment guidelines now simplified expanded, will be critical, but challenges poorly studied. After introducing tenofovir disoproxil fumarate (TDF) monotherapy expectant mothers with high-risk in Kinshasa, DRC, we conducted semi-structured interviews understand medication behaviors, complement pill counts measurement of TDF...
Purpose The Democratic Republic of Congo has one the highest burdens malaria in world, accounting for 12.3% cases and 11.6% deaths. country been scaling up various control interventions, but how burden risk factors have evolved remains unclear. This study aimed to estimate trend different settings Kinshasa Province assess contributing infection. Participants From 2018 2022, a cohort was conducted three health areas known varying endemicities: Voix du Peuple (urban), Kimpoko (peri-urban), Bu...
Abstract Background: The Systems Analysis and Improvement Approach (SAIA) is an evidence-based, multi-component implementation strategy that engages service providers in the use of routinely-available data to optimize delivery cascades promote systems-level thinking. SAIA was originally developed address bottlenecks HIV care low-and middle-income countries, but has since been adapted applied a variety systems including: cervical cancer screening, mental health treatment, hypertension...
Prevention of mother-to-child transmission (PMTCT) programs for hepatitis B virus (HBV) are critical to reach the World Health Organization's 2030 HBV elimination goals. Despite demonstrated feasibility utilizing HIV infrastructure, PMTCT not implemented in many African settings, including Democratic Republic Congo (DRC). In a previous pilot implementation DRC's capital, Kinshasa, we observed low TDF metabolite levels at delivery among women with high-risk who were given tenofovir disoproxil...
Malaria programs rely upon a variety of diagnostic assays, including rapid tests (RDTs), microscopy, polymerase chain reaction (PCR), and bead-based immunoassays (BBA), to monitor malaria prevalence support control elimination efforts. Data comparing these assays are limited, especially from high-burden countries like the Democratic Republic Congo (DRC). Using cross-sectional routine data, we compared performance Plasmodium falciparum estimates across health areas varying transmission...