KalaCORE researchers teamed up with the Liverpool School of Tropical Medicine and Rajendra Memorial Research Institute of Medical Sciences to understand insecticide resistance mechanisms and methods of best practice to avoid the development of resistance. The researchers have looked specifically at different insecticides and the utility of an insecticide rotation strategy as a sustainable method of effective vector control.
Findings from this work (expected to be published after the end of KalaCORE) will provide an evidence base that guides the future use of insecticides deployed within India’s Integrated Vector Management efforts.
Comprehensive health facility assessments of 36 facilities in Sudan were conducted at the start of the programme in 2015 and results from these assessments were used to guide facility strengthening, provision of basic equipment, drugs and diagnostics and training plans.
By 2016, each of these facilities had received equipment and a key trained contact person was nominated. Meanwhile, 23 clinics began to provide decentralized VL services in camps for South Sudanese refugees and internally displaced persons (IDPs) in the White Nile, South Kurdufan, North Darfur and South Darfur states. Seven new treatment centres (4 in Red Sea state and 3 in Kassala state) were established by March 2018 and rehabilitation of 2 VL wards in Gedarif teaching hospital and in Gedarif paediatric hospital was also initiated.
By October 2018, each of the VL treatment centres supported by KalaCORE and WHO, had at least one person trained in the last year, rapid tests and first and second line drugs available with no stock ruptures in last 3 months, VL guidelines and SOP's present, wards and a laboratory with basic standards in place.
Health facility strengthening has been largely facilitated by the clinical mentoring (CM) teams and the creation of a “Kala-azar hotline”. The CM teams have been visiting facilities to give on-site training, bedside monitoring and help address drug and diagnostic kit supply gaps, while the “Kala-azar hotline”, accessible 24/7, provides advice via mobile phones and immediate support for health personnel managing patients under treatment to.
Also, of note was the establishment of the Kala-azar Research Centre (KRC) in 2016. It is the first such centre on VL research allowing for the formation of collaborations between the University of Gedarif (UoG)(Sudan) and the University of Gondar (Ethiopia). KalaCORE M&E activities and studies on understanding access to VL care have been conducted there.
Together with partners at the Foundation for Research in Health Systems, Epicentre and Mekelle University, KalaCORE conducted research in India and Ethiopia to understand how to improve access to VL diagnostics and treatment for vulnerable groups. As a first step the research aimed to describe real or perceived barriers of access to VL diagnostic services and treatment by vulnerable groups, from the perspective of community and health care providers; followed by investigating the reasons that create such barriers. Outcomes of this research aim at providing recommendations to improve access, with an emphasis on migrants and displaced populations in Ethiopia and female patients in India.
- The study looking at gender barriers to care-seeking for visceral leishmaniasis in highly endemic districts in India is awaiting publication in spring 2019.
- The study in Ethiopia has been published and can be accessed as following:
Coulborn RM, Gebrehiwot TG, Schneider M, Gerstl S, Adera C, et al. (2018) Barriers to access to visceral leishmaniasis diagnosis and care among seasonal mobile workers in Western Tigray, Northern Ethiopia: A qualitative study. PLOS Neglected Tropical Diseases 12(11): e0006778. https://doi.org/10.1371/journal.pntd.0006778
KalaCORE teamed up with researchers from the University of Khartoum, Gedarif University and the Blue Nile Health Institute (Sudan) and University of Gondar (Ethiopia) to investigate multiple aspects of vector control in East Africa:
- Efficacy of different control measures on the vector of VL, Phlebotomus orientalis, and on transmission of visceral leishmaniasis in East Africa
- Vector bionomics and behaviour of the vector that influence the impact of these
- Acceptability of vector control tools under different cultural and socioeconomic contexts (migrant populations from Ethiopia and resident populations in Sudan).
Publications from these studies are expected after the end of the KalaCORE programme.
In parallel to pharmacovigilance, monitoring the susceptibility of Leishmania strains to anti-leishmanial drugs is key importance to achieving sustainable control.
In India, KalaCORE has worked with RMRI to set-up a national reference laboratory for drug susceptibility monitoring, assessing the susceptibility of Leishmania donovani clinical isolates to the standard anti-leishmanial drugs in current use. To ensure quality assurance of testing, cross-validation is currently underway.