Entomological Surveillance Planning Tool (ESPT) New Challenges, New Tools in Vector Control Workstream, RBM VCWG February 8, 2018 Mövenpick, Geneva

Transcription

1 Entomological Surveillance Planning Tool (ESPT) New Challenges, New Tools in Vector Control Workstream, RBM VCWG February 8, 2018 Mövenpick, Geneva

2 Before DDT, malariologists were trained to be problem solvers; after DDT malariologists were trained to be solution implementers. -José Najera, former WHO epidemiologist 2

3 An entomological surveillance planning tool (ESPT) is being developed to support problem solving and vector control decision making 3

4 Rationale why an ESPT? 1. Based on country demand 2. Lack of consolidated operational guidance for entomological surveillance 3. Growing need among programs for deeper understanding of transmission dynamics and gaps in protection to inform response 4. Efficient and ethical entomology and vector control more important than ever 4

5 Objectives of the ESPT 1. To support gap-filling in operational guidance for entomological surveillance 2. To align with and operationalize global normative guidance 3. To develop minimum essential entomological indicators to generate data that are actionable and collectable 4. To support national malaria programs in making evidence-based decisions on vector control 5. To deepen the integration of entomological and epidemiological surveillance and response 5

6 Entomological Surveillance Working Group (ESWG) 6

7 What is the ESPT (1/3) Site selection 7 Indicators Sampling methods Minimum essential indicators (all should be documented by vector species, site, and date of collection) Supplementary indicators (all should be documented by vector species, site, and date of collection) Indicator Calculation Indicator Calculation Vector species (species composition) Larval habitats Receptivity Seasonality (of transmission) Endophagy versus exophagy / Biting location Biting time Indoor resting density # Anopheles vector species / Total Anopheles collected / unit time # habitats with Anopheles vector larvae / Total habitats inspected / unit time Presence of Anopheles vector species (yes/no) and other ecological characteristics (see Glossary) Calendar months of predictable highs and lows of malaria transmission, if applicable, and often correlated with vector and rainfall data; used to measure changes in vector populations over time and by season # Anopheles collected feeding/landing (or proxy) indoor or outdoor / Total collected indoor + total collected outdoor (using same methods) # Anopheles collected feeding/landing (or proxy) by unit time # female anophelines caught resting indoor / Total houses Sporozoite rate (higher transmission only) Entomological inoculation rate (EIR) (higher transmission only) Host preference Human blood index Intensity of insecticide resistance Human behaviors High risk populations # sporozoite positive Anopheles / Total Anopheles tested Anopheles human biting rate x sporozoite rate # Anopheles collected feeding/landing on (or proxy) animals or humans / Total collected feeding/landing on(or proxy) animals + humans # Anopheles with human blood (bloodfed on humans) / Total bloodfed Anopheles collected # dead Anopheles tested / Total Anopheles exposed to 5xDC or 10xDC Methods dependent. Example: time points (e.g. 18:00-19:00 when humans are exposed outdoors unprotected to mosquitoes) Methods dependent. Example: individuals Additional datasets for integrated analysis Malaria incidence Index case investigation (as available) Rainfall and temperature Timing of vector control interventions Land usage Vulnerability ACT and RDT stocks Available budget

8 What is the ESPT (2/3) Operational guidance through the use of decision trees Baseline surveys what are the vectors in my country/district/etc. and what are their programmatically relevant behaviors and susceptibility to interventions? Routine sentinel surveys how are my vectors changing over time? Are my interventions working? Focus investigation what entomology should I do in a focus investigation in response to the trigger of an index case? Other key programmatic questions: what is driving this outbreak? What should I monitor to prevent reestablishment of transmission? 8

9 What is the ESPT (3/3) Linking these investigations Vector species identification Time and place of biting Resting habits Host preference Insecticide resistance & bioefficacy of vector control interventions Larval habitat characterization With these investigations Case investigations Human behavior High risk populations And with these datasets Malaria incidence Rainfall and temperature ACT stocks Land usage Vulnerability Timing of interventions Available budget Using the appropriate sampling method Analysis Interpretation Response options and considerations 9

10 Iterative process to evidence-based decision making Look at your data Analyze and respond Collect data Target audience is NMCPs decision-makers and entomology/vector control implementers And program partners Identify your question Formulate your hypothesis Develop plan and protocol 10

11 Potential use cases Annual entomological surveillance planning and protocol development Capacity gap analysis Training framework on entomological surveillance Program-oriented transmission investigations Field and laboratory data collection Integrated data analysis Intervention evaluations Others? 11

12 Vector bionomics and interventions Behavior Behavior Anopheles Species Vector Species Changes in Composition Intervention Intervention IRS Larval Bionomics Seasonality / Population dynamics ITN Biting Behaviors Place Larval Control Changes in Behavior Resting Behaviors Time Spatial Repellants Endectocides Host preference Insecticide Resistance Emergence and Spread 12

13 Pilot sites + others TBD? 13

14 Outcomes of interest from pilot evaluations Primary: ESPT-triggered vector control decision-making Secondary: Acceptability and utility of the ESPT Cost per indicator in the ESPT Capacity for entomological surveillance Coverage of vector control interventions Knowledge of local vector bionomics and control Prioritization of minimum essential indicators Technical, operational, and financial feasibility of the ESPT 14

15 Thank you! For questions, please contact Allison Tatarsky, Associate Director for Vector Control at the UCSF Global Health Group Malaria Elimination Initiative 15

16 The UCSF Global Health Group s Malaria Elimination Initiative (MEI) accelerates progress towards malaria elimination in countries and regions that are paving the way for global malaria eradication. 16