Modeling tool tells when pairing responses to “big three” and neglected diseases is a win-win

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The idea of pairing responses to diseases found in the global south that are so neglected that they are classified by that word with the better-funded, but still constrained responses to the so-called “Big Three” of HIV, tuberculosis and malaria, was not new. Neither was the hope that those combined efforts could streamline infectious disease control efforts, saving money and lives in the process. Making an effort to discover in advance that the concept would work on the ground in specific cases is new.

Now, a group of researchers from Georgetown University Medical Center write, there is an app for that.

Combined interventions against infectious diseases that overlap and are endemic in regions with limited health resources, hold promise of multiplied returns on investments, particularly when one disease has the potential to increase susceptibility to another, note authors of a report published April 12 in PLOS Neglected Tropical Diseases. The most obvious opportunities for combined interventions were among diseases so prevalent in specific areas that mass distribution of medicines to prevent them, or to counter their effects, was needed. Evidence from the last 10 years has indicated that integrated responses led to greater numbers of drugs delivered, higher national coverage rates, and estimates indicating the efforts were cost effective. But the more complicated the combination  — delivering treatments for one disease, while delivering preventive measures against another for example, the greater the possibility that local factors could affect efficiencies, and dilute impacts. While computer modeling can help project whether a combined intervention will deliver results or opportunity costs, local input is needed to enter the pertinent variables, the authors write.

They describe the web-based platform they developed, and how they tested it in Decision support for evidence-based integration of disease control: A proof of concept for malaria and schistosomiasis. The two diseases, both endemic in much of sub-Saharan Africa and parts of South America, the Middle East and Southeast Asia, have similar demographic impacts where they strike, with children the most heavily burdened, and with people already infected with schistosomiasis, a disease caused by worms, more susceptible to malaria. And while malaria is one of the relatively well-funded “Big Three” diseases receiving the attention of international funders, schistosomiasis has been neglected. Information on transmission rates of the two diseases, the effectiveness of treatments for malaria and schistosomiasis as well as of insecticide treated nets and indoor residual spraying to prevent malaria transmission was already available. Variables that include prevalence of schistosomiasis, seasonal transmission rates of malaria, information on current community or regional net distribution and indoor spraying efforts are for the locals to provide, in a step-by-step flow chart. The platform returns information on outcomes with and without the combined intervention. Partners in Mali, Uganda and Yemen — all countries where both diseases are endemic — provided the feedback, confirming that the platform made the most of data, and could be further expanded to predict logistical challenges, and used for in-country advocacy for adequate resources.

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