Towards Elimination of Visceral Leishmaniasis in the Indian Subcontinent—Translating Research to Practice to Public Health

Citation: Hirve S, Kroeger A, Matlashewski G, Mondal D, Banjara MR, Das P, et al. (2017) Towards elimination of visceral leishmaniasis in the Indian subcontinent—Translating research to practice to public health. PLoS Negl Trop Dis 11(10): e0005889. https://doi.org/10.1371/journal.pntd.0005889
Published: October 12, 2017

Abstract
Background: The decade following the Regional Strategic Framework for Visceral Leishmaniasis (VL) elimination in 2005 has shown compelling progress in the reduction of VL burden in the Indian subcontinent. The Special Programme for Research and Training in Tropical Diseases (TDR), hosted by the World Health Organization (WHO) and other stakeholders, has coordinated and financed research for the development of new innovative tools and strategies to support the regional VL elimination initiative. This paper describes the process of the TDR’s engagement and contribution to this initiative.
Methodology/principal findings: Multiple databases were searched to identify 152 scientific papers and reports with WHO funding or authorship affiliation around the following 3 framework strategies: detection of new cases, morbidity reduction, and prevention of infection. TDR has played a critical role in the evaluation and subsequent use of the 39-aminoacid–recombinant kinesin antigen (rK39) rapid diagnostic test (RDT) as a confirmatory test for VL in the national program. TDR has supported the clinical research and development of miltefosine and single-dose liposomal amphotericin B as a first-line treatment against VL. TDR has engaged with in-country researchers, national programme managers, and partners to generate evidence-based interventions for early detection and treatment of VL patients. TDR evaluated the quality, community acceptance, and cost effectiveness of indoor residual spraying, insecticide-treated bed nets, insecticide-impregnated durable wall linings, insecticidal paint, and environmental management as tools for integrated vector management in reducing sandfly density.
Conclusions/significance: TDR’s engagement with country policy makers, scientists, and clinicians in the development of effective diagnosis, treatment, case detection, and vector control represents an important example of TDR’s stewardship toward the elimination of VL in the Indian subcontinent.

Author summary: Since the early days of the kala-azar elimination programme in the Indian subcontinent, TDR has engaged with national control and research institutions to conduct research aimed at informing country policy and practice to identify and treat cases and to prevent transmission of the infection. This includes the evaluation of the rK39 rapid diagnostic test for the diagnosis of VL, the clinical development and evaluation of first-line treatments (miltefosine and liposomal amphotericin B), the generation of evidence-based tools for early detection and complete clinical management of VL, the evaluation of the cost effectiveness of indoor residual spraying, insecticide-treated bed nets, insecticide-impregnated durable wall linings, and environmental vector management as tools for integrated vector management. The interaction and interdependence between implementation research, technical advice, partnership, and policy is yet another example of TDR’s stewardship contribution and empowerment toward VL elimination in the Indian subcontinent. Continuing investment in translational research from the bench to the bedside to public health, established jointly by national control programmes, academics, and TDR coordinators, is imperative to block transmission and prevent a resurgence of VL in the future.

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