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IRM
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Rationale
Many
examples can be given of potentially effective disease control
products that have had only limited impact on the burden of
disease because of inadequate implementation resulting in poor
access. Some examples are:
-
Insecticide-treated
nets. These have proved difficult to implement on a large
scale and only a fraction of African children at risk have
access.
-
Antimalarials.
Those available have the potential to greatly reduce child
mortality in Africa, but less than 10% of children with symptoms of malaria have
access to appropriate treatment within 24 hours of onset of fever.
-
Prompt delivery of antimalarial
drugs at the household and community levels. Measures such as
training of shopkeepers and innovative packaging of antimalarial
drugs have been shown to improve child survival but have not yet
been implemented on a large scale.
-
Home management of febrile
illness. Studies suggest this can improve child survival but it is
not yet implemented on a large scale.
-
Praziquantel. This drug was a
breakthrough for schistosomiasis control but treatment coverage
remains poor.
-
Single-dose DEC and ivermectin.
These drugs were shown to be effective for large-scale treatment
of lymphatic filariasis but it is proving difficult to achieve a
sufficiently high treatment coverage to ensure elimination of
transmission.
-
Simple interventions based on
local hygiene with soap and water. These can greatly reduce the
suffering of patients with elephantiasis, but it is not evident
how to ensure effective access to this intervention on a large
scale.
All the above products have failed to have their full potential
impacts because of major implementation problems. It is now agreed
that research should not stop after providing the proof of
principle for a product, or after demonstrating its effectiveness
in selected situations, but that it has an additional critical
role to play in helping to solve major implementation problems.
Experience by TDR and others has shown that implementation
research can make a major difference and can help ensure that
proven control products have the intended health impact; examples
include community-directed treatment for onchocerciasis and home
management for uncomplicated malaria. Examples like these used to
be exceptions but, under its new strategy, TDR is addressing
implementation research as an integral part of the research
process. The Programme supports implementation research for proven
control products that are presently available, and implementation
research on new products that would have a significant impact on
disease burden if access were assured, such as rectal artesunate
for malaria or miltefosine for leishmaniasis. |
