Project: Alternative treatment strategies using anti-wolbachial drugs to accelerate elimination of onchocerciasis and lymphatic filariasis

Acronym ASTAWOL (Reference Number: TMA2018SF-2451)
Duration 01/01/2020 - 31/12/2024
Project Topic Background: The achievements of onchocerciasis and lymphatic filariasis (LF) mass drug administration (MDA) programmes have considerably reduced transmission and led to the formulation of the goal to eliminate these diseases. The development and implementation of new drugs or improved regimens will increase cost effectiveness by avoiding unnecessary treatments of uninfected individuals within the MDA schemes. This is needed in “end-game” scenarios when switching from MDA to a “Test and Treat” scheme. A major problem with the current MDA is that the drugs have limited efficacy against adult worms and do not permanently stop microfilarial production. The bacterial endosymbiont Wolbachia in most filarial worms is essential for the survival of the worms. In a pre-clinical trial, a combination of antiwolbachial drug, Rifampicin and Albendazole produced substantial synergy, and this synergy leads to long-term sterilizing effects and reduced treatment course to 7 days, and mediated an accelerated macrofilaricidal effect. As there is a lack of critical mass of scientists in neglected tropical diseases (NTDs) we also propose to expand capacity through this research programme. SCIENTIFIC AIMS: The main objective is to show efficacy of the combination of Rifampicin plus Albendazole using PCR and immunohistology compared to treatment with doxycycline or ivermectin alone. DEVELOPMENTAL AIMS: Embedded in the scientific proposal, there are strong development aims to be delivered by training world class research scientists using the train the trainer model, which builds upon previous work to enable progression to the next level. The core aim is to spread expertise in research methodologies, statistics, research governance and administration and laboratory skills. STUDY DESIGN: A prospective randomized, Phase II, monocenter open-label, parallel-group, international study of 35mg/kg/d Rifampicin plus 400mg Albendazole for 7 days or 14 days compared to 28 days of doxycycline or ivermectin. PRIMARY ENDPOINT Proportions of living female worms with normal vs. interrupted embryogenesis assessed by histology or PCR after 20 months. SECONDARY ENDPOINTS Proportion of study participants with absence of microfilariae in the skin or blood, assessed 4-6 and 20 months compared to pre-treatment. IMPACT If treatment proves successful, it will shorten the duration of treatment of filariasis which could help eliminate filariasis in Africa. This project will help maintain my ability to initiate, design, plan and execute a complex clinical research programme as an independent researcher through collaboration with others and there will be a significant impact on the pool of trained junior scientists. The work will also produce high impact scientific papers.
Network EDCTP2
Call Senior Fellowships 2018

Project partner

Number Name Role Country
1 Kwame Nkrumah University of Science and Technology Coordinator Ghana