Approach to identifying research gaps on vector-borne and other infectious diseases of poverty in urban settings:scoping review protocol from the VERDAS consortium and reflections on the project’s implementation

Background:This paper presents the overall approach undertaken by the“VEctor boRne DiseAses Scoping reviews”(VERDAS)consortium in response to a call issued by the Vectors,Environment and Society unit of the Special Programme for Research and Training in Tropical Diseases hosted by the World Health Organization.The aim of the project was to undertake a broad knowledge synthesis and identify knowledge gaps regarding the control and prevention of vector-borne diseases in urban settings.Methods:The consortium consists of 14 researchers,13 research assistants,and one research coordinator from seven different institutions in Canada,Colombia,Brazil,France,Spain,and Burkina Faso.A six-step protocol was developed for the scoping reviews undertaken by the consortium,based on the framework developed by Arksey and O’Malley and improved by Levac et al.In the first step,six topics were identified through an international eDelphi consultation.In the next four steps,the scoping reviews were conducted.The sixth step was the VERDAS workshop held in Colombia in March 2017.Discussion:In this article,we discuss several methodological issues encountered and share our reflections on this work.We believe this protocol provides a strong example of an exhaustive and rigorous process for performing broad knowledge synthesis for any given topic and should be considered for future research initiatives and donor agendas in multiple fields to highlight research needs scientifically.

A scoping review on the field validation and implementation of rapid diagnostic tests for vector-borne and other infectious diseases of poverty in urban areas

Background:Health personnel face challenges in diagnosing vector-borne and other diseases of poverty in urban settings.There is a need to know what rapid diagnostic technologies are available,have been properly assessed,and are being implemented to improve control of these diseases in the urban context.This paper characterizes evidence on the field validation and implementation in urban areas of rapid diagnostics for vector-borne diseases and other diseases of poverty.Main body:A scoping review was conducted.Peer-reviewed and grey literature were searched using terms describing the targeted infectious diseases,diagnostics evaluations,rapid tests,and urban setting.The review was limited to studies published between 2000 and 2016 in English,Spanish,French,and Portuguese.Inclusion and exclusion criteria were refined post hoc to identify relevant literature regardless of study design and geography.A total of 179 documents of the 7806 initially screened were included in the analysis.Malaria(n=100)and tuberculosis(n=47)accounted for the majority of studies that reported diagnostics performance,impact,and implementation outcomes.Fewer studies,assessing mainly performance,were identified for visceral leishmaniasis(n=9),filariasis and leptospirosis(each n=5),enteric fever and schistosomiasis(each n=3),dengue and leprosy(each n=2),and Chagas disease,human African trypanosomiasis,and cholera(each n=1).Reported sensitivity of rapid tests was variable depending on several factors.Overall,specificities were high(>80%),except for schistosomiasis and cholera.Impact and implementation outcomes,mainly acceptability and cost,followed by adoption,feasibility,and sustainability of rapid tests are being evaluated in the field.Challenges to implementing rapid tests range from cultural to technical and administrative issues.Conclusions:Rapid diagnostic tests for vector-borne and other diseases of poverty are being used in the urban context with demonstrated impact on case detection.However,most evidence comes from malaria rapid diagnostics,with variable results.While rapid tests for tuberculosis and visceral leishmaniasis require further implementation studies,more evidence on performance of current tests or development of new alternatives is needed for dengue,Chagas disease,filariasis,leptospirosis,enteric fever,human African trypanosomiasis,schistosomiasis and cholera.

Scoping review on vector-borne diseases in urban areas:transmission dynamics,vectorial capacity and co-infection

Background:Transmission dynamics,vectorial capacity,and co-infections have substantial impacts on vector-borne diseases(VBDs)affecting urban and suburban populations.Reviewing key factors can provide insight into priority research areas and offer suggestions for potential interventions.Main body:Through a scoping review,we identify knowledge gaps on transmission dynamics,vectorial capacity,and co-infections regarding VBDs in urban areas.Peer-reviewed and grey literature published between 2000 and 2016 was searched.We screened abstracts and full texts to select studies.Using an extraction grid,we retrieved general data,results,lessons learned and recommendations,future research avenues,and practice implications.We classified studies by VBD and country/continent and identified relevant knowledge gaps.Of 773 articles selected for full-text screening,50 were included in the review:23 based on research in the Americas,15 in Asia,10 in Africa,and one each in Europe and Australia.The largest body of evidence concerning VBD epidemiology in urban areas concerned dengue and malaria.Other arboviruses covered included chikungunya and West Nile virus,other parasitic diseases such as leishmaniasis and trypanosomiasis,and bacterial rickettsiosis and plague.Most articles retrieved in our review combined transmission dynamics and vectorial capacity;only two combined transmission dynamics and co-infection.The review identified significant knowledge gaps on the role of asymptomatic individuals,the effects of co-infection and other host factors,and the impacts of climatic,environmental,and socioeconomic factors on VBD transmission in urban areas.Limitations included the trade-off from narrowing the search strategy(missing out on classical modelling studies),a lack of studies on co-infections,most studies being only descriptive,and few offering concrete public health recommendations.More research is needed on transmission risk in homes and workplaces,given increasingly dynamic and mobile populations.The lack of studies on co-infection hampers monitoring of infections transmitted by the same vector.Conclusions:Strengthening VBD surveillance and control,particularly in asymptomatic cases and mobile populations,as well as using early warning tools to predict increasing transmission,were key strategies identified for public health policy and practice.

Interventions for vector-borne diseases focused on housing and hygiene in urban areas:a scoping review

Background:Over half the world’s human populations are currently at risk from vector-borne diseases(VBDs),and the heaviest burden is borne by the world’s poorest people,communities,and countries.The aim of this study was to conduct a review on VBD interventions relevant to housing and hygiene(including sanitation and waste management)in urban areas.Main body:We conducted a scoping review,which involved systematically searching peer-reviewed and grey literature published between 2000 and 2016 using five scientific databases and one database for grey literature.Different data extraction tools were used for data coding and extraction.We assessed the quality of each study using the Mixed Methods Appraisal Tool and extracted descriptive characteristics and data about implementation process and transferability from all studies using the Template for Intervention Description and Replication and ASTAIRE(a tool for analyzing the transferability of health promotion interventions)tools.We reviewed 44 studies.Overall,the studies were judged to be of high risk for bias.Our results suggest multifaceted interventions,particularly community-based interventions,have the potential to achieve wider and more sustained effects than do standard vertical single-component programs.The evaluations of multifaceted interventions tend to include integrated evaluations,using not only entomological indicators but also acceptability and sustainability indicators.Conclusions:This review highlighted the important need for higher quality research in VBDs and improved and standardized reporting of interventions.Significant research gaps were found regarding qualitative research and implementation research,and results highlighted the need for more interventions focus on sanitation and hygiene practices.

Containment measures for emerging and re-emerging vector-borne and other infectious diseases of poverty in urban settings:a scoping review

Background:The emergence and re-emergence of vector-borne and other infectious diseases of poverty pose a threat to the health of populations living in urban and low-income settings.A detailed understanding of intervention strategies,including effectiveness of past outbreak containment,is necessary to improve future practices.The objective was to determine what is known about the effectiveness of containment measures for emerging and re-emerging vector-borne and other infectious diseases of poverty in urban settings and identify research gaps and implications for public health practice.Main body:We conducted a scoping review and systematically searched peer-reviewed and grey literature published between 2000 and 2016.Different data extraction tools were used for data coding and extraction,and data on implementation process and transferability were extracted from all studies.A quality assessment was conducted for each included study.We screened 205 full-text articles and reports for a total of 31 articles included in the review.The quality of the studies was generally low to moderate.The largest body of evidence concerned control activities for Ebola virus and dengue fever.The majority of interventions(87%)relied on multiple types of measures,which were grouped into four categories:1)healthcare provision;2)epidemiological investigation and/or surveillance;3)environmental or sanitary interventions;and 4)community-based interventions.The quality of the majority of studies(90%)was poor or moderate,and one-third of the studies did not provide a clear description of the outcomes and of the procedures and/or tools used for the intervention.Conclusions:Our results highlight the difficulty of establishing causation when assessing the effect of containment measures.Studies that extend beyond solely reporting on effectiveness and take into account the complexity of real-world settings are urgently needed.We recommend the allocation of research efforts to the evaluation of the implementation processes of interventions as well as their comprehensive and systematic description using validated checklists.

Impact,economic evaluation,and sustainability of integrated vector management in urban settings to prevent vector-borne diseases:a scoping review

Background:The control of vector-borne diseases(VBD)is one of the greatest challenges on the global health agenda.Rapid and uncontrolled urbanization has heightened the interest in addressing these challenges through an integrated vector management(IVM)approach.The aim was to identify components related to impacts,economic evaluation,and sustainability that might contribute to this integrated approach to VBD prevention.Main body:We conducted a scoping review of available literature(2000-2016)using PubMed,Web of Science,Cochrane,CINAHL,Econlit,LILACS,Global Health Database,Scopus,and Embase,as well as Tropical Diseases Bulletin,WHOLIS,WHO Pesticide Evaluation Scheme,and Google Scholar.MeSH terms and free-text terms were used.A data extraction form was used,including TIDieR and ASTAIRE.MMAT and CHEERS were used to evaluate quality.Of the 42 documents reviewed,30 were focused on dengue,eight on malaria,and two on leishmaniasis.More than a half of the studies were conducted in the Americas.Half used a quantitative descriptive approach(n=21),followed by cluster randomized controlled trials(n=11).Regarding impacts,outcomes were:a)use of measures for vector control;b)vector control;c)health measures;and d)social measures.IVM reduced breeding sites,the entomology index,and parasite rates.Results were heterogeneous,with variable magnitudes,but in all cases were favourable to the intervention.Evidence of IVM impacts on health outcomes was very limited but showed reduced incidence.Social outcomes were improved abilities and capacities,empowerment,and community knowledge.Regarding economic evaluation,only four studies performed an economic analysis,and intervention benefits outweighed costs.Costeffectiveness was dependent on illness incidence.The results provided key elements to analyze sustainability in terms of three dimensions(social,economic,and environmental),emphasizing the implementation of a community-focused eco-bio-social approach.Conclusions:IVM has an impact on reducing vector breeding sites and the entomology index,but evidence of impacts on health outcomes is limited.Social outcomes are improved abilities and capacities,empowerment,and community knowledge.Economic evaluations are scarce,and cost-effectiveness is dependent on illness incidence.Community capacity building is the main component of sustainability,together with collaboration,institutionalization,and routinization of activities.Findings indicate a great heterogeneity in the interventions and highlight the need for characterizing interventions rigorously to facilitate transferability.

Establishing research priorities in prevention and control of vector-borne diseases in urban areas:a collaborative process

Background:In 2015,following a call for proposals from the Special Programme for Research and Training in Tropical Diseases(TDR),six scoping reviews on the prevention and control of vector-borne diseases in urban areas were conducted.Those reviews provided a clear picture of the available knowledge and highlighted knowledge gaps,as well as needs and opportunities for future research.Based on the research findings of the scoping reviews,a concept mapping exercise was undertaken to produce a list of priority research needs to be addressed.Methods:Members of the six research teams responsible for the“VEctor boRne DiseAses Scoping reviews”(VERDAS)consortium’s scoping reviews met for 2 days with decision-makers from Colombia,Brazil,Peru,Pan-American Health Organization,and World Health Organization.A total of 11 researchers and seven decision-makers(from ministries of health,city and regional vector control departments,and vector control programs)completed the concept mapping,answering the question:“In view of the knowledge synthesis and your own expertise,what do we still need to know about vector-borne diseases and other infectious diseases of poverty in urban areas?”Participants rated each statement on two scales from 1 to 5,one relative to‘priority’and the other to‘policy relevance’,and grouped statements into clusters based on their own individual criteria and expertise.Results:The final map consisted of 12 clusters.Participants considered those entitled“Equity”,“Technology”,and“Surveillance”to have the highest priority.The cluster considered the most important concerns equity issues,confirming that these issues are rarely addressed in research on vector-borne diseases.On the other hand,the“Population mobility”and“Collaboration”clusters were considered to be the lowest priority but remained identified by participants as research priorities.The average policy relevance scores for each of the 12 clusters were roughly the same as the priority scores for all clusters.Some issues were not addressed during the brain-storming.This is the case for governance and for access and quality of care.Conclusions:Based on this work,and adopting a participatory approach,the concept mapping exercise conducted collaboratively with researchers from these teams and high-level decision-makers identified research themes for which studies should be carried out as a priority.

Effective surveillance systems for vectorborne diseases in urban settings and translation of the data into action:a scoping review

Background:Vector-borne diseases(VBDs)continue to represent a global threat,with“old”diseases like malaria,and“emergent”or“re-emergent”ones like Zika,because of an increase in international trade,demographic growth,and rapid urbanization.In this era of globalization,surveillance is a key element in controlling VBDs in urban settings,but surveillance alone cannot solve the problem.A review of experiences is of interest to examine other solution elements.The objectives were to assess the different means of VBD surveillance in urban environments,to evaluate their potential for supporting public health actions,and to describe the tools used for public health actions,the constraints they face,and the research and health action gaps to be filled.Main body:For this scoping review we searched peer-reviewed articles and grey literature published between 2000 and 2016.Various tools were used for data coding and extraction.A quality assessment was done for each study reviewed,and descriptive characteristics and data on implementation process and transferability were analyzed in all studies.After screening 414 full-text articles,we retained a total of 79 articles for review.The main targets of the articles were arboviral diseases(65.8%)and malaria(16.5%).The positive aspects of many studies fit within the framework of integrated vector management.Public awareness is considered a key to successful vector control programs.Advocacy and legislation can reinforce both empowerment and capacity building.These can be achieved by collaboration within the health sector and with other sectors.Research is needed to develop well designed studies and new tools for surveillance and control.Conclusions:The need for surveillance systems in urban settings in both developing and developed countries was highlighted.Countries face the same challenges relating to human,financial,and structural resources.These findings also constitute a wake-up call for governments,academia,funders,and World Health Organization to strengthen control programs and enhance VBD research in urban environments.