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Driven by the questions faced in clinical practice and whether clinical or laboratory based, SMRU studies seek to identify community needs and strengths to help populations effectively fight infectious diseases. SMRU’s scientific output continues to be prolific, with 227 publications since 2015, 41 of them to date in 2019.

Metf_mya_pfalciparum
Incidence of P. falciparum in the METF area as of September 2019

SMRU’s unique research agenda has resulted in significant achievements in:

Malaria | Malaria in pregnancy | Malaria elimination | Tuberculosis | Mother and child health | Bioethics & community engagement | Other laboratory work

Malaria

  • Validation of new G6PD point of care tests (Biosensors) against gold standard quantitative spectrophotometry and genotyping. This study assessed quantitative rapid G6PD deficiency diagnostic tests that have the potential to be used in the field and can ensure the safe delivery of 8-aminoquinolines for vivax radical cure.
  • Established the relationship between sub-microscopic carriage and infection transmission to the malaria vectors (J Infect Dis. 2018. doi: 10.1093/infdis/jiy686).
  • Completed large clinical trials on the treatment of P. vivax (Clin Infect Dis. 2018;67(10):1543-9. doi: 10.1093/cid/ciy319ciy and Clin Infect Dis. 2018. doi: 10.1093/cid/ciy735).
  • Successfully established a platform for the testing of new compounds against hypnozoites of P. vivax (Science. 2018;362(6419). doi: 10.1126/science.aat9446).
  • Analysis of the relationship between G6PD deficiency and asymptomatic carriage of malaria in a 24-month cohort study.

Malaria in pregnancy

  • Published the first PK study on primaquine in breast milk showing a negligible risk to the infant (Clin Infect Dis. 2018;67(7):1000-7. doi: 10.1093/cid/ciy235).

Malaria elimination

  • Demonstrated the impact of the elimination strategy using mass drug administration, at scale (Lancet. 2018;391(10133):1916-26. doi: 10.1016/S0140-6736(18)30792-X).
  • The Malaria Elimination Task Force (METF) has continued to operate in a major effort to eliminate malaria from Karen State while simultaneously carrying out operational research. P. falciparum was eliminated in the majority of the village tracks in the area and efforts continue in the more remote northern township despite logistic difficulties and the chronic instability.
  • Developed effective strategies for rapid malaria elimination in a context of antimalarial resistance.
  • Documented the impact of generalized access to early diagnosis and treatment on malaria incidence in 4 townships of Eastern Myanmar (>1200 villages) and contribution of targeted MDA in hotspots (Lancet. 2018;391(10133):1916-26. doi: 10.1016/S0140-6736(18)30792-X).
  • Describing the spatio-temporal distribution of malaria incidence and prevalence hotspots.
  • Lymphatic filariasis prevalence and risk-factors in METF malaria prevalence surveys.
  • Relationships between malaria prevalence, incidence and temporal trends in villages with access to early diagnosis and treatment.

Tuberculosis

SMRU’s TB programme operates in two clinics along the Thai-Myanmar border, with laboratory and logistical support in Mae Sot. Here, an SMRU staff prepares a TB patient’s daily drug cocktail as the patient waits© 2019 MORU SMRU’s TB programme operates in two clinics along the Thai-Myanmar border, with laboratory and logistical support in Mae Sot. Here, an SMRU staff prepares a TB patient’s daily drug cocktail as the patient waits

TB Programme achievements

The TB programme operates in two clinics along the Thai-Myanmar border, with laboratory and logistical support in Mae Sot. Between 2015 and December 2018, 1519 TB cases were diagnosed, 1204 enrolled for treatment under SMRU-TB, with a success rate at 3 years (2015-2017) of 83%. The HIV co-infection rate was 18%; MDR-TB was present in around 4%. Histories and mapping of MDR-TB patients demonstrate contact with high numbers of people and potential for transmission across a wide geographic range, without effective treatment (Int J Tuberc Lung Dis. 2017 Jul 1;21(7):753-758. doi: 10.5588/ijtld.16.0658.)

Ongoing pharmacokinetic study

Studying the blood levels of first-line anti-tuberculosis drugs in relation to treatment outcomes among newly diagnosed adults with pulmonary tuberculosis on the Thai-Myanmar Border. The study began in 2015, with 61 patients recruited. Samples are in the MORU pharmacology lab for assays.

Mother and child health

Clinical studies (other than malaria)

The MCH department has completed recruitment to three large prospective cohort trials with the major analysis still ongoing.

  • Perinatal mental health problems (PLoS One. 2018;13(5):e0197403. doi: 10.1371/journal.pone. 0197403, BMJ open. 2018;8(1):e017129. doi: 10.1136/bmjopen-2017- 017129, and BMC Psychiatry. 2018;18(1):229. doi: 10.1186/s12888-018-1815-7)
  • Neonatal jaundice where potentially harmful local health practices have been identified (BMC Pediatr. 2018;18(1):190. doi: 10.1186/ s12887-018-1165-0 and J Trop Pediatr. 2017 Feb;63(1):50-56. doi: 10.1093/tropej/fmw055)
  • The INTERBIO-21st study is under analysis
  • A clinical trial was initiated on the prevention of vertical transmission of Hepatitis B with Tenofovir (NCT02995005).

Data analysis

  • Preparatory work on detecting and treating anaemia in pregnancy has commenced with an analysis on inherited RBC disorders in nearly 13,000 women: haemoglobin variants affect at least 15% (HbE and beta-thalassaemia) and possibly up to 40% (including alphathalassaemia) of women overall; while phenotypic G6PD deficiency affects in 2.9% of women, with >95% Mahidol variant by genotyping. (Wellcome Open Res. 2017;2:72. doi: 10.12688/ wellcomeopenres.12338.2).
  • Immunization remained an area for improvement amongst migrants (J Immigr Minor Health. 2016 Oct;18(5):1038-45. doi: 10.1007/s10903-015-0294-x) and the use of ultrasound improved care for women with gestational trophoblastic disease (Glob Health Action. 2017;10(1):1296727. doi: 10.1080/16549716.2017.1296727).
  • Local collaborations permitted analysis of 30 years of contraception data (the longest known review period for a refugee population) (PLoS One. 2017 Feb 23;12(2):e0172007. doi: 10.1371/ journal.pone.0172007).
  • Two studies reported on successful implementation of educational and training programs in low resource settings including skilled birth attendants (PLoS One. 2016 Oct 6;11(10):e0164363. doi: 10.1371/journal.pone.0164363) and the front-line medics (BMC Med Educ. 2017 Aug 31;17(1):149. doi: 10.1186/s12909-017-0975-3).

Bioethics & community engagement

Biomedical ethics

The Tak Province Community Advisory Board has continued its activities. It provides a platform for the establishment of a Karen Ethics Committee, probably attached to the Borderland Health Foundation.

Community engagement

As part of the malaria elimination program we have developed a culturally appropriate approach to Community Engagement with the help of social scientists. This involves multiple activities to gain trust of the population and has proved very successful in the elimination efforts (Wellcome Open Res. 2018. doi: 10.12688/wellcomeopenres.14698.1)

Other laboratory work

  • SMRU conducts research on the local malaria vectors and the screening of new compounds against the hypnozoites of P. vivax.
  • Ongoing CDC Influenza surveillance project
  • SMRU is a study site for the clinical trial on the treatment of scrub typhus as part of a multicentre study coordinated at MORU enrolling approximately ¼ patients to date (NCT03083197).