The Lake Victoria island intervention study on worms and allergy-related diseases (LaVIISWA): study protocol for a randomised controlled trial

Nampijja, Margaret; Webb, Emily L.; Kaweesa, James; Kammerer, Robert; Namutebi, Milly; Nakazibwe, Esther; Oduru, Gloria; Kabuubi, Prossy; Kabagenyi, Joyce; Kizito, Dennison; Muhangi, Lawrence; Akello, Mirriam; Verweij, Jaco J.; Nerima, Barbara; Tukahebwa, Edridah M.; Elliott, Alison M.

doi:10.1186/s13063-015-0702-5

Cited by 37 publications

(65 citation statements)

References 46 publications

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“…Questionnaire data were obtained from 2316 participants . Their characteristics and those of participants for whom cytokine and antibody responses were assessed are shown in Table .…”

Section: Resultsmentioning

confidence: 99%

Schistosoma mansoni‐specific immune responses and allergy in Uganda

Nkurunungi

Kabagenyi

Nampijja

et al. 2017

Parasite Immunology

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SummaryLow allergy‐related disease (ARD) prevalence in low‐income countries may be partly attributed to helminth infections. In the Schistosoma mansoni (Sm)‐endemic Lake Victoria islands (Uganda), we recently observed positive helminth‐allergy associations, despite low ARD prevalence. To understand how Sm‐induced cytokine and antibody profiles might influence allergic response profiles in this population, we assessed Schistosoma worm (SWA)‐ and egg antigen (SEA)‐specific Th1 (IFN‐γ), Th2 (IL‐5, IL‐13) and regulatory (IL‐10) cytokine profiles (n = 407), and total (n = 471), SWA‐, SEA‐ and allergen (house dust mite [HDM] and cockroach)‐specific (as)IgE and IgG4 profiles (n = 2117) by ELISA. Wheeze was inversely associated with SWA‐specific IFN‐γ (P < .001) and IL‐10 (P = .058), and SEA‐specific IL‐5 (P = .004). Conversely, having a detectable asIgE response was positively associated with SWA‐specific IL‐5 (P = .006) and IL‐10 (P < .001). Total, SWA‐, SEA‐ and allergen‐specific IgE and IgG4 responses were higher among Sm Kato‐Katz positive (SmKK+) and skin prick test (SPT)+ individuals compared to SmKK‐ and SPT‐ individuals. However, total and asIgG4/IgE ratios were lower among SPT+ and wheezing individuals. We conclude that, in this population, helminth‐induced antibody and cytokine responses may underlie individual positive helminth‐atopy associations, while the overall IgG4‐IgE balance may contribute to the low overall prevalence of clinical allergies in such settings.

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“…Questionnaire data were obtained from 2316 participants . Their characteristics and those of participants for whom cytokine and antibody responses were assessed are shown in Table .…”

Section: Resultsmentioning

confidence: 99%

Schistosoma mansoni‐specific immune responses and allergy in Uganda

Nkurunungi

Kabagenyi

Nampijja

et al. 2017

Parasite Immunology

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“…Despite the willingness to use toilets, coverage is very low (<10%) in these communities [3]. The communities feel that it is costly to construct and maintain latrines due to the terrain and some landlords are unwilling to provide land.…”

Section: Discussionmentioning

confidence: 99%

“…Mass drug administration of praziquantel is being provided to these communities as an intervention in a cluster randomised trial investigating the effects of anthelminthic intervention on health outcomes–the Lake Victoria Island Intervention Study on Worms and Allergy-related diseases (LaVIISWA) [3]–in collaboration with the Vector Control Division, Ministry of Health, Uganda. In this trial, 13 villages were randomised to receive the standard intervention against helminths (single dose praziquantel once a year, single dose albendazole twice a year) and 13 were randomised to intensive intervention (single dose praziquantel four times a year, triple dose albendazole four times a year).…”

Section: Methodsmentioning

confidence: 99%

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Perceptions about interventions to control schistosomiasis among the Lake Victoria island communities of Koome, Uganda

et al. 2017

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BackgroundPraziquantel-based mass treatment is the main approach to controlling schistosomiasis mansoni in endemic areas. Interventions such as provision and use of safe water, minimising contact with infested water, disposal of stool in latrines and snail control provide key avenues to break the transmission cycle and can sustain the benefits of mass treatment in the long term. Efforts are also being made to develop a schistosomiasis vaccine which, if effective, might reduce the incidence of re-infection after treatment. However, any interventions deployed need to be acceptable to, and sustainable by, the target communities.MethodsIn this qualitative study, we investigated the perceptions of six Lake Victoria island communities of Koome, Uganda, about interventions to control Schistosoma mansoni infection and their willingness to participate in Schistosoma vaccine trials. Thirty-two in-depth interviews, 12 key informant interviews and 10 focus group discussions were conducted. Data were analysed using a thematic content approach.FindingsIntestinal schistosomiasis was not regarded as a serious health problem because a mass treatment programme is in place. However, the communities lack safe water sources and latrines. Mass treatment with praziquantel, safe water supplies and use of toilets were deemed the most acceptable interventions by the participants. The communities are willing to participate in Schistosoma vaccine trials.Conclusion/SignificanceKnowledge of a community’s perception about interventions to control schistosomiasis can be valuable to policy makers and programme implementers intending to set up interventions co-managed by the community members. In this study, the views of the Lake Victoria island communities of Koome are presented. This study also provides data to guide further work on alternative interventions such as Schistosoma vaccine trials in these communities.

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“…Interactions between helminths and HIV, mediated by immunological mechanisms, may therefore be especially important for schistosomiasis. In addition, HIV- Schistosoma co-infection is particularly common among fishing communities, such as those on the shores and islands of Lake Victoria, where S. mansoni infection is almost universal 15 and HIV prevalence among adults is up to 37% 16 . These are recognised key populations with respect to HIV infection and regarded as likely reservoirs for the continuing HIV epidemic in the general population.…”

Section: Introductionmentioning

confidence: 99%

Effect of high-intensity versus low-intensity praziquantel treatment on HIV disease progression in HIV and Schistosoma mansoni co-infected patients: a randomised controlled trial

Abaasa¹,

Asiki²,

Ekii³

et al. 2018

Wellcome Open Res

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Background: It has been hypothesised that Schistosoma co-infection exacerbates HIV progression, and hence anthelminthic intervention in co-infected individuals will delay it. We evaluated effects of high-intensity versus low-intensity praziquantel treatment of schistosomiasis on HIV disease progression among co-infected patients from fishing populations around Lake Victoria, Uganda. Methods: Between August 2012 and September 2015, we conducted an open-label randomised, controlled trial. Adults, antiretroviral therapy-naïve, CD4 counts ≥350 cells/μl, HIV and S. mansoni co-infected, were randomised 1:1 to praziquantel (40mg/kg) given quarterly (starting at enrolment) or annually (starting 12 weeks after enrolment; such that low-intensity participants were still untreated when sampled at 12 weeks). A non-randomised HIV-positive S. mansoni-negative comparison group was recruited. The primary outcome was mean change in plasma viral load at 12 and 60 weeks. Results: In total 363 participants (high-intensity 113, low-intensity 113, comparison group 137) were recruited; 96 (85.0%), 97 (85.8%) and 107 (78.1%) completed 60 weeks of follow up, respectively. Adjusting for baseline age and viral load, the geometric mean ratio (aGMR [95%CI]) viral load for high-intensity vs low-intensity groups at 12 weeks was 0.90 [0.65, 1.25] p=0.55 and at 60 weeks 1.88 [0.78, 4.53] p=0.16. Results in the comparison group were similar to trial arms. High-intensity, compared to low-intensity, treatment resulted in substantially lower S. mansoni prevalence at all follow up visits (p<0.05). Conclusions: In communities with a high burden of both S. mansoni and HIV infection, high-intensity treatment of S. mansoni does not delay HIV progression despite relevant benefit for parasite clearance. Trial registration: ISRCTN15371662 (17/11/2016)

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The Lake Victoria island intervention study on worms and allergy-related diseases (LaVIISWA): study protocol for a randomised controlled trial

Cited by 37 publications

References 46 publications

Schistosoma mansoni‐specific immune responses and allergy in Uganda

Schistosoma mansoni‐specific immune responses and allergy in Uganda

Perceptions about interventions to control schistosomiasis among the Lake Victoria island communities of Koome, Uganda

Effect of high-intensity versus low-intensity praziquantel treatment on HIV disease progression in HIV and Schistosoma mansoni co-infected patients: a randomised controlled trial

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