February 22, 2020

DeWorm3 at NHM: Celebrating the Intervention Phase

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Since 2015, DeWorm3 has been managed from a central hub at the Natural History Museum, and after five and a half successful years we are delighted to close out the programme on a high after the prodigious delivery of the Intervention Phase.

DeWorm3 is a large-scale, community cluster randomised trial which seeks to determine the feasibility of interrupting the transmission of soil transmitted helminths (STH) in India, Malawi, and Benin. Overseen by Senior Responsible Officer Dr Tim Littlewood and Principal Investigator Dr Judd Walson (University of Washington), the programme was originally conceived as a 5 year Neglected Tropical Disease investment from the Bill and Melinda Gates Foundation which aimed to develop effective strategies for scaling-up STH transmission interruption programs. This was done by broadly administering the deworming drug albendazole to people of all age groups in affected areas (community-wide deworming), compared to the standard regime of only deworming children (school-based deworming). Study areas with target populations between 80,000-110,000 were selected, censused, and then randomly allocated to clusters to receive either the twice-annual community-wide MDA or the standard school-age deworming for three years.

As of December 2020, all three DeWorm3 sites have successfully completed Intervention activities with consistently high coverage and compliance, and a stalwart reputation with local communities. Annual censuses enumerated approximately 260,000 households and 1,065,000 individuals across three sites over three years. Annual longitudinal monitoring (LMC) and a baseline Cross-Sectional Survey (CSS) resulted in approximately 93,000 stool samples being collected and stored for future analysis in the next phases of the project. Similarly, all six rounds of planned MDA and subsequent coverages surveys have been delivered in India, Malawi, and Benin with 890,134 albendazole doses being distributed to eligible participants- a monumental logistical operation.

Before the outcome of the trial can be assessed, early epidemiological modelling from Imperial College London indicated the need for a two-year surveillance period during which time no treatment should take place between the study rounds of MDA and testing for final prevalence. This natural break in the study facilitated the project being viewed in distinct phases, and the project was subsequently expanded into a series of grants. The University of Washington grant is attempting to tackle the challenge of determining the study endpoint using novel molecular methods, while the 5-year NHM grant which focused on the delivery of the MDA Intervention was extended by 6 months and is now in the process of wrapping up the marathon undertaking.

NHM has been the lead on project management, financial management, grant management, publication management, communications, and governance. The NHM DeWorm3 office coordinated an international matrix team of individuals and organisations spanning various time zones, cultures and working styles, while managing over 400 interdependent project deliverables and milestones. The success of the programme could not have been possible without the proficiency and tenacity of the wider project team and we wish to take this opportunity to thank and congratulate our partners for a job well done. We are delighted to share a gallery of some of our favourite moments throughout the last five years, and we hope you will join us in celebrating the successes of this ambitious project.