Public Health and Infectious Disease Research Center (PHIDReC), Kathmandu, Nepal.
Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal.
PLoS Negl Trop Dis. 2023 Nov 9;17(11):e0011714. doi: 10.1371/journal.pntd.0011714. eCollection 2023 Nov.
Nepal, Bangladesh, and India signed a Memorandum of Understanding (MoU) in 2005 to eliminate visceral leishmaniasis (VL) as a public health problem from the Indian subcontinent by 2015. By 2021, the number of reported VL cases in these countries had declined by over 95% compared to 2007. This dramatic success was achieved through an elimination programme that implemented early case detection and effective treatment, vector control, disease surveillance, community participation, and operational research that underpinned these strategies. The experience offered an opportunity to assess the contribution of implementation research (IR) to VL elimination in Nepal. Desk review and a stakeholder workshop was conducted to analyse the relationship between key research outputs, major strategic decisions in the national VL elimination programme, and annual number of reported new cases over time between 2005 and 2023. The results indicated that the key decisions across the strategic elements, throughout the course of the elimination programme (such as on the most appropriate tools for diganostics and treatment, and on best strategies for case finding and vector management), were IR informed. IR itself responded dynamically to changes that resulted from interventions, addressing new questions that emerged from the field. Close collaboration between researchers, programme managers, and implementers in priority setting, design, conduct, and review of studies facilitated uptake of evidence into policy and programmatic activities. VL case numbers in Nepal are now reduced by 90% compared to 2005. Although direct attribution of disease decline to research outputs is difficult to establish, the Nepal experience demonstrates that IR can be a critical enabler for disease elimination. The lessons can potentially inform IR strategies in other countries with diseases targeted for elimination.
尼泊尔、孟加拉国和印度于 2005 年签署了一份谅解备忘录（MoU），旨在到 2015 年消除印度次大陆的内脏利什曼病（VL）这一公共卫生问题。到 2021 年，与 2007 年相比，这些国家报告的 VL 病例数下降了 95%以上。这一显著成就得益于消除计划的实施，该计划包括早期病例发现和有效治疗、病媒控制、疾病监测、社区参与以及为这些策略提供支持的运营研究。这一经验为评估实施研究（IR）对尼泊尔 VL 消除的贡献提供了机会。进行了桌面审查和利益相关者研讨会，以分析关键研究成果、国家 VL 消除计划中的主要战略决策以及 2005 年至 2023 年期间报告的新病例年度数量之间的关系。结果表明，在消除计划的整个过程中（例如，关于最适合诊断和治疗的工具，以及最佳的病例发现和病媒管理策略），关键决策都受到了 IR 的影响。IR 本身也对干预措施产生的变化做出了动态反应，解决了从实地出现的新问题。在优先事项设定、研究设计、进行和审查方面，研究人员、方案管理人员和实施人员之间的密切合作促进了证据纳入政策和方案活动。与 2005 年相比，尼泊尔的 VL 病例数减少了 90%。尽管难以确定疾病下降直接归因于研究成果，但尼泊尔的经验表明，IR 可以成为消除疾病的关键推动因素。这些经验教训有可能为其他目标消除疾病的国家提供信息，帮助制定 IR 策略。
