South and Southeast Asian Community-based Trials Network MORU
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Progress updates

Grant to use metagenomics to determine febrile illness causes in South and SE Asia

On 24 Oct, Liz Batty, Senior Bioinformatician and co-Head of the Molecular Microbiology group in MORU Microbiology, was awarded U$200,000 by the Chan Zuckerberg Initiative (CZI) with the Bill & Melinda Gates Foundation (BMGF) to use metagenomic sequencing to define the causes of febrile illness in remote and rural areas of South and Southeast Asia. 

Liz’s grant will analyse samples from South and Southeast Asia Community-based Trials Network (SEACTN) work package B (WP-B) sites, in Laos, Thailand and Bangladesh via collaborations with LOMWRU, SMRU, and the Bangladesh Rural Advancement Committee (BRAC]. Led by Prof Yoel Lubell, and supported by the Wellcome Innovations Flagship Programme, SEACTN seeks to ascertain the incidence, causes and outcome of febrile illness in SE Asia.

By enabling scientists to analyse all nucleic acids in a sample, metagenomic next-generation sequencing (mNGS) can be used to detect novel pathogens in outbreaks and investigate diseases with complex etiology, such as encephalitis and antimicrobial resistance. 

“This metagenomic work will help us define the burden of febrile illness by identifying pathogens causing febrile illness that are novel, or missed by traditional diagnostics,” said Liz. “It will improve our understanding of the causes of febrile illness and how we choose target diagnostics for febrile illness.”

Accurately determining which infection is causing fever could have a significant impact on health in South and Southeast Asia, where febrile illness contributes substantially to morbidity and mortality. 

With the decline of malarial illness and mortality in this region, the burden has shifted to non-malarial causes of fever. However, the causes of non-malarial fever remain unknown in many patients – and febrile patients are incorrectly treated as if they had malaria. 

Liz’s grant was part of U$2 million awarded by CZI and BMGF to researchers investigating novel, emerging pathogens with a focus on building metagenomics capacity in high-potential countries that have been historically under-resourced in SE Asia and elsewhere.  

– Text contributions by Liz Batty and John Bleho.

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Progress updates

Impressive start to SEACTN recruitment in Bangladesh

From 29 Oct to 2 Nov, the South and Southeast Asia Community-based Trials Network (SEACTN) team was finally able to visit some of its study sites in Cox’s Bazar, Bangladesh to witness all the wonderful progress our Bangladesh Rural Advancement Committee (BRAC] collaborators have made in running the project. BRAC have already recruited over 6,500 patients into SEACTN WP-A across 130 villages (with total WP-A recruitment now exceeding 32,000 patients!). The team also visited the Bangladesh Institute of Tropical Infectious Diseases (BITID) to enlist their support for SEACTN and discuss future collaborations with MORU. Pictured: MORU and BRAC team members visiting a primary health centre in Chakaria, Bangladesh.

Funded by the Wellcome Trust, SEACTN aims to better understand the epidemiology and burden of febrile illness in rural areas in five countries of South and Southeast Asia by developing a framework to collect information about the burden and impact of febrile illness. 

– Text and photo courtesy of Yoel Lubell.

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SEACTN verbal autopsy training at SMRU

On 11-13 Oct, SEACTN verbal autopsy research coordinator Dr Nan Shwe Nwe Htun (front row, 6th left), Dr Tom Peto (back row, left), and Ms. Chonticha Menggred (front row, 3rd right) visited SMRU to provide verbal autopsy training and technical support to the SMRU-SEACTN team, including newly recruited staff and an SEACTN public engagement team.

Led by Prof Yoel Lubell, and supported by the Wellcome Innovations Flagship Programme, the South and South-east Asia Community-based Trials Network (SEACTN) is a network of ~750 villages across Southeast Asia (SEA) where village health workers and peripheral health facilities with be supplied and trained with mobile devices and sample collection tools to ascertain the incidence, causes and outcome of febrile illness. Dr Aung Phyo Pyae (front row, 3rd left), heads the SMRU SEACTN team, which will conduct verbal autopsy public engagement activities. These will start in 2 weeks, with data collection expected in November. SEACTN-VA, the Verbal Autopsy component of SEACTN, will classify the causes of deaths according to the 10th International Classification of Diseases in 40 villages along the Thai-Myanmar border first and later expand to nearby villages.  

– With thanks to Nan Shwe Nwe Htun for text and photo.

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MORU visits Savannakhet SEACTN project study sites

Prof Yoel Lubell, PI of the SEACTN (Southeast Asia Clinical Trials Network) project and Dr Chris Chew (project coordinator) came to Laos from MORU 26-28 Sept to visit some of the study sites in Savannakhet province. Their visit took in Savannakhet Provincial Hospital where they met with the Director, Dr Chanthala Phamisith, as well as Atsaphangthong district, when they were accompanied by Dr Tiengkham Pongvongsa, Deputy director of Savannakhet Provincial Health Department, the main partner for Work Package A (WP-A), with implementation supported by LOMWRU. 

The LOMWRU Vientiane contingent was led by Dr Koukeo Phommasone (Lao sites coordinator), with Ms Vayouly Vidhamaly (Head of LOMWRU-CTSG), and Ms Latsaniphone Boutthasavong (lab coordinator). WP-A has already reached almost half of the target of 20,000 consultations. The hospital-based fever study (Work Package B) started more recently and aims to recruit around 2000 patients.

Our hardworking study team in Savannakhet includes Dr Xaipasong Xaiyaphet (site coordinator and research physician), Dr Aitlada Soulivong (site research physician), Dr Khambang Seevanhthong (site research physician), Mr Souksavanh Simanivong (logistician) Mr Somdy Xayalath (verbal autopsy study), Dr Khanxayaphone Phakhounthong (site research physician), Dr Xaykhamphet Phommavanh (site research physician), and Mr Khamxeng Khounpaseuth (lab technician).

Yoel and Chris left on Wed the 28th but Jaruwan Tubprasert (2nd right) and Akanittha Poochai (right) from MORU CTSG stayed on to monitor the study data and to discuss the upcoming initiation of another study (PLATCOV) in Laos.

SEACTN is funded by Wellcome Innovations and aims to better understand the epidemiology of febrile illness in rural areas in five countries of South and Southeast Asia by developing a framework for the collection of information about the burden and impact of febrile illness. 

– Thanks to Liz Ashley for text and Dr Koukeo for photos.

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SEACTN WP-A Dashboard updates

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Progress updates

SEACTN-HHS pilot to start 3 Oct

On 22-23 Sept, the CCRU team completed training for the study, Overview of disease burden in rural South and Southeast Asia: A cross-sectional household health survey with questionnaire interviews and selected laboratory tests (SEACTN-HHS). The entire survey team participated the training, including CCRU staff, recruited nurses, and hill tribe language interpreters. The team is now ready to start the pilot on 3 Oct. CCRU will be the first site starting recruitment for SEACTN-HHS. Upon completion of the pilot, the fieldwork will start in the Cambodia and Bangladesh sites. It will last about 4 months, with 1500 participants to be recruited from each site. 

Pictured at Wat Rong Suea Ten (Blue Temple) are CCRU team (trainers and trainees) along with some study investigators. Back row, from left: Phattharath Thira-Preedatap, Carlo Perrone, Tom Peto, Kwanchanok Supaluck. Middle row, from left: Rujira Yuin, Nattika Klahan, Anothai Weerapongsuchart, Darunee Netsuwan, Ratchadaporn Papwijitsil, Eakkamon Wongchai, Meiwen Zhang, Duanghathai Yasaeng. Bottom, from left: Nipaphan Kanthawang, Nongyao Khatta, Walaipan Choatworapan, Jarntrah Sappayabanphot.

– Thank you, Meiwen Zhang, for text and photo.

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Progress updates

Rains can’t stop SEACTN-WPA

Congratulations to all involved in the Southeast Asia Clinical Trials Network Work Package A (SEACTN-WPA) project, which has been running for a year now in Savannakhet. We wish to thank the team for their ongoing dedication and good spirits, despite the heavy rains, floods and landslides affecting many provinces in northern and southern Laos. The picture shows the SEACTN-WPA team heading off to the Nalai Health Centre, Pha Lan District, undaunted by the rain and road damage that slowed their travels – but didn’t stop them from reaching their destination. 

– Text courtesy of Laddaphone Bounvilay, with thanks to Dr Nammun for the photo.

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Progress updates

SEACTN recruits first patient in Savannakhet

The final training sessions for the new SEACTN Work Package B were held in Savannakhet last week with the first patient recruited 28 July. The project aims to recruit 1,800 people between now and September 2023. 

Thanks to Dr Sayaphet Rattanavong and Dr Koukeo Phommasone for words.

Also, in July, Dr Aung Pyae Phyo and the SMRU SEACTN research team along with Mae Ramat hospital team paid an orientation visit to CCRU before initiating SEACTN work in SMRU clinics and at long-standing SMRU collaborator Mae Ramat Hospital (MRMH). The CCRU, SMRU and Mae Ramat Hospital teams are pictured in front of Doi Chang Health Centre (SEACTN WP-A site). 

– With thanks to Carlo Perrone for text. Photo courtesy of Jindaporn.

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SEACTN visits SMRU sites

Pictured, at the Mae Tao Clinic, from left: Widi (Research Officer, SMRU), Yoel Lubell, MaeTao clinic deputy Director Naw Sophia, Dr Aung Pyae Phyo (Site co-Investigator), Hanhah Kozlowski (MD/PhD student), Carlo Perrone (CCRU), Dr Chris Chew, A/Prof Shaun Morris (University of Toronto), Mae Tao Clinic Director Dr Cynthia Maung, Saw Than Lwin (Co-ordinator MaeTao clinic), Dr Ladaporn (CTSG), Watcharintorn (SEACTN Diagnostic coordinator), Jindaporn (Research Assistant SMRU), and Chonticha (Data Manager, CTSG)

Led by PI Prof Yoel Lubell, on 30 May-1 June the SEACTN (South and Southeast Asian Community-based Trials Network) team visited Mae Tao clinic, Mae Kwer Thai clinic, and MaeRaMart hospital, the SMRU recruitment sites for SEACTN work package B. SEACTN aims to strengthen primary health care for management of febrile illness at health centre level.

– Thank you, Aung Pyae Phyo, for text and Ladda Kajeechiwa for photo.

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Malaria team back in the field!

A team from MORU — Arjun Chandna, Tom Peto, and Rupam Tripura (1st, 2nd and 4th from left, respectively), with support from Bipin Adhikari and James Callery — conducted a workshop on the Chembio multiplex Dual Pathogen Panel with Action for Health and Development (AHEAD), an NGO led by Dr Vanna Moul and Mr Sam Ol.

This is part of the RAI3E and SEACTN projects in Battambang and Pailin, western Cambodia. During May and June, Dr Jacklyn Adella, a University of Oxford MSc student, will lead workshops and focus group discussions at 9 health centres to assess the feasibility and acceptability of deploying new diagnostics to improve the management of febrile illnesses, and this work will also include assessing dengue rapid diagnostics and malaria-CRP combo tests. The team are finally starting to get back into the field after a long COVID-19 induced gap, and it’s been great!

 –  Thank you, Tom Peto, for text and photo.