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An International Network of field sites with continuous Demographic |
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Karonga DSS - Malawi
The Karonga programme began in 1978 with support from the British Leprosy Relief Association (LEPRA), as a population laboratory for evaluation of tools developed by the IMMLEP (Immunology of Leprosy) component of the WHO/TDR programme (the first skin and serological tests for M. leprae infection and an M. leprae antigen-based vaccine). It was designed initially as a large cohort study for risk factors of leprosy infection and disease, covering the entire district of Karonga (the population was selected because it had the highest burden of leprosy in that part of Africa). It assumed responsibility for tuberculosis diagnosis and treatment in the district in 1984, became the largest vaccine trial ever carried out in Africa in 1986 (comparing one versus two doses of BCG versus a combined BCG plus killed M. leprae vaccine, against both leprosy and tuberculosis) and began studies of HIV in 1987 (since which date an effort has been made to HIV test all leprosy and tuberculosis cases, and appropriate controls). The combined epidemiological and vaccine trial activities became known as the Karonga Prevention Study (KPS), by which name the project is still known. The trial codes were broken in 1995, revealing that BCG had provided appreciable protection against leprosy (50 % one dose; 75 % two doses) but none against tuberculosis.1 The trial results raised a variety of scientific questions, which, in combination with a unique sample archive and body of knowledge about the population, led to two Wellcome Trust supported programmes, first from 01/09/96 to 31/08/01 and the second (current) from 01/09/01 to 31/08/05. Throughout its history the programme has been linked closely to the London School of Hygiene & Tropical Medicine, for overall scientific direction, data management support, technical laboratory support, supplies and communication.
Priority Research Areas The current multidisciplinary research programme at KPS concentrates on 3 broad project areas:
The Karonga CRS was tailored to maximise the overlap with a population based HIV cohort study (Family Health Study) that was conducted during the previous research programme. In preparation for operational research into the modes of delivery of PMTCT the CRS area was also designed to match the catchment area of 2 ANC clinics in the south of the district. We are hoping to contribute to the assessment of the practicalities and the impact of large-scale introduction of HAART in a rural setting. As in the previous programmes the project continues to be interested in vaccine related research and data on vaccination histories are routinely collected from all children under 5 seen in the census.
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