Title: South and Southeast Asian Community-based Trials Network: Rural Fever
Funder: Wellcome Trust

Abstract: This Project will establish the Sowth and Southeast Asian Community-based Trials Network (SEACTN), which in the first instance will be used for monitoring the incidence, causes and outcomes of febrile illness in rural communities in the region. The SEACTN infrastructure will be used in later projects for the trialling of interventions delivered by village health workers (VHWs) and rural clinics to improve the management of febrile illness. During the initial three-year funding period the SEACTN infrastructure will be built up across 750 villages in three South and Southeast Asian countries, facilitating the capturing of over 100,000 episodes and outcomes of febrile illness in remote and underserved communities. Key activities include the provision of mobile devices with data collection applications to VHWs and health facility staff for them to record the incidence of patients presenting with febrile illness. They will then be prompted to follow patients up to record the outcomes of the illness episodes. Samples from febrile patients will also be taken for aetiological investigations ·to better understand the causes and spatiotemporal heterogeneity of fever, and to investigate whether host biomarkers of severe illness can predict which patients are most likely to require referral from the community to higher level facilities. Health seeking behaviour surveys will also be carried out, and health facilities and services in the region will be mapped. The findings will provide an unprecedented account of the incidence and associated morbidity and mortality of febrile illness in rural settings in South and Southeast Asia, home to hundreds of millions of people with restricted access to healthcare. More importantly, the findings will be used to develop and deploy bespoke, spatially-explicit, electronic decision-support tools incorporating point-of-care tests for the management of febrile illnesses. The impact of these and other interventions on improving outcomes for patients with febrile illness will be evaluated in follow-on projects using pragmatic cluster-randomised trials across the SEACTN villages and health facilities."

Lay abstract: This proposal relates to the first project within the Rural Febrile Illness Programme of the ‘Innovations for Impact in Resource-limited Settings’ flagship. We propose to build the Southeast Asian Community-based Trials Network (SEA-CTN), a regional platform for the continuous evaluation of interventions to promote early access to effective diagnosis and treatment for febrile illness and other common causes of ill-health in rural communities in South and Southeast Asia. We will establish a network of 520 village health workers and eight rural health facilities across three countries in South and Southeast Asia, where we will enable ongoing surveillance of incidence, causes and outcomes of febrile illness. This will provide a detailed description of the morbidity and mortality burden associated with febrile illness in areas with very limited contact with formal health system, as well as aetiological information that will direct subsequent diagnostic and treatment strategies. Armed with this information we will then identify optimal point of care tests that will be deployed alongside bespoke electronic decision support tools, informed by local aetiology and other contextual factors. Upon completion of the project we aim to proceed to large cluster-RCTs, initially at health facilities and later in villages, to determine the efficacy and effectiveness of the decision support tools, incorporating clinical features and POCTs, to reduce mortality from febrile illness.

Research activity codes: 2.1 BIOLOGICAL AND ENDOGENOUS FACTORS;2.2 FACTORS RELATING TO PHYSICAL ENVIRONMENT;7.1 INDIVIDUAL CARE NEEDS;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: INFECTION;INFLAMMATORY AND IMMUNE SYSTEM;CANCER AND NEOPLASMS;DISPUTED AETIOLOGY AND OTHER