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Targeted Call for Research - public call for research priorities in Aboriginal and Torres Strait Islander health

ID: 
14
This submission reflects the views of
Organisation Name: 
The National Strongyloides Working Group
Personal Details
Specific Questions
1. What is the research priority (a significant research knowledge gap or unmet need) you are nominating? How would a TCR in this area greatly advance our understanding of this issue? (200 word maximum): 
Strongyloidiasis, caused by infection with the nematode Strongyloides stercoralis, is classified by the World Health Organization as a neglected tropical disease. It is rare in mainstream Australia. However in Indigenous Australian communities, infection is very common, with estimates of infection of 25 – 80% (Shield, et al 2016). Infected people may be asymptomatic, or they may suffer from gastrointestinal, respiratory and/or dermatological symptoms, ranging from mild and intermittent to severe and unrelenting. Due to an autoinfective life-cycle of the pathogen, infection is chronic and often life-long. When individuals are immunosuppressed, a systemic form of strongyloidiasis is initiated, leading to pneumonia, meningitis and septicaemia with high fatality rates. A collaborative approach to eliminate strongyloidiasis in Australia is needed. A TCR in the area of Strongyloides would bring together research groups in clinical research, parasitology, Indigenous engagement experts, health promotion, public health and environmental health. Areas that are not well understood include the environmental factors influencing survival and transmission of S. stercoralis, the role that dogs have in transmission of S. stercoralis, understanding of barriers to control and prevention in Aboriginal and Torres Strait Islander communities and availability and utilisation of current diagnostic techniques
2. What are the relevant Australian Government Priorities, and/or Ministerially-agreed State and Territory health research priorities linked to your nominated priority? (200 word maximum): 
1. The National Preventive Health Research Strategy 2013-2018 2. NHMRC Road Map II: a Strategic Framework for Improving the Health of Aboriginal and Torres Strait Islander People through Research, specifically, the action area of: supporting researchers in biomedical, clinical, health services and public health research to work collaboratively 3. The National Aboriginal and Torres Strait Islander Health Plan 2013–2023 4. Disseminated strongyloidiasis was added to the Northern Territory CDC’s notifiable disease register in 2011, in recognition of the impact of Strongyloidiasis.
3. How would a TCR in this area contribute to Aboriginal and Torres Strait Islander health and improve health outcomes for the individual and/or community? (200 word maximum): 
A TCR in this area would address those factors that result in high infection rates in Indigenous communities compared with low or rare infection in mainstream Australia, by investigating those factors listed above that are not well understood (the environmental factors influencing survival and transmission of S. stercoralis, the role that dogs have in transmission of S. stercoralis, understanding of barriers to control and prevention in communities and availability and utilisation of current diagnostic techniques). Improved health outcomes would be reduced infection. As noted above, generally people infected with Strongyloides present with a chronic form of strongyloidiasis. Infected people may be asymptomatic, or they may suffer from gastrointestinal, respiratory and/or dermatological symptoms, ranging from mild and intermittent to severe and unrelenting. Due to the autoinfective life-cycle, infection may be life-long. Secondary infection may cause pneumonia, meningitis or septicaemia, and is more likely to occur in immunosuppressed individuals. Disseminated infections are generally fatal.
4. How will the TCR reduce the burden of disease on the health system and Australian economy? (200 word maximum): 
The economic costs of chronic Strongyloidasis in Indigenous communities have not been reported, however elimination of neglected tropical diseases have been demonstrated to show a high rate of return on investment (Hotez 2009; Molyneux 2008). With infection rates are in communities extremely high, an inevitable economic cost ensures in terms of nutritional deficiency secondary to enteropathy, inability to work, inability to fully engage in social and caring activities, etc. The rare but fatal disseminated Strongyloidiasis causes great financial burden. Barriers to control have been identified (Miller et al. 2014), which suggests the likelihood of successful reduction of the burden of disease is increased. Hotez PJ, Fenwick A, Savoli, L, Molyneux (2009) Rescuing the bottom billion through control of neglected tropical diseases Lancet 373: 1570-75 Miller, A., Smith, M.L., Judd, J.A. and Speare, R., 2014. Strongyloides stercoralis: systematic review of barriers to controlling strongyloidiasis for Australian indigenous communities. PLoS Negl Trop Dis, 8(9), p.e3141. Molyneux DH. Combating the “other diseases” of MDG 6: Changing the paradigm to achieve equity and poverty reduction? (2008) Transactions of the Royal Society of Tropical Medicine and Hygiene; 102: 509–19.
5. Are there any reports or findings that support your nomination for the suggested topic? (200 word maximum): 
There has been growing calls for recognition and action to control this neglected tropical disease both in Australia and worldwide including a number of earnest demands for action in the medical literature: “Strongyloides stercoralis: A Plea for Action (Bisoffi et al. 2013) and “Chronic strongyloidiasis - don't look and you won't find”(Page and Speare 2016). A small but dedicated group in Australia, The National Strongyloides Working Group, has been actively working towards Strongyloides elimination for over ten years and recently published "The National Strongyloides Working Group in Australia Ten Workshops On: Commendations and Recommendations", which supports the need for a concerted effort to reduce the burden of this disease in Australian Indigenous communities. Disseminated strongyloidiasis was added to the Northern Territory CDC’s notifiable disease register in 2011, in recognition of the impact of strongyloidiasis. Letters to the Medical Journal of Australia (2015) advocated for strongyloidiasis to be made notifiable and the need for antenates to be screened for strongyloidiasis, as there is a lack of strategies to prevent unnecessary, and often undiagnosed, morbidity and mortality. Another generation of Indigenous children will continue to suffer for a lifetime if strongyloidiasis continues to be neglected by health authorities.

Page reviewed: 30 August, 2018