Emerging infectious diseases pose an intensifying global health threat, especially in the context of fragile health systems in developing countries. A pressing need exists for continuous surveillance, rapid diagnosis and real-time tracking of emerging infectious diseases and antimicrobial resistance (AMR).

Through piloting a real-time integrated sentinel surveillance and response system, the project is generating evidence to enable the implementation of rapid-response strategies for surveillance of malaria and other vector-borne diseases (VBDs). At the same time, the project is strengthening PNG capacity for research implementation and developing policy options to safeguard the country against VBDs.

The program is designed around two Core Objectives:

I – Strengthening VBD sentinel surveillance to allow rapid identification of outbreaks, resurgent and resistant pathogens and utilise data for decision-making.

II – Developing policy options for key health systems supports to respond to febrile illness, resistant pathogens and provide better support to front line health workers in surveillance, adherence and reporting.

The second objective aims to ensure that feasible and appropriate health system options are available to make best use of the new surveillance information generated through Objective 1, and to ensure proper integration with other elements of the health system. Specific research and capacity development activities exist within all aims (outlined below), together with regular monitoring, evaluation, knowledge sharing and dissemination activities.

Aim 1: Integrated real-time vector borne pathogen surveillance, mapping and response network

Aim 2: Molecular monitoring of vector-borne pathogens and P. falciparum anti-malarial drug resistance markers - strengthening laboratory capacity at the Molecular Hub

Aim 3: Vector monitoring for insecticide resistance and arbovirus detection – strengthening vector surveillance capacity at Provincial and District level

Aim 4: Options for better support to front-line health workers in surveillance, adherence and reporting

Aim 5: Strengthening linkages between surveillance and medical supply chain data

Aim 6: Policy-relevant modelling of options for system strengthening and outbreak

Timeline

May 2018 - June 2022

Results

• Sentinel surveillance sites collecting febrile illness data and sample collection for molecular confirmation of malaria and arboviruses are operational in 6 of the 8 strategically selected provinces; Morobe, National Capital District, New Ireland, Madang, West Sepik, Milne Bay, Western and Chimbu Provinces.

Samuel McEwen, Zebedee Kerry, Billy Ian & the Buimo Health Facility team, Lae

• STRIVE has adopted the Tupaia platform to link and visualise febrile illness surveillance data with diagnostic test results, parasite genomic data, mosquito abundance and insecticide resistance data and available resources (including diagnostic and treatment consumables). The STRIVE-Tupaia real-time integrated surveillance platform has been available online since November 2019, with users from both PNG and Australia currently accessing the platform.

Snapshot of the STRIVE-Tupaia real-time integrated surveillance platform with interactive map overlays and data dashboards

• Molecular assays for the detection of five regionally important arboviruses have been developed and deployed to the PNG Molecular Hub, and relevant laboratory staff training was conducted in February 2020.

Dr Paul Horwood & Ms Rebecca Narokobi at the PNG Molecular Hub, Port Moresby

• Surveillance for molecular marker of artemisinin resistance detected Pf C580Y mutant parasites in Lae, providing critically important information to the PNG National Malaria Control Program, National Department of Health.

• The Vector surveillance team, together with key staff from NAQIA and PNGIMR, have carried out insecticide resistance bioassays (IRM assays) for Aedes and Anopheles mosquitoes collected from sites in and around Lae, Port Moresby and Vanimo. During these visits staff from the provincial health authorities and relevant organisations receive training on the methods of larval collection, insectary maintenance and larval rearing, the IRM bioassays, morphological identification of mosquitoes and data entry.

STRIVE PNG’s Vector Surveillance Team working closely with partners from West Sepik Province

Outcomes

• STRIVE PNG has facilitated the effective collaboration between 13 research institutes across Papua New Guinea and Australia. STRIVE partners co-developed a Partnership Agreement to guide their collaboration practice and achieve their shared goal of developing comprehensive and effective partnerships between implementation and research organisations to realise meaningful and sustained change. STRIVE Partners have jointly agreed to undertake a Partnership Health Check to assess the effectiveness and efficiency of the partnership, reflect on internal and external operating factors and continue to embed collaborative mindsets within the partnership.

STRIVE PNG Vector Surveillance Meeting, Port Moresby, 2019

• The establishment of the PNG Molecular Hub, Port Moresby, in May 2019 has allowed for efficient communication and standardisation of SOPs for Plasmodium and arbovirus molecular diagnostics between all institutions involved (PNGIMR, CPHL, UPNG-SMHS and NAQIA) and will have long-term benefits for sustaining the capacity for strengthened VBD surveillance that is developed under this project.

• The STRIVE PNG Vector working group has supported Provincial health teams in Lae, Vanimo and Port Moresby sentinel sites to strengthen capacity and establish semi-permanent insectaries for routine vector surveillance, including larval mapping, larval and adult collections and WHO phenotypic insecticide resistance bioassays.

Ms Naomi Vincent (right) conducting roadside collections for Anopheline larvae in Vanimo