title: The urgent need for clinical, diagnostic, and operational research for management of Buruli ulcer in Africa.
abstract: Despite great advances in the diagnosis and treatment of Buruli ulcer, it is one of the least studied major neglected tropical diseases. In Africa, major constraints in the management of Buruli ulcer relate to diagnosis and treatment, and accessibility, feasibility, and delivery of services. In this Personal View, we outline key areas for clinical, diagnostic, and operational research on this disease in Africa and propose a research agenda that aims to advance the management of Buruli ulcer in Africa. A model of care is needed to increase early case detection, to diagnose the disease accurately, to simplify and improve treatment, to reduce side-effects of treatment, to deal with populations with HIV and tuberculosis appropriately, to decentralise care, and to scale up coverage in populations at risk. This approach will require commitment and support to strategically implement research by national Buruli ulcer programmes and international technical and donor organisations, combined with adaptations in programme design and advocacy. A critical next step is to build consensus for a research agenda with WHO and relevant groups experienced in Buruli ulcer care or related diseases, and we call on on them to help to turn this agenda into reality.
authors.affiliation: Manson Unit, Médecins Sans Frontières, London, UK; Department of Infectious Diseases, Geelong Hospital, Geelong, VIC, Australia; Department of Medicine and Infectious Diseases, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia. Electronic address: daniel.obrien@amsterdam.msf.org.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: O'Brien
authors.affiliation: Medical Unit, Médecins Sans Frontières, Geneva, Switzerland.
authors.forename: Eric
authors.initials: E
authors.lastname: Comte
authors.affiliation: Medical Unit, Médecins Sans Frontières, Geneva, Switzerland.
authors.forename: Micaela
authors.initials: M
authors.lastname: Serafini
authors.affiliation: Médecins Sans Frontières, Yaounde, Cameroon.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Ehounou
authors.affiliation: Medical Unit, Médecins Sans Frontières, Geneva, Switzerland.
authors.forename: Annick
authors.initials: A
authors.lastname: Antierens
authors.affiliation: Department of Rehabilitation and Palliative Care, Medical Rehabilitation Division, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Hubert
authors.initials: H
authors.lastname: Vuagnat
authors.affiliation: Department of HIV, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Christinet
authors.affiliation: Médecins Sans Frontières, Yaounde, Cameroon.
authors.forename: Mitima D
authors.initials: MD
authors.lastname: Hamani
authors.affiliation: Manson Unit, Médecins Sans Frontières, London, UK.
authors.forename: Philipp
authors.initials: P
authors.lastname: du Cros
mesh_terms: D000349:Africa; D054312:Buruli Ulcer / Q000175:diagnosis* / Q000188:drug therapy; D042241:Early Diagnosis; D006801:Humans; D019911:Mycobacterium ulcerans / Q000302:isolation & purification*; D058069:Neglected Diseases; D009874:Operations Research