02553nas a2200289   4500000000100000008004100001260002300042100001700065700001400082700002100096700001300117700002700130700001700157700002400174700001600198700001700214700001200231700001400243700001400257700001900271245012000290856009900410300001300509490000700522520172000529022001402249       2021                            d  c12/2021bPlos NTDs1 aRasoanaivo T1 aBourner J1 aRandriamparany R1 aGamana T1 aAndrianaivoarimanana V1 aRaherivelo M1 aRandriamampionona H1 aRajerison M1 aRaberahona M1 aSalam A1 aEdwards T1 aOlliaro P1 aRandremanana R00aThe impact of COVID-19 on clinical research for Neglected Tropical Diseases (NTDs): A case study of bubonic plague.  uhttps://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0010064&type=printable  ae00100640 v153 a<p><strong>BACKGROUND: </strong>Among the many collaterals of the COVID-19 pandemic is the disruption of health services and vital clinical research. COVID-19 has magnified the challenges faced in research and threatens to slow research for urgently needed therapeutics for Neglected Tropical Diseases (NTDs) and diseases affecting the most vulnerable populations. Here we explore the impact of the pandemic on a clinical trial for plague therapeutics and strategies that have been considered to ensure research efforts continue.</p>

<p><strong>METHODS: </strong>To understand the impact of the COVID-19 pandemic on the trial accrual rate, we documented changes in patterns of all-cause consultations that took place before and during the pandemic at health centres in two districts of the Amoron'I Mania region of Madagascar where the trial is underway. We also considered trends in plague reporting and other external factors that may have contributed to slow recruitment.</p>

<p><strong>RESULTS: </strong>During the pandemic, we found a 27% decrease in consultations at the referral hospital, compared to an 11% increase at peripheral health centres, as well as an overall drop during the months of lockdown. We also found a nation-wide trend towards reduced number of reported plague cases.</p>

<p><strong>DISCUSSION: </strong>COVID-19 outbreaks are unlikely to dissipate in the near future. Declining NTD case numbers recorded during the pandemic period should not be viewed in isolation or taken as a marker of things to come. It is vitally important that researchers are prepared for a rebound in cases and, most importantly, that research continues to avoid NTDs becoming even more neglected.</p>
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