{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T14:56:11Z","timestamp":1790693771112,"version":"4.1.0"},"update-to":[{"DOI":"10.1371\/journal.pntd.0010064","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2022,1,3]],"date-time":"2022-01-03T00:00:00Z","timestamp":1641168000000}}],"reference-count":34,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2021,12,20]],"date-time":"2021-12-20T00:00:00Z","timestamp":1639958400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"UK Foreign, Commonwealth and Development Office and Wellcome","award":["215091\/Z\/18\/Z, 216273\/Z\/19\/Z"],"award-info":[{"award-number":["215091\/Z\/18\/Z, 216273\/Z\/19\/Z"]}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>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\u2019I 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.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Discussion<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pntd.0010064","type":"journal-article","created":{"date-parts":[[2021,12,20]],"date-time":"2021-12-20T18:58:38Z","timestamp":1640026718000},"page":"e0010064","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["The impact of COVID-19 on clinical research for Neglected Tropical Diseases (NTDs): A case study of bubonic plague"],"prefix":"10.1371","volume":"15","author":[{"given":"Tsinjo Fehizoro","family":"Rasoanaivo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4687-8380","authenticated-orcid":true,"given":"Josephine","family":"Bourner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1942-0884","authenticated-orcid":true,"given":"Ravaka Niaina","family":"Randriamparany","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3508-2486","authenticated-orcid":true,"given":"Th\u00e9odora Mayouya","family":"Gamana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Voahangy","family":"Andrianaivoarimanana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mily Harijaona","family":"Raherivelo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harivelo","family":"Randriamampionona","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minoarisoa","family":"Rajerison","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8857-5834","authenticated-orcid":true,"given":"Mihaja","family":"Raberahona","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex Paddy","family":"Salam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6110-014X","authenticated-orcid":true,"given":"Tansy","family":"Edwards","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1426-3680","authenticated-orcid":true,"given":"Piero L.","family":"Olliaro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rindra Vatosoa","family":"Randremanana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,12,20]]},"reference":[{"issue":"5","key":"pntd.0010064.ref001","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1016\/S1473-3099(20)30120-1","article-title":"An interactive web-based dashboard to track COVID-19 in real time","volume":"20","author":"E Dong","year":"2020","journal-title":"Lancet Infect Dis"},{"key":"pntd.0010064.ref002","article-title":"Assessing the Effect of Global Travel and Contact Restrictions on Mitigating the COVID-19 Pandemic","author":"S Lai","year":"2021","journal-title":"Engineering"},{"issue":"2","key":"pntd.0010064.ref003","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1056\/NEJMp2007637","article-title":"Disease Control, Civil Liberties, and Mass Testing\u2014Calibrating Restrictions during the Covid-19 Pandemic","volume":"383","author":"DM Studdert","year":"2020","journal-title":"New England Journal of Medicine"},{"issue":"1","key":"pntd.0010064.ref004","doi-asserted-by":"crossref","first-page":"e14","DOI":"10.1111\/bjh.17168","article-title":"COVID-19 and myeloma clinical research\u2014experience from the CARDAMON clinical trial","volume":"192","author":"M Camilleri","year":"2021","journal-title":"British journal of haematology"},{"issue":"3","key":"pntd.0010064.ref005","doi-asserted-by":"crossref","first-page":"878","DOI":"10.3126\/nje.v10i3.31622","article-title":"Impact of COVID-19 on clinical trials and clinical research: A systematic review","volume":"10","author":"B Sathian","year":"2020","journal-title":"Nepal J Epidemiol"},{"issue":"5","key":"pntd.0010064.ref006","doi-asserted-by":"crossref","first-page":"e0251410","DOI":"10.1371\/journal.pone.0251410","article-title":"The impact of COVID-19 on the clinical trial","volume":"16","author":"Z Chen","year":"2021","journal-title":"PLOS ONE"},{"key":"pntd.0010064.ref007","unstructured":"World Health Organisation. 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