Large scale deployment of Wolbachia across diverse urban communities in Rio de Janeiro and Niterói and development of a pilot model for national roll-out.

Since 2011 the Eliminate Dengue Program has been undertaking limited, open field releases of Wolbachia-infected mosquitoes in five countries. Large cluster randomized trials are commencing in the Indonesian city of Yogyakarta and the Vietnamese city of Nha Trang. These trials are expected to deliver the highest quality evidence of efficacy by 2020.
In this proposal we intend to undertake a large scale deployment in areas of Rio de Janeiro and Niterói, and a pilot deployment in the city of Belo Horizonte from which we will develop a model for national roll-out. These deployments will be complementary to the randomized trials in SE Asia and proposed large scale pilot implementation in Colombia, and will demonstrate our ability to deploy over significant population centers cost effectively. In addition, the deployment across Rio de Janeiro will allow the development of specific engagement and delivery strategies targeted towards poor and informal communities (favelas), which represent more than 20% of the overall Rio de Janeiro population. The complexities of these communities are considerable, and include risks associated with security, access, societal and physical structures, and conflicting priorities. As these communities often represent the highest risk transmission settings, appropriate strategies will need to be developed to ensure health equity amongst these poor and marginalized communities. The proposed approach will leverage off existing community structures and reach out to trusted sources within favela communities, notwithstanding our current partnership with the Municipality and including established NGOs, community groups and/or associations and businesses.
By completing these Brazil deployments, we will gather complemental evidence to that collected in our randomized trials on potential disease impact that will be sufficient for early adopter countries to commence deployments; we will build the expertise and experience to deploy rapidly and at scale in a South American setting; we will continue our work on developing an online platform (Catalyst) to capacity build for future global deployments.