Priority implementation research for measles-rubella microarray patches identified using the Child Health and Nutrition Research Initiative methodology

Background: Measles and rubella continue to be a significant global health challenge, disproportionately impacting marginalised communities in low- and middle-income countries (LMICs). Innovative technologies such as measles-rubella microarray patches (MR-MAPs) are currently in development and can potentially improve immunisation coverage and equity through their unique product characteristics. Nonetheless, the limited evidence around their use cases, optimal implementation, cost-effectiveness, and integration into national immunisation programmes raises the need for the development of a prioritised implementation research agenda. Methods: We used the Child Health and Nutrition Research Initiative (CHNRI) methodology to prioritise 36 research questions (RQs), which we identified through a rapid literature assessment and consultations with experts. We then prepared an online survey and asked stakeholders to assess each question considering the selected CHNRI criteria. We calculated research priority scores (RPS) and average expert agreement (AEA) and conducted stratified analyses restricted to: LMIC government representatives, respondents based in middle-income countries, those with at least moderate experience in implementing health products in LMICs, those with at least moderate knowledge of MR-MAPs, and representatives from academic or research institutions. Results: A total of 139 respondents identified a diverse range of priorities for MR-MAP implementation research. The 36 RQs had a median RPS of 80%. The key priorities identified included research on vaccine supply chain management, vaccine uptake among underserved populations, and human resource implications for integration in routine immunisation services. Stratified analyses revealed a diversity of scores, with representatives from LMIC governments generally prioritising operational questions related to human resources, vaccine administration, and managing dual delivery mechanisms. Fifteen RQs were prioritised to accommodate different perspectives. Conclusion: This exercise prioritised implementation questions that will inform MR-MAPs' research investments and efforts over the next 10 years in order to prepare for their introduction in LMICs. While the questions identified in this exercise were specifically about MR-MAPs, the RQs and potential evidence may apply to other vaccine MAPs. This research addresses critical evidence needed towards the successful roll-out of this innovative technology in LMICs, to ensure equitable access to measles and rubella vaccination and accelerate progress towards measles and rubella control and elimination.