dgis -itg imt a. von humboldt (imtavh) lima, peru institutional strengthening & collaboration
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DGIS -ITG
IMT A. von HUMBOLDT
(IMTAvH)
Lima, Peru
Institutional strengthening
& collaboration
Lima & UPCH• Lima, massive rural immigration
in 1970-1980: 2 10 M
• Universidad Peruana Cayetano Heredia
National General Hospital (4th line)
Northern Lima, 3 million inhabitants
UNIVERSIDAD PERUANACAYETANO HEREDIA
Facultades
Facultad de Medicina “Alberto Hurtado”
Facultad de Ciencias y Filisofía
Facultad de Estomatología
Facultad de Veterinaria y Zootecnia
Facultad de Educación
Facultad de Enfermería
Facultad de Salud Pública y Administración “Carlos Vidal Layseca”
Facultad de Psicología
- Private University, founded 1962
- 8 Facs, 6.500 students
- Hospital: 420 beds, training in 28
medical specialities, 900 students
- 3 Research Institutes,
including IMT AvH
IMTAvH (1968)
•Clinics for Tropical and Infectious Diseases
150 consultations /day, 36 beds,
9 infectiologists, 3 dermatologists
• 7 labs
• 9 courses, pre- & post-graduate incl. Gorgas Course
Instituto de Medicina Tropical Alexander von Humboldt
Founded 1968, German Foundation von Humboldt Support PNUD / WB / WHO / TDR Link with National Institute of Health, MOH Peru for epidemiology 2 poles of excellence, clinical and biological resulting from academic
(University) and medical (Fac Med + National Hospital) environment
Constraints
80's: international cooperations pulled off by lack of confidence indemocracy of current regime
90's: Fujimori stopped governmental funding to private Universities
IMTAvH- ITG
1987 Spin-off from DGIS/IMTA cooperation with Bolivia joint research project EC-STD (INCO) Leishmaniases
1988 Collaboration for Mycobacterioses Françoise Portaels / Humberto Guerra
1987 Collaboration for Mycoses Danielle Swinne / Betty Bustamante
1989 Memorandum of Understanding (MoU)1996 Collaboration in Malnutrition (P. Kolsteren)
joint EC-INCO project Antwerp -Lima - Cochabamba1996 MoU expanded + Nutrition, Public Health, STD1998 Framework Programme DGIS-ITG-IMTAvH "International Strenthening & Collaboration"
COLLABORATION
5 topics 12 partners 4 ITMA departmentsLeishmaniases *Jorge Arevalo Parasitologycut., muco-cut. Alejandro Llanos-
Cuentas, MD*Jean-Claude Dujardin,
D Sc •Mycobacterioses Humberto Guerra, MD MicrobiologyTB, MDR-TB, Buruli Françoise Portaels, D Sc Mycoses Betty Bustamante, MD Clinical Sciences & Sporotrichosis Danielle Swinne, D Sc Institute of Public
Health Brussels •Malnutrition Iris Pecho Public Health Micronutrients, Anna Pradaco-infections Patrick Kolsteren •Clinical Research Eduardo Gotuzzo Clinical Sciences (since 2000) Tine VerdonckHIV/TB, skin ulcer* Coordination: 2 local coordinators (JA/Lima, JDC/Antwerp) + 1 promotor (DLR/Antwerp)
SYNERGY BETWEEN TOPICS
Clinical epidemiology of HIV/TB and skin ulcerMolecular tools for diagnosis and epidemiology
INSTITUTIONAL STRENGTHENING
Human Resources: tech training, M Sc, PhDCentralized equipment for cryobanking & molecular biologyComputerized management of reference collections: clinical specimens, pathogens, seraDistance Learning: CD- ROM Trop. Med. cfr Erwin Van den Ende
4,2
7,0
12,4 14,0
-
5,0
10,0
15,0
1998 1999 2000 2001
BUDGET M BEF
DGIS INPUT, BUDGETARY
BREAKDOWN 2000
BUDGET 12 M 4
19%
18%
27%
14%
13%
9%
EQUIPMENT
CONSUMABLES
PERSONNEL
TRAINING GRANTS
TRAVELS & STAYS
ADMINISTRATIONCOSTS
QUALITY CONTROL
2001 Administrative management: 2nd back-up site visit (LS + JVL)
External evaluation: 1 Lat-Am + 1 EU experts
2002 New 5-yr Master Plan to be identified by IMTAvHinstitutional prioritiesQC indicatorssustainability
DGIS PROGRAMME
Strengthens institutional sustainability reference and teaching capacity
competitivity in research fund raising: EC-INCO, WHO/TDR, NIH…
Major achievements (equipment)
• Improvement of basic laboratory facilities
• Common facilities for sample storage (-70°C)
•Bio-Safety
•Common laboratory facilities for molecular biology
Major achievements (training)
• Clinical research: 2 MDs • Leishmania: 2 PhD, 4 MSc, 2 MSc• Mycology: 1 MSc• Mycobacteriology: 5 Medical students, 1 MSc• Nutrition: 2 experts, multidisciplinary team• Common activities: management biological
samples
Major achievements (science)
Clinical research:• TB: many patients with MDR, frequent co-infection PCP-
TB
• Skin ulcer (differential diagnosis): predictive value of clinical and epidemiological information; mostly due to Leishmania, PCR without biopsy (scrap)
• Translation of CD-Rom on Tropical Medicine in spanish (+/- 75% achieved)
Major achievements (science)
Leishmania: • PCR identification of Leishmania species directly in
biopsies (first in the world): prognosis and epidemiological
surveillance • Development of methodologies for analysis of differential
gene expression (virulence, drug resistance)
• Opening of a research line on the influence of vit A on disease progress
Major achievements (science)
Mycobacteriology:• Implementation of phage-based methodology for
identification of Mycobact. infection and determination of drug-resistance
• Detection of resistance to second line drugs in the general population of TB patients and in patients with MDR-TB (16% kanamycin, 10% ofloxacin)
• Detection of autochtonous cases of Buruli ulcer
Mycology:• possibility to be regional/national reference centre
• initiation of studies on molecular epidemiology of fungi
Nutrition:• 71% anemia < 5 years: despite good quality of iron-
enriched bread, this is not provided to children; search for alternative strategies.
• Effect of nutritional supplements on parasitoses
Major achievements (science)
Output (publications)
• Leishmania: 1 PhD thesis, 1 MSc thesis, 3 papers
• Mycology: 3 papers
• Mycobacteriology: 1 manual, 1 paper, 5 abstracts in proceedings
• Nutrition: reports, papers in the pipeline
• Clinical research: 1 paper in preparation
Output (projects)• Leishmania: 2 TDR, 1 INCO-Dev (Drug
resistance), 1 QOL (epidemiological surveillance)
• Mycology: 2 clinical trials• Mycobacteriology: 1 INCO-Dev (concerted
action), 1 submission to TDR• Nutrition: 1 INCO-Dev, 1 USAID• Clinical research: 2 submissions to TDR
Synergy
Clinical research
Tropical and Infectious diseasesLeishmaniases
MycosesMycobacterioses
HIV/AIDS
Molecular diagnosisand epidemiology
Ref. Sample collection
Role of nutritionalstatus
Prospects
• Clinical trials
• Reference centre for molecular diagnosis and epidemiology of pathogens (inter-regional course)
• Immunology (starting from HTLV/Strongyloides)?
• …(Cysticercose, neuro-)
DGIS
Institutional strengthening
Stability, continuity, pilot studies for competitivity in research projects(EC-INCO, WHO-TDR, NIH..)