NTDs and eye health: lessons learnt

and opportunities for collaboration

Adrian D Hopkins

Director: Mectizan Donation Program

Task Force for Global Health

Emory University; Atlanta, USA

NTDs and Eye HealthTrachoma

• Strategy for eliminating blinding Trachoma

– Surgery of Trichiasis– Antibiotic MDA– Facial cleanliness– Environmental Change

NTDs and Eye HealthOnchocerciasis

• Strategy for elimination of the disease– MDA– (Rehabilitation of the blind)

Other NTDs and MDA

• Lymphatic Filariasis – Strategy for Elimination– MDA– Morbidity control

• Shistosomiasis– MDA– Water and Sanitation– ?? Snail control

• STH– MDA– Water and Sanitation

Community Directed Treatment with Ivermectin (CDTI) in action

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Mectizan treatments approved for Onchocerciasis

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Mectizan treatments approved for Lymphatic Filariasis

Other NTDs

• NTDs without community diagnosis methods• NTDs with difficult or toxic treatments• NTDs with complicated individual diagnostic

tools• These diseases require Intensified Disease

Management (IDM) for case finding, laboratory diagnosis and individual care

• HAT, Leprosy, Chagas Disease, Leishmaniasis, Leprosy, Buruli Ulcer and others

What are NTDs and relationship to Blindness

• Both diseases of the poor– More prevalent in the “bottom billion”– Occur where health services are inaccessible– The two major causes of infectious blindness are

NTDs for MDA– No simple strategies for some diseases.

• Disease management strategies– Community diagnosis– Require community mobilisation– Require a multi-sectorial approach

Community involvement

Linking CBR, VHWs, and CDDs

• Same community but different programmes and different workers. WHY?– Why are there different vertical programmes with

different funding sources and controls?– Is it impossible to coordinate eye care with other

activities?

• Why is CBR not empowering enough to become CDR?

Advocacy

• Clear simple messages– Tool ready strategies– Simple cost strategies– Clear results– Defined impact

• Success in what you can do leads to research funding for what you cannot do

• Long-term commitment.– NO 3 year programmes.

Needs for Political Commitment

• Need wide stakeholder input at international and national level, WHO, governments (MoH M of Finance, M of Education) with NGDOs and WHO in country.

• Need peer pressure between governments, using regional meetings (success of APOC)

• Need to involve local governments. Local priority setting

• Need strong advocacy to medical authorities.

Challenges with Integration

• Morbidity Control and prevention– Emphasis on MDA - pill packages & coverage– Who will attend to the visually impaired– Who will care for eyes and limbs– Who will do the health education– Who will attend to water and sanitation

• Specificity– Reduction to lowest common denominator – No flexibility for alternative drug regimens– What about specific control/elimination parameters

Let’s finish the job properly!