Le Compte à Rebours est Lancé !

Professors Louis-Albert Tchuem Tchuenté, Samuel Wanji & Russell Stothard

Overview and introduction

Helminth Infections Soil-transmitted helminth infections

• Ascariasis-Trichuriasis-Hookworm

Lymphatic filariasis

Onchocerciasis

Schistosomiasis

Dracunculiasis (guinea-worm disease)

Cysticercosis

Echinococcosis

Foodborne trematodes infections

and other "neglected zoonotic diseases"

Bacterial Infections Leprosy Trachoma Buruli ulcer Endemic treponematoses

Viral Infections Dengue Rabies

Protozoan Infections Human African trypanosomiasis Chagas disease Leishmaniasis

WHO focus on 17 Neglected Tropical Diseases

Soil-transmitted helminth infections

• Ascariasis-Trichuriasis-Hookworm

Lymphatic filariasis

Onchocerciasis

Schistosomiasis

Trachoma

Disease Intervention approaches Tool Availability AFR Goal

Soil-transmitted Helminthiasis

Preventive Chemotherapy (PC)

Tool-Ready

Control

Schistosomisis

Lymphatic Filariasis

EliminationOnchocerciasis

Blinding trachoma

Guinea worm disease

Innovative & Intensified Disease Management

(IDM)

Tool-Ready

Eradication

Leprosy EliminationHuman African Trypanosomiasis

(HAT)*

Tool-DeficientBuruli ulcer

ControlLeishmaniasis

10 Priority NTDs in WHO African Region

2015 2020Eradication • Dracunculiasis (guinea-worm disease) • Yaws

Global elimination

• Lymphatic filariasis• Blinding trachoma

Regional elimination

• Onchocerciasis in Latin America• Schistosomiasis in the Eastern

Mediterranean, Caribbean, Indonesia and Mekong River basin

• Schistosomiasis in the American and the Western Pacific regions

Country elimination

• Onchocerciasis in Yemen • Onchocerciasis in selected countries in Africa

• Schistosomiasis in selectedcountries in Africa

WHO NTD Roadmap: targets and milestones for 2015-2020 period

2012

694M

705M

711

M

729M

700M

0

10

20

30

40

50

60

70

80

90

100

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

Target date for full PC scale-up

20

20

go

als

WHO target of 75% coverage across diseases

%

Projected % of

people receiving

PC for at least

one disease

(including LF,

ONCH, SCH and

STH) out of total

number that

require PC

WHO identify scale-up of future PC to reach 2020 targets

Urgent need to address

bottlenecksin scale-up

of PC

and

to acceleratetowards

WHO 2020 targets

History behind NTD control programmes in Cameroon

NTD Control/EliminationProgramme

Datestarted

Onchocerciasis 1998

HAT 1998

Buruli Ulcer, Yaws, Leishmaniasis, Leprosy*

2001

Schistosomiasis and STH 2003

Lymphatic Filariasis 2008

Trachoma 2010

6 Existing NTD Control Programmes National NTD Master Plan 2012-2016Launched in Oct 2012

and currently been updated until 2020

Drug Distribution Channels for PC-NTDs

• School-based de-worming for Schistosomiasisand STH

• Community-based interventions for Onchocerciasis , Lymphatic Filariasis and Trachoma

• Vaccination campaigns for de-worming Pre-School Aged Children (<5 years)

• Insufficient few impact studies and need for better financial forecasting

• Period of school-based campaign too close to end of school year

• Delays in reporting treatment results from lower to higher levels

• Co-endemicity Lymphatic Filariasis/Onchocerciasis/Loa Loa Low treatment coverage

• Incentives issues for drug distributors demotivation and increase of attrition rates

• High reinfection rates (transmission dynamics) & limited vector control

Some key bottlenecks to NTD control in Cameroon

A broader perspective on COUNTDOWN

Professors Russell Stothard & Mark Taylor

Why was COUNTDOWN needed?

What will COUNTDOWN do?

What lasting legacy will COUNTDOWN leave?

Looking towards WHO’s 2020 Roadmap & SDG’s 2030 Targets

• Preventive chemotherapy • NTDs exacerbate poverty & suffering

Thinking further ahead 2015-2030: further domestic funding needed

The WHO/World Bank Framework & SDGs

• A minimum of 80% essential health services coverage

• 100% financial protection from out-of-pocket expenses

Control and elimination of NTDs is a ‘litmus test’ of progress

implementation research to optimise/strengthen performance

Reducing poverty in Africa with implementation science for NTD control

Programme of implementation research to inform the effective and sustainable scaling-up of integrated Neglected Tropical Disease (NTD) control initiatives

OJEU: 2013/S 181-312697

Open tender: one final application for £8M in the Nov. 2014 - Oct. 2019 period

In 2008, DfID committed £50M for to support control of NTDs

Implementation portfolio including:Sightsavers (Trachoma)Schistosomiasis Control Initiative (ICOSA)Filariasis Programmes Support Unit (LSTM)UNITED (Nigeria)

….with The Research and Evidence Division supporting

Why was COUNTDOWN needed?

What will COUNTDOWN do?

What lasting legacy will COUNTDOWN leave?

Rationale for research themes and approaches

PC NTDs

Diseases: ONCH*

LF

SCH

STH

(TRA)

Drugs: IVM/DEC/ALB/MEB/PZQ

(ZRT)

DOXY*

Q1) What are effective, cost-effective, sustainable and acceptable current and complementary strategies for scale-up?

Q4) How can integrating NTD programmes strengthen health systems and foster cross-sector working (e.g. sanitation & agriculture)?

Q2) What generalizable factors influence the acceptance, effectiveness, efficiency, and equity impact of scale-up within the health system?

Q3) What are the most effective strategies to work with CDDs and CHW to extend scale-up of MDA to include hard-to-reach communities?

Our IR questions were subsequently developed and are:

Multi-disciplinary studies: from social science to field epidemiology

How we will do it

IntegratedComplementary Strategy Theme

ICST 1

ICST 2

Liberia GhanaCameroon

MDA Scale-up Theme (MST 1 – 3)

elimination

: country & context-specific settings of MDA

MST 1: Evidence synthesisPaul Garner and Cochrane group

MST 2: Applied social scienceSally Theobald and Margaret Gyapong

MST 3: Health economicsLouis Niessen

ICST 1: ‘Hotspots’ and SAEs Mark Taylor, Lisa Riemer/Jo TurnerNana Biritwum and Sam Wanji

scale-up in Nigeria & responsive research

ICST 2: Access to MDA and CLTS Russ Stothard, Emily Adams, Kamal KarLouis Tchuem-Tchuente and Mike Osei

control

Impact and pathways to achievement

IMPACT: Reduced morbidity,mortality, and povertyassociated with NTDs throughincreased knowledge andevidence for cost effectivescale-up and sustainablecontrol and elimination of NTDsas a public health problem inline with the WHO 2020 NTDRoadmap

Community

Global

Regional

National

District

What are the COUNTDOWN expected results?

2: Provide rigorous and generalizable evidence to improve and support scale-up of MDA programmes, fostering optimal co-ordination

3: Develop knowledge management strategy and multi-sectoral platforms for cross-talk and dialogue, ensuring open access knowledge products

4: Increase research capacity and integrate multi-sectoral evidence for optimisation of NTD control programmes

Our results are framed in four outputs:

1: Form a vibrant multidisciplinary IR consortium engaged with national NTD programmes and international stakeholders

Why was COUNTDOWN needed?

What will COUNTDOWN do?

What lasting legacy will COUNTDOWN leave?

A successful launch on March 12th at LSTM, hosted policy positioning meetings

Formal research outputs already starting to change opinions and focus efforts

Launch of COUNTDOWN in Ghana 14th October

In October there are 4 key events before the end of inception year

Chairing 2 sub-meetings at COR-NTD in USA 22/23rd October

Cameroon launch 9th and RU uptake meeting on 12th October

Year 2 activities set to start with on-the-ground actions in country in 2016

Research structure in across two universities and interface with NTDs

- Buea Evidence synthesis, Social science, Health economics, ONCHO

- Yaounde Evidence synthesis, Social science, Health economics, SCH, STH

COUNTDOWN in Cameroon

New ways to rid Cameroon of River Blindness (Onchocerciasis)

Professor Samuel Wanji

Community-directed treatment with ivermectin (CDTI)

CDTi after 14 years in SW Region Cameroon

39 communities, 3 river basins, SW Cameroon

Poor coverage is linked to fear of severe adverse reactions from eye worm

Doxycycline, a proven safe Onchocerca cure targeting Wolbachia

0

10

20

30

40

50

Ivermectin Doxycycline

Active Worms

Community based intervention with doxycycline

Adopted as policy drug for alternative strategy by APOC, 2014

"many people are asking for the drugs in my community and those who have already been treated are still requesting for another treatment" CHI, Sanke

"I used to have a nodule on my knee, but it has disappeared after doxycycline treatment” Mbokambo community member

Ground larviciding – vector control to reduce/stop transmission

ICST-1

• How to implement these two alternative strategies?

• Test and treat with doxycycline in 10,000 people in Meme River Basin

• Combination with Temephos ground larviciding

Shifting from control to elimination of schistosomiasis

Professor Louis-Albert Tchuem Tchuenté

• Wide distribution of disease, 2M people infected

• Over 5 million people at risk of infection

• Highest endemicity in the Northern regions

• Occurrence of 3 schistosome species, several host snails

(S. haematobium, S. mansoni, S. guineensis)

• Various transmission dynamics, including single and mixed species infections

Schistosomiasis distribution

Main Features of schistosomiasis in Cameroon

Systematic deworming of school-age children and groups at risk …

Main Control Strategy: School-based delivery of PZQ

… in collaboration with the Ministry of Basic Education and the Ministry of Secondary Education

Steady Progress in SCH and STH treatments across Cameroon

0

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

7,000,000

8,000,000

9,000,000

2006 2007 2008 2009 2010 2011 2012 2013 2014

STH Schistosomiasis • MDA boosted by donated medicines

• Increase of Schistosomiasistreatment from 35 000 in 2006 to 2 818 604 in 2014

• Increase of STH treatment from 170 000 in 2006 to 8 252 171 in 2014

However, better access to PZQ and other Interventions are needed

• Pre-School-age children are not treated

• All SAC out-of-school are not reached

• Adults are not treated

• Rapid reinfection rates in high transmissionsettings, due to intense water contacts, requirealternative strategies

• Need to implement environment control: snailcontrol, sanitation improvement

ICST-2

• Scale-up of integrated access to Mass Drug Administration and Community Led TotalSanitation for the control and elimination of SCH and STH:

Equitable access to treatment for preschool-aged-children, out-of-school-children and adults Contribution to Universal Health Coverage

Improve of hygiene and sanitation in communities, snail monitoring

• Optimized strategies related to transmission dynamics:

Treatment twice per year Reduction of the impact of rapid reinfection rates in hightransmission settings

• Applied Social Science research to address impediments in control and scale-up

• Female genital schistosomiasis and capacity development for surveillance

In conclusion – implentation research of international importance

P C - NTDs

environment

COUNTDOWN will help moving from single intervention (treatment) to co-ordinated interventions optimizing impact.

PHASE approach:

Preventive chemotherapy,

Health education and behavioural change ,

Access to clean water and safe practices,

Sanitation and hygiene,

Environmental control

A New Asset: China-Africa Cooperation for Schistosomiasis Elimination

6th October signing the MOUIn Cape Town, South-Africa

Thank You for Your Attention

At the dawn of a new era of NTD control and a future

towards elimination