Working to overcome the global impact of neglected tropical diseases

Regional Lymphatic Filariasis EliminationProgram Managers’ Meeting

Southeast Asia RegionJakarta, Indonesia 23–24 Sep 2014

Progress updates in GPELF

Global Status of Preventive Chemotherapy

Global Programme to Eliminate Lymphatic Filariasis (GPELF)

Global Programme to Eliminate Lymphatic Filariasis (GPELF)

Global elimination by 2020

1. Stop the spread • Reduce infection prevalence to low levels at which

transmission considered unsustainable

2. Reduce suffering and improve quality of life

• Access to a basic recommended package of care

WASH

GPELF - an integrated strategyGPELF - an integrated strategy

GPELF's programmatic stepsGPELF's programmatic steps

Mapping MDA Post-MDAsurveillance1. MDA

2. MMDP

VC/IVM

Situationanalysis

Plan Minimum package of MMDP care

Situationanalysis

Do

ssie

r d

evel

op

men

t

VE

RIF

ICA

TIO

N

MMDP and rehabilitation

integrated into health services

M&ETAS

BeninCameroon

Central African RepublicCôte d’Ivoire

CongoEthiopia

Guinea-BissauMadagascar*

Kenya*Liberia

MozambiqueNigeria*SenegalUganda*

United Republic of Tanzania*

Domincan Republic*Guyana*Sudan

Bangladesh*Indonesia*Myanmar*

Timor-LestePapua New Guinea

Togo*

Yemen*

Maldives

Sri Lanka*

Thailand*Cambodia*

Vietnam*

American Samoa*

Cook Islands*

Marshall Islands

Niue

Palau

Tonga

Vanuatu

Wallis and Futuna

Burkina Faso*Comoros*

Ghana*Malawi*

Mali*Niger*

Sierra-LeoneBrazilHaiti*Egypt

India*Nepal*

Brunei DarussalamLao PDRMalaysia*

FijiFrench Polynesia

FSMKiribati

Philippines*SamoaTuvalu

AngolaChad

DR CongoEquatorial Guinea

EritreaGabonGambiaGuinea

Sao Tome and PrincipeRepublic of South

SudanZambia

Zimbabwe

New Caledonia

MDA not started

SurveillanceMDA <100% geographical

coverage

MDA at 100% geographical

coverage

Country status in GPELF, 2013

13 (18%) 23 (32%) 22 (29%) 15 (21%)

*29 have reported some MMDP data at least once in the past 5 years

Global status of Preventive Chemotherapy (PC) in 2012 2012 PC implementation LF ONCHO

STH SCHTRA PC4

PreSAC SAC SAC Adults

Number of countries requiring PC1 60 29 112 52 51 122

Number of people requiring PC 1,380M 130.5M 266.4M 609.5M 114.3M 135.1M 241.5M 1,891M

Number of countries reporting2 28 27 45 59 31 27 75

Number of people treated 596M 99.5M 86.1M 251.9M 42.1M 48.8M 807.6M

Coverage (%)3 43.2 76.2 27.7 37.5 14.4 20.2 41.91 Number of endemic countries moved to PTS stage are not included in total. 2 Number of countries reporting data on PC implementation. Countries submitted blank reports are not included in total.3 Coverage is calculated as number of people treated in need of PC out of population requiring PC.4 Number of people required/received PC for at least one disease. Trachoma is not included.

Global status of PC in 2013 (preliminary data) 2013 PC implementation LF ONCHO

STH SCHTRA PC4

PreSAC SAC SAC Adults

Number of countries requiring PC1 58 29 106 52 51 115

Number of people requiring PC 1,242M 132M 266.6M 609.7M 121.2M 139.8M 231.7M NA

Number of countries reporting2 33 NA 29 57 17 21 59

Number of people treated 410.5M NA 35.8M 199.5M 30.1M 54.9M 527.9M

Coverage (%)3 33.1 NA 12.2 30.1 10.4 23.7 NA1 Number of endemic countries moved to PTS stage are not included in total. 2 Number of countries reporting data on PC implementation. Countries submitted blank reports are not included in total.3 Coverage is calculated as number of people treated in need of PC out of population requiring PC.4 Number of people required/received PC for at least one disease. Trachoma is not included.

2013 implementation

AFR AMR EMR EUR SEAR WPR GLOBAL

# of countries requiring PC1 34 4 2 - 6 12 58

# of people requiring PC 472.1M 12M 20.4M - 700.9M 36.3M 1,242M

# of countries reporting2 18 2 2 - 5 6 28

# of people treated 127.6M 7.1M 0.8M - 253.6M 21.4M 410.5M

Coverage (%)3 27.0 59.2 3.9 - 36.2 58.8 30.11 Number of endemic countries moved to PTS stage are not included in total. 2 Number of countries reporting data on PC implementation. Countries submitted blank reports are not included in total.3 Coverage is calculated as number of people treated in need of PC out of population requiring PC.

Global status of PC in 2013 - lymphatic filariasis

Strategic Plan 2010-2020

Year Milestone Progress Report

2011 WHO guidelines and criteria for verifying absence of transmission

Common platform for the process of validation, verification and certification of NTD elimination

2012 Mapping completed in all countriesAll countries have initiated mapping. Mapping is ongoing in 14 countries with only 655 districts remaining

2014 All endemic countries collecting and reporting data on MMDP

40% of endemic countries provided morbidity information

2016 Full geographical coverage with MDA achieved 45% (33/73) countries have achieved

2020

70% of countries verified as free of LF and 30% under post-intervention surveillance

None of 73 countries verified free of LF

22% (16/73) of endemic countries moved into the surveillance phase

Full geographical coverage and access to basic care for lymphoedema (and hydrocele in areas of bancroftian filariasis)

40% of endemic countries are implementing MMDP

WHO STAG and its working groupsWHO STAG and its working groups

NTD STAGWorking Group on

Capacity Strengtheningfor NTDs

Working Group on Access to Quality-Assured

Essential Medicines

Working Group on Monitoring and Evaluation

of PC Interventions

Working Group on NZDs

Working Group on Investments for

Impact

Just established

1. Supporting countries to increase coverage with integrated interventions

2. Establishing principles and processes for validation, verification and certification

3. Positioning NTDs in the global health/development agenda: – Sustainable Development Goals (post-2015)– Universal Health Coverage

4. Mobilizing resources for yaws eradication

5. Accelerating the work to control NZDs

6. Responding to the dengue epidemic

STAG 2014Main recommendations

STAG 2014Main recommendations

1. Supporting countries to increase coverage with integrated interventions

1. Supporting countries to increase coverage with integrated interventions

Developing plans of action and building capacity to implementAnnual Work Plan

Standardized national and district-level NTD management training

Using data for decisions the national NTD database template

2. Establishing principles and processes for validation, verification and certification

2. Establishing principles and processes for validation, verification and certification

Disease-specific targets (NTD Roadmap):

Standard Operating Procedures (SOPs) to be developed and presented to STAG 2015

Target Focus Required process

Control Morbidity -

Elimination as a public health problem

Transmission and/or morbidity

Validation

Elimination Transmission Verification

Eradication Transmission Certification (formal)

Proposed process of validation:lymphatic filariasis

COUNTRY RO and RPRG HQ

*full documentation of the PELF, evidence of sustained prevalence below indicators, case detection and management; General guidance found in WHO/HTM/NTD/PCT/2011.4

Update on Guidelines and FormsUpdate on Guidelines and Forms

TAS training manuals and modules

TAS Eligibility and Reporting Form (under revision)

TAS – STH integrated assessment

MMDP Programme Managers Guide

MMDP Toolkit

Practical Entomology

Elimination dossier template (draft under review)

Joint Application Package (JAP) is an integrated planning tool, rather than just an application form for WHO-managed drug donations, composed of:

i. Joint Request for Selected PC Medicines (JRSM)

ii. Joint Reporting Form (JRF)

iii. Annual Work Plan (AWP)

iv. PC Epidemiological Data Reporting Form

• To be submitted when new data are available

New Reporting FormatNew Reporting Format

New version of ICT – Filariasis Test StripNew version of ICT – Filariasis Test Strip

Current ICT characteristics

• Storage temperatures of 2-8°C

• Shelf life of 15 months in cold chain, 3 months in ambient temperatures

• Cost of $2.50-$6.00 per test

• Manufactured in 50k batches

• Test readability of 10 minutes

Proposed FTS characteristics

• Storage temp 2-37°C

• Shelf life of 1-2 years in ambient temperatures

• Cost of $1.00-$1.50 per test

• Manufactured in >15k batches

• Test readability of 10 minutes

• Improved analytical sensitivity

Next Steps – Filariasis Test StripNext Steps – Filariasis Test Strip

Review diagnostic and operational characteristics identified from the field trials [complete]

Determine whether acceptable for programmatic use [complete]

Make recommendations to STAG [in process]

If recommendation approved by STAG– incorporate into WHO Catalogue as is ICT currently– create a demand plan based on reported country needs– develop centralised order and procurement management process

Consortium of donors ready to subsidise diagnostic needs

Update training materials and repeat regional TAS trainings

Operational ResearchOperational Research

New strategies MDA– Annual vs. biannual– Triple drug therapy (Albendazole, DEC, Ivermectin)– Albendazole monotherapy twice yearly (Loa loa areas)

New strategies MMDP– Doxycycline 200mg/day 6 weeks improves lymphedema

independent of ongoing infection

Ongoing surveillance strategies and diagnostic tools

Thank you for a future free of filariasis