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A Global Overview of the Program to Eliminate Lymphatic Filariasis

Lymphatic Filariasis Elimination in the Americas 6th Regional Program Managers’ Meeting (San José, Costa Rica, October 2005). A Global Overview of the Program to Eliminate Lymphatic Filariasis. Dr. Steven Ault, Regional Advisor in Communicable Diseases

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A Global Overview of the Program to Eliminate Lymphatic Filariasis

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  1. Lymphatic Filariasis Elimination in the Americas6th Regional Program Managers’ Meeting (San José, Costa Rica, October 2005) A Global Overviewof theProgram to Eliminate Lymphatic Filariasis Dr. Steven Ault, Regional Advisor in Communicable Diseases Pan American Health Organization, Regional Office of the World Health Organization (PAHO/WHO)

  2. Mapping LF Distribution In Endemic Countries 54 countries completed

  3. Mapping LF Distribution In Endemic Countries 54 countries completed 15 countries in progress 14 still unmapped

  4. Countries with LF Elimination Programs Mapping LF Distribution In Endemic Countries As of now, 42 countries under MDA

  5. Scaling Up MDA

  6. Proportion of Endemic Countries That Have Initiated Mass Drug Administration (MDA) Programs

  7. Population Covered and Reported Drug Intake per RPRG in 2004

  8. Progress in Geographical Coverage by MDA in India, 1996-2004

  9. Progress in MDA Using WHO-Recommended Two-Drug Strategy or Diethylcarbamazine Citrate (DEC)-Fortified Salt

  10. Cumulative Targets of Population Covered by MDA (Cairo, March 2004)

  11. Ensuring a Safe MDA Campaign • Dissemination of TAG recommendations and emphasis to program managers at PM meetings on reporting and managing severe adverse experiences (SAEs) • Visit of pharmacovigilance expert to investigate SAEs • Review by an external expert • Recording all SAEs in the Uppsala database

  12. DEC Supply • Presently, due to changes in reapplication, of the three pre-qualified GMP/GLP standard manufacturers, only one is pre-qualified. • The two remaining should requalify once manufacturing moves to a modern plant by the end of the year.

  13. Percent Decline in Microfilaria (MF) Prevalence in Sentinel Sites after MDA

  14. Binax "Now" Immunochromatographic Test (ICT) • 131 000 ICT cards procured by WHO for provision to countries • Presently relying on one manufacturer • Instability of results, product recalls, interruption of production and high cost • Shelf life reduced to 9 months • High cost • Looking at alternatives

  15. Projects on Prevention of LF-Related Disabilities • Community home-based care for lymphoedema management • in Brazil, Burkina Faso, Dominican Republic, Guyana, Haiti, Madagascar, Sri Lanka and Zanzibar (United Rep. of Tanzania) • Operational research to increase access to hydrocele surgery and follow-up of operated cases for complications and recurrence • in Burkina Faso, Madagascar and Zanzibar

  16. Decrease in Proportion of Lymphoedema Sufferers Experiencing Adenolymphangitis (ADL) Attacks in the Month Preceding the Start of Home-Based Self-Care • (next three slides)

  17. Funding Country Program Implementation • Central funding is diminishing • Some success in funding at country level has been experienced, e.g. • National funding for entire programme in India, Malaysia, Thailand, others • JICA support extended for 5 years to PacELF countries; DEC and volunteers for Bangladesh • Asian Dev. Bank support for Mekong group • DFID funds through the Liverpool School for identified countries for 5 years • AusAID funding to Indonesia, Timor-Leste, Philippines, Papua New Guinea • Mectizan® funding in Africa • GSK support for epidemiological assessment • There is a large gap between need and availability

  18. Synergy with Other Disease-Control Programs • Programme Synergy • Berlin meetings to generate an overall consensus on moving forward with neglected tropical diseases. • Ministries of health being motivated to move towards a coordinated and synergistic programmes links with Centers for Disease Control, Atlanta, USA and other partners. • A full session in the 6th meeting of the Technical Advisory Group on Lymphatic Filariasis.

  19. Monitoring and Evaluation • Guideline for managers at implementation unit level was produced and distributed. • Technical assistance was provided to countries nearing or completing five rounds of MDA. • Technical assistance is being given to China for verification of interruption of transmission. • Development and testing of WHO DAS as an evaluation tool for interventions against disability is ongoing.

  20. Informal Consultation on Issues arising after 5 Years of Program Implementation, Miami, November 2004 • Program goals and how to measure their achievement • Increasing the impact of interventions to achieve the goals

  21. Miami Informal Consultation: Conclusions • The existing WHA resolution still holds true. • PELF can be seen in three phases: • Initial implementation demonstrating rapid reduction of MF • Scaling up interventions • Moving towards interruption of transmission • The utility of a two-tiered programmatic goal structure • Level 1: When prevalence of filarial infection is below the level of Initiating interventions • Level 2: When parasitological indices are at levels are not conducive to recrudescence on stopping interventions

  22. Miami Informal Consultation: Recommendations • Protocols for assessing whether the transmission threshold has been achieved. • Test the protocol in countries completing 4 to 5 rounds of MDA. • Apply the protocol using several different tools in different settings. • Investigate questions related to tool development and performance in prospective studies. • Investigate the larger public-health benefit and the impact on the health system and the Millennium Development Goals (MDGs).

  23. Challenges Facing the Global Program • Scaling up program interventions • Ensuring high quality of program interventions • Generating data and experience to better define "endpoints": When to stop MDA • Simplifying program monitoring guidelines • Post-MDA surveillance and how to detect early resurgence • Ensuring regular supply of diagnostic tests and DEC for the programme • Funding to most countries to implement PELF • Implication and opportunities of integration for PELF

  24. Strategic Direction • Consolidation • Ensure "effective" MDA in ongoing areas. • Ensure countries completing five round of MDA in following M&E criteria. • Scaling-up in countries with MDA to minimize the total duration of programme interventions. • Start MDA in already-mapped countries vs. mapping the remaining central African countries.

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