Experiences and perspectives of tb-work in Malawi Lars H. Vorland - - PowerPoint PPT Presentation

Experiences and perspectives of tb-work in Malawi

Lars H. Vorland CEO Helse Nord RHF

Helse Nord Tuberculosis Initiative (HNTI): College of Medicine 2011-2016

Importance

TB

• 9.6 million new cases
• 1.5 million deaths
• 33% of HIV deaths due to TB

HIV

• 2.1 million new HIV infec>ons
• 1.2 million deaths
• ↑risk of TB cases and deaths,

drug interac>ons

TB Research priori>es

• New diagnos7cs
• New drugs
• New vaccines
• Basic research to guide above
• Implementa7on science &

impact evalua7on: what can we do with exis>ng tools?

HIV Research priori>es

• New vaccines
• Cure
• GeIng to 90-90-90 targets
• Combina7on preven7on
• NCDs and aging with HIV

Helse Nord TB Initiative

• Capacity building grant to College of Medicine
• Helse Nord RHF and University of Tromso
• Support for all stages of post grad research

training – Senior Leadership – PhD and Masters training – Short Course training

• Funding a suppor>ve environment

– Strong scien7fic administra7ve capacity – Research infrastructure including laboratory – Networking

Jon Odland Hanne Haukland Lars Vorland

HNTI: BACKGROUND

• Joint College of Medicine (COM) and Malawi

Liverpool Wellcome (MLW) TB laboratory

• 2010: Grant applica7on

– Catherine Grey, Geoffrey Chipungu Microbiology unit of the Pathology Department COM – Liz CorbeX: MLW

• 2011: COM HNTI started its ac7vi7es
• HNTI cons7tutes a Secretariat and Steering group.

Vision

• To produce and support interna7onally excellent

collabora7ve and mul7disciplinary TB and HIV research within MLW and the College of Medicine

• To have a broader impact on na7onal and global

health policy

• To invest in local scien7fic capacity-building

Specific Objectives

• Strengthening HR (Capacity building) to form a

research and training group

• Postgraduate research training --- Short courses
• Establishing clinical liaison scheme with QECH
• Networking , collabora7ons and mee7ngs
• Inves7ng in infrastructure and capital equipment

Research strategy

• Forma>ve research and trial of community-level HIV/

TB interven>ons, linked mathema7cal modelling

• Clinical trials: to reduce high early TB mortality
• Linking molecular and clinical pharmacology to

support Phase II and III clinical trials of TB

• Consolidate emerging strengths in qualita7ve

research, health economics, and popula7on sciences

• Build on MLW strengths in genomics
• Chronic lung disease in HIV-infected adolescents

2010-13: getting started

• Basic capacity within Dept of Microbiology

– Malawian lead (Geoff Chipungu) – Scien7fic administrator (Mphatso Mwapasa), lab tech, driver – Post Grad Fellows (PhD, Interns): 2 stage compe>>ve process – Distance-based Masters in Epidemiology

• Research infrastructure

– Laboratory equipment / Office Space / Vehicle – Data management & connec7on

• Postgraduate research training

– Short courses

• Networking and crea>ng demand to do TB research studies

– Networking mee7ngs, small grants, clinical liaison

2013-16: consolidation

• Human Resources

– Malawian leads: Tamiwe Tomoka & Chisomo Msefula – Scien7fic administrator: Mphatso Mwapasa – Clinical Microbiology specialist training – 2 further PhD Fellows: – 2 Distance-based Masters in Clinical Trials and Epidemiology

• Research infrastructure

– Biosafety Level 3 Modular Lab with MLW

• Postgraduate research training

– Ins7tu7onalise Post Grad 01-03 Short courses

• Networking and crea>ng demand to do TB research studies

– Networking mee7ngs, small grants, clinical liaison

Field sites

Laboratories

• MLW
• College of Medicine

Field sites

• Blantyre urban

– Field site of 108,000 adults – High HIV/TB – Extended M+E via TB Officers

• Thyolo rural

– 12 Primary Care Clinics – NIH-funded CHEPETSA study – Xpert MTB/RIF vs iLED microscopy Thyolo

ACF area:
 114k adults

Blantyre

HIV/TB in Malawi

Uniquely placed

• High disease burden Southern Region
• Interna7onal leadership in HIV/TB

policy and prac7ce

• Policy-makers very pro-research

– Open to innova7on

• Simple, robust, reproducible M+E
• World class laboratory facili7es

– MLW & HNTI ini7a7ve in College

• f Medicine
• Major collabora7ve input

– MLW & College of Medicine – Na7onal TB programme – District Health Office

Adult Smr+ve TB case-no>fica>on rates in Blantyre, 2010-15

Case-finding interven>on Non-interven>on Blantyre City

PhD Fellows & MSc Studentships

Wellcome Trust PhD HNTI/Commonwealth

• 4. McEwen Khundi

Moses Kumwenda Augus>ne Choko Thandie Mwalukomo Marriof Nlawisa Noel Kayange Victor Ndlovu Jamilah Meghji Peter MacPherson

Distance Masters

• 7. Aaron Mdolo
• 8. Deus Thindwa
• 1. Tamiwe Tomoka
• 2. Mphatso Mwapasa
• 3. Lingstone Chiume
• 6. Lucky Ngwira

Ankur Gupta- Wright Kruger Kaswaswa

• 9. Augus>ne Choko
• 5. George Sinjani

Short Courses in Postgraduate Research Methods (PRM)

• Highly successful
• Each session is aXended by

30+ candidates

• Delivered in collabora7on

with MLW, LSHTM, The Ethox Centre.

HNTIS VISION 2016 and BEYOND

• To support Malawi's role interna7onally as a

Pathfinder country for the WHO Global Ac7on Framework for TB Research, and lead the first term

• f the Na7onal TB Research Network within Malawi
• To invest in local Postdoctoral clinical scien7sts, and

in postgraduate research training

Malawi as a pathfinder country

• To be awarded a Pathfinder status

– Already have substan7al research capacity – May be able to develop and implement a na7onal TB research plan rapidly – These countries will achieve milestones more quickly and will serve as path finding or model countries for TB research

• Other Pathfinder countries: Peru, South Africa,

Indonesia, Vietnam, Ethiopia

Current grants

UNITAID: HIV Self Tes7ng BREATHe Trial STAMP Trial ACF in the community Helse Nord TB Initiative Biosafety 3 TB lab

Collaborative CoM/MLW TB lab

MLW

• 6 WT Fellows

– Liz CorbeX – Henry Mwandumba – Kondwani Jambo – Hannah Jary – Jamilah Meghji – Andy McCallum

• Other Funders

– NIH – FIND – TREAT TB

COM TB Research Group

n EDCTP: n PanBIOME n TESA n HNTI Fellows n TB in prisons n MSF

Thank you!

Strengt engthening hening HR HR to

• for
• rm

m a a res esear earch h and and training aining group

• up
• Research Group Director ( Dr Tamiwe Tomoka)
• Microbiology Lead ( Dr Chisomo Msefula)
• Scien7fic Administrator ( Mr Mphatso Mwapasa)
• Data Officer ( Ms Kumbukani Komakoma)
• Mentors:

– Liz CorbeX – Anthony BuXerworth

Infrastructure & Equipment

Modular CL3 Laboratory work in progress q With the financial investments from : i. Wellcome Trust

• ii. Helse Nord RHF, Norway
• iii. HNTI ( USD 55,000.00)

q Expected to Increase the capacity in securing grants GeneXpert Procured – with four modules OMR – Teleform system installed. q Used by both the CoM and MLW.

3 pillars of the End TB Strategy

• Integrated, pa7ent-centred care and preven7on
• Old policies and suppor7ve systems
• Intensified research and innova7on: through:

– WHO Global Ac7on Framework for TB Research

• Describes how to strengthen TB research in all

countries

Key external collaborators

MLW

LSTM CoM LSHTM UK, US, SA, Norway Policy maker

NTP and HIV Dept & DHO WHO

Haileyesus Getahun Rachel Baggaley

U of Warwick

Hendy Maheswaran Nigel Stallard Petrou Stavros Peter Dodd

USA: John Hopkins Uni

Dick Chaisson, David Dowdy

Norway

Jon Odland, Hanne Haukland

LSHTM

Richard Hayes, Helen Weiss Katherine Fielding Anna Vassalls Richard White

LSTM

Steve Ward, Ber7e Squire, Carmen Gonzalez

UoL

Saye Khoo Gerry Davies Peter MacPherson

CoM

Tamiwe Tomoka Victor Mwapasa South Africa UCT Helen McIlleron Mark Nicol

PhD Fellows MMED (UCT) DBL MSc Epi

Postgraduate Training

Kruger Kaswaswa Marriof Nliwasa Margaret Khonga Aaron Mdolo Tamiwe Tomoka Mphatso Mwapasa Victor Ndhlovu Moses Kumwenda

DBL MSc CT (LSHTM)

Establis blishing hing Clinical linical Liais Liaison

• n

Scheme heme

• Established in 2011.
• CoM/MLW TB laboratory receives

samples of TB suspects (QECH).

• At least 40 samples go through this

scheme every month.

Collaborations beyond the COM/MLW lab

Groups and organisa7ons doing TB Work – Na7onal TB control program – Dignitas – Challenge TB – KNCV TB founda7on – MEIRU (Karonga preven7on study) – UNC

WHO Global Action Framework for TB Research

• May 2014 WHO members states adopted the End TB

strategy – Serves as a blue print for countries to end global TB epidemic – Target by 2035:

• Reduce TB incidence by 90%
• Reduce TB deaths by 95%
• Eliminate catastrophic costs for TB affected

households by 2020

WHO Global Action Framework for TB Research

• Has 3 parts
• Part 1: How to strengthen research in low and

middle income countries: The role of pathfinder countries

• Part 2: How to enhance TB research globally
• Part 3: WHO support

How to strengthen research in low and middle income countries:

• Na7onal TB research network
• Country specific TB research network agenda
• Capacity building in TB
• Research funding
• Advocacy for public support
• Monitoring and evalua7on

Milestones by 2020

• Milestones have been grouped into Country, Global

and WHO

• The 4 Country milestones by 2020:

– Established a na7onal TB research network; – Integrated TB research within the Na7onal TB Strategic Plan; – Developed a list of na7onal TB research priori7es; – Ini7ated in-country research training

Thank you!

Vision

• To support interna7onally excellent

collabora7ve and mul7disciplinary TB and HIV research within MLW and the College of Medicine

• To have a broader impact on na7onal

and global health policy

• To invest in local scien7fic capacity-

building