The following is part of a training exercise for MSc Students in International Health and Tropical Medicine, University of Oxford * equal contribution from all co-authors listed by alphabetic order INTEGRATING NEGLECTED TROPICAL DISEASES INTO GLOBAL FUND AGENDA Nicole F. de Colombi (Argentina) Mona Ibrahim (Sudan) Sulaiman Jalloh (Sierra Leone) Rita Njeru (Kenya) Francisco Obando (Ecuador) Li Ann Ong (Malaysia) MSc in International Health and Tropical Medicine Centre for Tropical Medicine and Global Health Nuffield Department of Medicine
PRESENTATION OUTLINE 1. Overview Neglected Tropical Diseases (NTDs) Global Fund (GF) 2. Entry points Health and economic impact stemming from co-endemicity Impact NTDs on host susceptibility to HIV 3. Opportunities for integration Operational synergies for NTDs and GF programmes Health systems strengthening 4. Concluding messages Thoughts for action
OVERVIEW OF NTDS AND GLOBAL FUND • Affecting 1/6 of global population, causing substantive • 4 billion USD per year to address HIV, Tuberculosis and morbidity Malaria initiatives in LMIC Paucity of recognition, surveillance and funding 27% of investment towards strengthening health systems • • • Treatment costs billions USD per year • Funded a joint programme for Malaria & lymphatic vs prevention with MDA costing 0.5 USD per person filariasis in Togo
THE RELEVANCE OF NTDS IN GLOBAL FUND AGENDA Co-morbidity stemming from co-infections Health Outcomes Diagnosis and Economic Impact Rise in Vector-Borne Treatment Diseases Enhanced anaemia Difficult to diagnose Longer duration of Climate change • • • • • Increased mortality, • High rates of illness • Urbanisation stunting and cognitive treatment failure • Direct and indirect • Global travel impairment High rates of relapse costs • Dengue + Malaria e.g. Liver and bleeding STH + Malaria Leishmaniasis + HIV complications • Mutually reinforcing Dengue + Malaria • Accelerating disease progression Leishmaniasis + HIV
THE RELEVANCE OF NTDS IN GLOBAL FUND AGENDA NTDs increase host susceptibility and transmission risk of HIV Schistosomiasis Female urogenital disease increasing risk of HIV acquisition and • Increased susceptibility to transmission HIV WHO-recommended policy of Praziquantel treatment in • school children needs to be extended to adults in endemic areas Increases HIV Lymphatic filariasis transmission risk • Doubles the risk of HIV • LF can influence the success of HIV programmes Undermines Important to integrate NTDs control to reduce HIV control the burden of HIV in co-endemic region
OPERATIONAL SYNERGIES Opportunity for integrated control of NTDs into Global Fund agenda 1. Enhanced benefits 2. Synergistic benefits Intermittent Preventative Treatment Mass Drug Administration Ivermectin MDA IVERMAL study Malaria against Scabies, LF Ivermectin safety & & Onchocerciasis mosquitocidal Schistosomiasis Disruption of malaria parasite transmission for weeks School based programme IPT Malaria + NTDs Ivermectin MDA during Reduction in anaemia high Malaria transmission season Improved attention and recall in the children NTD + Malaria control Pregnant women IPT Malaria + Helminths Target anaemia from multi-infections
OPERATIONAL SYNERGIES Integrated Vector Management Currently Global Fund uses insecticide treated bed nets and indoor residual spraying for Malaria. Personal protection Opportunities for integration 1. Co-endemicity of multiple vectors amenable to Health Chemical integrated vector control strategy education Integrated e.g. Dengue, Malaria, Lymphatic Filariasis Vector Control 2. One method is unlikely to be effective Increasing resistance to pesticide and environment pollution Source 3. Prevention is the more cost effective Biological reduction e.g. Leishmaniasis
STRENGTHENING HEALTH SYSTEMS Strategic Objective of the Global Fund 27% of investment goes towards strengthening health systems Applicants are required to assess their health system Outcomes • Gathering quality data in the DRC • Improving efficiency of supply Source: Global Fund chains to reduce costs in Nigeria GF works with the Mozambique government to refurbish storage facilities, outsource transportation to improve delivery of medicine • Retaining and training health and train warehouse employees in supply chain management. workers in Zimbabwe and Senegal
FURTHERING THE GLOBAL FUND’S IMPACT ON HEALTH OUTCOMES Improve metrics to measure the effectiveness of health systems Current allocation utilisation and absorptive capacity PC: Commonwealth Secretariat 2019 Understand the opportunity cost of a country investing heavily in the three diseases Does limited capacity of Ministry’s of Health lead to disregarding other health priorities? Global Fund Replenishment Conference in Montréal . September 17, 2016 PC: Government of Canada
CONCLUDING MESSAGES Integrating NTDs into Global Fund Agenda Strengthen Global Funds’ capacity to identify synergistic programmes Allocate funding where there is the greatest potential for gains from synergies Increase support and funding towards strengthening Health Systems Monitor and evaluate the opportunity cost of funding three diseases Advance R&D through partnership
QUESTIONS?
IVERMECTIN MOSQUITOCIDAL EFFICACY
Recommend
More recommend
