IDM-NTDs: Challenges for Health Systems

IDM-NTDs: challenges for health systems (case study: tri-tryps) Julien Potet Médecins Sans Frontières / Doctors without Borders Washington, November 17th 2012

Human African Trypanosomiasis (HAT – sleeping sickness) Visceral Leishmaniasis (VL – kala azar) Chagas Disease (American Trypanosomiasis)

Dx (inc.test for cure) - Sensitive -Specific

Rx - Safe - Effective

Measuring both the efficacy of tools and their adaptedness to health systems in resourcelimited settings

SAFE EFFECTIVE ACCURATE

Dx (inc. test for cure) - Affordable - User-friendly - Rapid - Robust - Equipment-free - Deliverable to those who need them Rx - Affordable - Short-course - Oral - No cold chain - Minimal monitoring - Outpatient

ADAPTED TO HEALTH SYSTEMS IN RLS

Measuring both the efficacy of tools and their adaptedness to health systems in resourcelimited settings SAFE EFFECTIVE ACCURATE

Rx: Safe, effective, oral, short-course Dx: ‘ASSURED’ Toolreadiness

Tooldeficiency ADAPTED TO HEALTH SYSTEMS IN RLS

Available tools for Human African Trypanosomiasis

SAFE EFFECTIVE ACCURATE

CATT Microscopy on CSF

1

NECT

Pentamidine

2 Microscopy on blood and CSF

Melarsoprol (phasing out)

ADAPTED TO HEALTH SYSTEMS IN RLS

Rx

1st-line ttt (stage one) 1st-line ttt (stage two)

1

Screening test

2

Confirmation test and determination of stage

Dx

Post-ttt follow-up

Test for cure

Available tools for Human African Trypanosomiasis

SAFE EFFECTIVE ACCURATE

CATT Microscopy on CSF

1

NECT

1 2013?

Pentamidine

2 Microscopy on blood and CSF

Rapid lateral flow tests

Rapid screening tests open the door to new approaches to case-finding: door-to-door screening by CHWs, passive screening at PHC level

ADAPTED TO HEALTH SYSTEMS IN RLS

Rx

1st-line ttt (stage one) 1st-line ttt (stage two)

1

Screening test

2

Confirmation test and determination of stage

Dx

Post-ttt follow-up

Test for cure

SAFE EFFECTIVE ACCURATE

Available tools for chronic Chagas Disease

Serological lab tests

Benznidazole

Negativization of Ab

Nifurtimox

ADAPTED TO HEALTH SYSTEMS IN RLS

Rx

1st-line antiparasitic ttt

Dx

Diagnostic test

Post-ttt follow-up

Test for cure

SAFE EFFECTIVE ACCURATE

Available tools for chronic Chagas Disease

Serological lab tests

2013?

RDTs

A better drug than benznidazole and a test for cure are needed to treat the millions of patients who could be diagnosed with RDTs Benznidazole

Negativization of Ab

Nifurtimox

ADAPTED TO HEALTH SYSTEMS IN RLS

Rx

1st-line antiparasitic ttt

Dx

Diagnostic test

Post-ttt follow-up

Test for cure

Available tools for Visceral Leishmaniasis in South Asia

SAFE EFFECTIVE ACCURATE

L-AmB & combination therapies

Rk39 RDT

Microscopy on aspirates

Conventional AmB

Miltefosine

SSG (phasing out)

ADAPTED TO HEALTH SYSTEMS IN RLS

Rx

Treatment

Dx

Diagnostic test

Post-ttt follow-up

Test for cure/relapse

Available tools for Visceral Leishmaniasis in South Asia

SAFE EFFECTIVE ACCURATE

L-AmB & combination therapies

Rk39 RDT

Microscopy on aspirates

Uptake of best treatments in 2013?

Conventional AmB

Miltefosine

(phasing-out?)

(phasing-out?)

L-AmB is likely to become a pivotal drug for kala azar in South Asia. Efforts for access to L-AmB, including support to generics, will be needed.

ADAPTED TO HEALTH SYSTEMS IN RLS

Rx

Treatment

Dx

Diagnostic test

Post-ttt follow-up

Test for cure/relapse

Conclusion •

So-called ‘tool-deficiency’ was an excuse for inaction. Scale-up available treatments now !

•

Mass active screening through mobile teams can be considered as an opportunity for other outreach public health services.

•

The ‘RDT revolution’ has started for tri-tryps and opens door to taskshifting onto lay workers.

•

More R&D with NCEs is needed to develop treatments that can be easily rolled-out at lowest levels of care.

Thank you !