idm-ntds: challenges for health systems
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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)
SAFE
EFFECTIVE
ACCURATE
ADAPTED
TO HEALTH SYSTEMS IN RLS
Dx (inc. test for cure)- Affordable- User-friendly- Rapid- Robust- Equipment-free- Deliverable to those who need them
Dx (inc.test for cure)- Sensitive-Specific
Rx- Safe- Effective
Rx- Affordable - Short-course- Oral- No cold chain- Minimal monitoring- Outpatient
Measuring both the efficacy of tools and their
adaptedness to health systems in resource-
limited settings
SAFE
EFFECTIVE
ACCURATE
ADAPTED TO HEALTH
SYSTEMS IN RLS
Measuring both the efficacy of tools and their
adaptedness to health systems in resource-
limited settings
Tool-
readiness
Tool-
deficiency
Rx: Safe, effective,
oral, short-course
Dx: ‘ASSURED’
SAFE
EFFECTIVE
ACCURATE
ADAPTED TO HEALTH
SYSTEMS IN RLS
1
2
Melarsoprol(phasing out)
NECTMicroscopyon CSF
1st-line ttt(stage two)
1
2
Screening test
Confirmation testand determinationof stage
CATT
Rx Dx
1st-line ttt(stage one)
Penta-midine
Available tools for Human AfricanTrypanosomiasis
Test for curePost-ttt
follow-up
Microscopyon bloodand CSF
SAFE
EFFECTIVE
ACCURATE
ADAPTED TO HEALTH
SYSTEMS IN RLS
1
2
NECTMicroscopyon CSF
1st-line ttt(stage two)
1
2
Screening test
Confirmation testand determinationof stage
CATT
Rx Dx
1st-line ttt(stage one)
Penta-midine
Available tools for Human AfricanTrypanosomiasis
Test for curePost-ttt
follow-up
Microscopyon bloodand CSF
Rapid screening
tests open the door
to new approaches
to case-finding:
door-to-door
screening by
CHWs, passive
screening at PHC
level
1
2013?Rapid
lateralflow tests
SAFE
EFFECTIVE
ACCURATE
ADAPTED TO HEALTH
SYSTEMS IN RLS
Benznidazole
Negativization
of Ab
1st-line antiparasitic ttt
Diagnostic test Test for cure
Available tools for chronicChagas Disease
Serologicallab tests
Rx DxPost-ttt
follow-up
Nifurtimox
SAFE
EFFECTIVE
ACCURATE
ADAPTED TO HEALTH
SYSTEMS IN RLS
Benznidazole
Negativization
of Ab
1st-line antiparasitic ttt
Diagnostic test Test for cure
Available tools for chronicChagas Disease
RDTs
Serologicallab tests 2013?
Rx DxPost-ttt
follow-up
A better drug than benznidazole and a test
for cure are needed to treat the millions of
patients who could be diagnosed with RDTs
Nifurtimox
SAFE
EFFECTIVE
ACCURATE
ADAPTED TO HEALTH
SYSTEMS IN RLS
Miltefosine
L-AmB & combination
therapies
Microscopy
on aspirates
Treatment Diagnostic test Test for cure/relapseRx Dx
Available tools for Visceral Leishmaniasis in South Asia
Rk39 RDT
SSG(phasing out)
Post-ttt
follow-up
Conventional AmB
SAFE
EFFECTIVE
ACCURATE
ADAPTED TO HEALTH
SYSTEMS IN RLS
Miltefosine
L-AmB & combination
therapies
Microscopy
on aspirates
Treatment Diagnostic test Test for cure/relapseRx Dx
Available tools for Visceral Leishmaniasis in South Asia
Rk39 RDT
Uptake of best treatments in 2013?
Post-ttt
follow-up
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.
(phasing-out?)
Conventional AmB
(phasing-out?)
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 task-shifting onto lay workers.
• More R&D with NCEs is needed to develop treatments that can beeasily rolled-out at lowest levels of care.
Thank you !
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