the public health value of public-private partnership (ppp ... filethe public health value of...

The Public Health Value of Public-Private

Partnership (PPP) in Africa:

A personal perspective

Prof. Francois-Xavier Mbopi-Keou,

Member, UNAIDS Scientific and Technical Advisory CommitteeCouncil Member, International Society for Infectious Diseases

University of Yaounde I & Cameroon Ministry of Health

UNESCO-Merck Africa Research Summit , Geneva, 19-20 October 2015

Outline (1)

1. Background

2. The Understanding of Public Health value of Public-

Private Partnership

3. HIV-related Public-Private Partnership and Health

System Strengthening in Africa:

• Contributing to a better understanding and the

Management of STDs interactions : The case of GSK in

the clinical and Biological studies of HIV and HSV

interactions in Africa

• Contributing in strengthening Research & Public Health

labs : The role of PEPFAR, ASLM, WHO, FIND, CDC,

The IDA in this historic change in Cameroon

Outline (2)

• Contributing to equitable access to essential Medical

products and Technologies : The case of Merck Millipore

in the development and Validation of the Muse® Auto

CD4/CD4% Assay in Cameroon

• Contributing to effective access to Health care delivery :

The case of the Mobile Health Units in Cameroon

sponsored by the Cotco Pipeline Chad/Cameroon Project

4. Lessons learned

5. Acknowledgements

1. Background

• Infectious diseases, do compound an already heavy public

health burden and threaten the health and survival of

millions in Africa

• PPP between governments and companies (in cooperation

with additional partners such as donors, technical agencies

and nongovernmental organizations) gain new importance

in extending health services

• This presentation will focus on selected cases of

HIV/AIDS related PPP and health sector strengthening in

Africa

2. The Understanding of Public Health value of Public-

Private Partnerships (PPP)

• PPP refers to :

a) global health initiatives of impressive magnitude (Buse &

Harmer, Soc Science and Med, 2007)

b) Partnership of private companies and development

agencies (Beckman et al, ILO, Geneva, 2005)

c) Business relation of the private sector with public

organizations (United Nations, A frame work for

collaboration, 2008)

d) The privatization of public services and the public-private

mix of health care provision (Evans D, Bull World Heath

Organization, 2006; Seikh et al, Trans R Soc Trop Med

& Hyg, 2005)

3. HIV-related Public-Private Partnership and

Health System Strengthening in Africa

Mbopi-Keou et al. J Infect Dis 1999

Mbopi-Keou & De Mowbray, Lancet Infect Dis 2003

Mbopi-Keou et al. Lancet Infect Dis, 2002

Belec & Mbopi-keou, Lancet, 2012

Contributing to a better understanding and the

Management of STDs interactions : The case

of GSK in the clinical and Biological studies

of HIV and HSV interactions in Africa

* Genital herpes and HIV: deadly synergy

- clinical reactivation of HSV-2 with HIV

- increased shedding of HIV in patients

with symptomatic and asymptomatic genital herpes

* Genital herpes increases the per-contact transmission

of HIV-1

[Gray et al, Lancet 2001]

Journal of Infectious Diseases 2000; 182:1090-6

HSV-2 antibody prevalence and HSV-2 shedding by

HIV-1 status

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

HIV negative (N=221) HIV positive (N=79)

Serum IgG to HSV-2

Genital HSV2 in HSV-2 sero+ve

20%

43%

P<0.0001

(35)

(174)

(73)

(31)

Neutralizing antibodies to HSV

Mbopi-Keou F.X., L.

Belec, Dalessio, J., Gresenguet, G., Mayaud, P.,

Weiss, H.A., Brown, D.W.G., Ashley-Morrow

RL. Neutralizing antibodies to Herpes simplex

virus type-2 (HSV-2) in cervicovaginal

secretions of African women.

Clin Diagn Lab Immunol 2003, 3: 388-393.

•Biological interactions between HSV and HIV

Mbopi-Keou and colleagues, Clinical Microbiology and

Infection 2003, 3: 388-393.

The public Health value of the GSK

HIV/Herpes project

* Assess the burden of clinical disease due to

HSV-2 in different settings

* Evaluate the potential of anti-herpetic therapy to

reduce HIV transmission:

- Effect of suppressive therapy on HIV shedding

among dually infected

- Effect of therapeutic treatment for GUD on HIV

* Develop and test preventive interventions

(youth interventions, safe & effective vaccine)

.

Contributing in strengthening Research &

Public Health labs : The role of PEPFAR,

ASLM, UNAIDS, WHO, FIND, CDC &The

IDA in this historic change in Cameroon

• A National Public Health Lab is under construction

• 600 laboratories within the central, regional and district

levels that are enrolled in and actively implementing basic

quality assurance systems

• 595 laboratories enrolled and actively participating in the

national Proficiency Testing program for HIV testing.

• 9 labs have gone through external audit by SLIPTA

certified auditors for accreditation

• Cameroon has 7 trained ASLM certified SLIPTA Auditors

who provide support to other countries across the continent

Contributing to equitable access to essential

Medical products and Technologies : The case

of Merck Millipore in the development and

Validation of the Muse® Auto CD4/CD4%

Assay in Cameroon

Background

The 2010 WHO revised guidelines for scaling up ART in resource limited countries emphasized the need of immunological assessment based on CD4 enumerationand HIV viral load

Belec L, Mbopi-Keou FX, Gershi-Damet GM, Mboup S. Lancet Infect Dis, 2012

Background

Previous studies evaluated other platforms for CD4

enumeration in ressource limited settings:

Mbopi-Keou FX, Sagnia B, Ngogang J, Angwafo

FF, Colizzi V, Montagnier L, Bélec L. J Transl

Med, 2012;

Mbopi-Keou et al, Clin Vaccine Immunol, 2012

Objective

To evaluate the simplified, robust, single-platform

Muse® Auto CD4/CD4% Assay (EDM Millipore, Merck

KGaA, Darmstadt, Germany) for CD4 T cell numeration

in absolute count and in percentage, compared against

the reference CE IVD-qualified Guava auto CD4/CD4

percent system® (EDM Millipore) flow cytometry

method

Methods

Muse AutoCD4/CD4 Assay

Results with pediatric samplesComparative device

Muse

Comparative deviceMuse

Result from adult sample

Comparative deviceMuse

CD4 T cell count (Comparative Device)

CD

4 T

cel

l co

unt

(Muse

Auto

CD

4/C

D4%

)

CD4% (Comparative Device)

CD

4%

(M

use

Auto

CD

4/C

D4%

)

CD4 T cell Count Analysis

32

CD4 T cell Count Data y = 0.95 x + 25.22 R2= 0.99

y = 0.92 x+ 1.01, R2= 0.97

CD4% Data

Total Lymphocyte count (Comparative Device)

To

tal L

ym

ph

ocy

te c

ount

(Mu

se A

uto

CD

4/C

D4%

)

Total Lymphocyte Counts

Total Lymphocyte Count Data

Y= 0.99 x + 113.7 R2= 0.98

Example Staining patterns from Study

P3 Muse

CD4 Count

(Cells/uL) 543.4

CD4% 25.8

TLC

(cells/uL) 2102.7

A7 Muse

CD4 Count

(Cells/uL) 632.4

CD4% 39.1

TLC

(cells/uL) 1616

P3 Muse

CD4 Count

(Cells/uL) 2918.6

CD4% 38.5

TLC

(cells/uL) 7588.3

P3 Muse

CD4 Count

(Cells/uL)

143.1

CD4% 17.4

TLC

(cells/uL)

822.5

Adult Pediatric Pediatric Low Count

Control

Example Low CD4 Count Screenshots from Study

MA9

CD4 (cells/µL) 51.8

CD4% 5.7

TLC (cells/µL) 913.8

CD4 (cells/µL) 72.2

CD4% 4.5

TLC (cells/µL) 1591.7

MA3

CD4 (cells/µL) 216.9

CD4% 12.8

TLC (cells/µL) 1692.4

MA12

CD4 (cells/µL) 186.4

CD4% 47.0

TLC (cells/µL) 396.7

MA16

Muse® AutoCD4/CD4% Assay: CE/IVD

Assay for CD4 Monitoring

Features Benefits

Assay provides CD4 T cell count, CD4% & Total

Lymph Count Results in blood

One Method for Adult & Pediatric Samples

30 min Sample Prep Time; No wash Rapid Results; Simple sample prep

Automated Acquisition & Gating Software Easy to use; Usable by less skilled operators

Low Biohazardous waste (based on microcapillary

cytometry)

Less Disposal Issues

CD4 Counts & CD4% Results

Acquire on Muse ® Cell Analyzer

15

Acquire on Muse® Cell Analyzer

The public Health value of the Merck

Millipore Muse® Auto CD4/CD4% project

• The Muse® Auto CD4/CD4% Assay analyzer is a reliable

alternative flow cytometer for CD4 T lymphocyte

enumeration to be used in routine for immunological

monitoring according to the WHO recommendations in

HIV-infected adults as well as children living in resource-

constrained settings

Mbopi-Keou et al, ICAAC, Washington DC, USA,

September 5-9, 2014, Abstract no D-1511;

Mbopi-Keou et al., ICASA 2015, to be held in Zimbabwe 29

November - 4 December 2015 Abstract no TUPDB001

Contributing to effective access to Health care

delivery : The case of the Mobile Health Units

in Cameroon sponsored by the Cotco Pipeline

Chad/Cameroon Project

Taking the health care closer to the millions in our villages

Mbopi-Keou et al, AIDS 2007;

Mbopi-Keou et al, Plos Negl Trop Dis, 2014

4. Lessons learned

• PPP works well if they reconcile philantropy with business

strategy for the private partner and systemic surplus for the

public partner

• PPP needs a clear policy & priority fields

• PPP requires mutual understandings

• Time-limited PPP can have a meaningful contribution

• Succesful PPP can help define future Public health

interventions and research arenas

5. Acknowledgements

The University of Yaoundé I & Ministry of Health Cameroon

(H Gonsu Kamga, J Amougou, GCM Kalla, W. Mbacham, C

Ebana Mvogo, J-E Pondi, MA Sosso)

The Institute for the Development of Africa

Université des Montagnes (F Mimo Tanghu et al.)

The Chantal Biya International Research Center on

HIV/AIDS Yaounde (MS Sosso, B Sagnia, A Ndjolo, V Colizzi)

Hôpital de la Cité Verte (P Omgba Bassega, J Mindimi )

Université of Paris (L Bélec)

LSHTM & HPA London (P Mayaud, R Peeling, D Mabey ,

DW Brown, P Piot et al)

CDC Atlanta (CG Teo, J Nkengasong et al.)

Nat Ref Center for HIV & STDs in Senegal (S Mboup)

Merck Millipore (Jim, John, Philippe, Kamala, Julie et al.)

.

Jeune Afrique

Economie 2002; 346: 87

Conclusion

“...I was taught from a young age to place all my cares in the hands of the Lord.”

Melanie Schurr, 1998

Thank you