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 !