Expanded Working Group on Monitoring & Evaluation - Focus on Preventive Chemotherapy

1. Expanded Working Group on Monitoring & Evaluation - Focus on Preventive Chemotherapy Dr. Sam Zaramba

2. Outline of presentation • Updates - Dr. Sam Zaramba • Structure • Update on implementation of STAG 2013 recommendations for M&E • WG M&E 2014 - Dr. Sam Zaramba • Progress reports • Work of Subgroup1, Subgroup 2 • Expert groups • 12 Recommendations • 7 general recommendations • 5 specific recommendations - request for STAG endorsement • WG Monitoring Drug Efficacy – Prof.MamounHomeida • Progress and planned work

3. Update Structural change: Merging of Working Groups = EXPANDED Working Group of Monitoring & Evaluation (WG M&E) • WG M&E – Focus on Preventive Chemotherapy • Sub group 1: M&E needs of national programmes • Sub group 2: Monitoring of disease-specific indicators • Sub-group 3: Measuring enhanced outcomes and impact ►WG Investment for Impact • WG M&E – Focus on Monitoring Drug Efficacy • Expanded WG M&E – 3 days, back-to-back • February 18,19 & 20 February 2014

4. STAG 2013 recommendations for M&E Seven recommendations, of which 3 endorsed • Monitoring scale-up of treatment coverage • Intensify efforts for integrated monitoring • Strengthen end-stage strategies & surveillance methods

5. Monitoring use of donated medicines in scaling-up • Developed Joint Application Package (JAP) which countries submit • Joint Request for Selected PC Medicines • Joint Reporting Form (implementation data) • Annual Work Plan • PC Epidemiological Data Reporting Form • JAP is also an integratedplanning tool, rather than just an application form for WHO-managed drug donations

6. Snapshot of the forms (Excel format) ENGLISH: http://www.who.int/neglected_diseases/preventive_chemotherapy/reporting/en/index.html FRANÇAIS: http://www.who.int/neglected_diseases/preventive_chemotherapy/reporting/fr/index.html ESPAÑOL: http://www.who.int/neglected_diseases/preventive_chemotherapy/reporting/es/index.html

7. Summary of JAPs as of February 2014 (Increasingly adopted and used by NTD partners as well)

8. Improving timeliness, completeness & triangulation of data • Maintained close interaction with HQ, WHO regions throughout the year to obtain data that was used to regularly update PCT databank and Global Health Observatory • Developed national NTD database template, in collaboration with AFRO, SEARO, WPRO, APOC, NTD partners (RTI, CNTD, SCI) • Field-tested and country adaptation in Nigeria, Jan 2014 • Training of Trainers (36 participants), 24 – 26 Feb 2014

9. Improving data quality • Developed a Data quality assessment (DQA) tool which is able to expose technical and implementation data issues in order to PLAN and DEPLOY data enrichment strategies for national NTD programmes. • Field-tested in Uganda, Nicaragua, Cameroon with good results. • Integrated into PAHO/EPI M&E toolkit for <15 years • Training of trainers (36 trained), 27 – 28 Jan 2014

10. Strengthening end-stage strategies & surveillance methods • Finalized & published the handbook of practical entomology for lymphatic filariasis elimination • Field-tested new strip test Alere™ to overcome drawbacks of ICT cards (ICT cards required a cold-chain) • Strip test can be used for LF mapping • Additional data being collected to validate its use and reliability for LF transmission assessment surveys

11. GPELF: Country progress by programme steps (2012 data) Surveillance MDA Mapping* 64% 18% 18% *Countries in mapping step includes those which haven't completed mapping but started MDA in a part of the country.

12. New tools for STH control and elimination Presently developing a spatiotemporal model that can predict evolution of STH epidemiology following implementation of preventive chemotherapy Draft guidelines: Collection of STH data during LF transmission assessment surveys (STH-TAS) Draft guidelines for Treatment of Women of Child Bearing Age Draftguidelines on the use of historical data for STH mapping

13. WG M&E 2014progress Report & Recommendations

14. Global status of PC in 2012 1 Number of endemic countries moved to PTS stage are not included in total. 2 Number of countries reporting data on PC implementation. Countries submitted blank reports are not included in total. 3 Coverage is calculated as number of people treated in need of PC out of population requiring PC. 4 Number of people required/received PC for at least one disease. Trachoma is not included.

15. Global status of PC in 2012 – Summary by WHO Region 3 Coverage is calculated as number of people treated in need of PC out of population requiring PC.

16. PC data updates & sharing through regular publications The number of people receiving preventive treatment for schistosomiasis in 2012 increased by 40.5% compared to 2011 2014 28 March 2014 | GenevaSoil-transmitted helminthiases: number of children treated in 2012.Weekly epidemiological record, No. 13, 2014, 89, 133–140 10 January 2014 |Geneva¦ Schistosomiasis: number of people receiving preventive chemotherapy in 2012. Weekly Epidemiological Record, No. 2, 2014, 89, 21–28 2013 28 October 2013 | Geneva¦ “Contributions of Non-Governmental Organizations to WHO Targets for Control of Soil-Transmitted Helminthiasis” based on the work done with the Global NGO Deworming Inventory. 19 April 2013 | Geneva¦ Rolling out and scaling up integrated preventive chemotherapy for selected neglected tropical diseases. Weekly Epidemiological Record, No16, 2013, 88, 161–166. 5 April 2013 | Geneva¦ Soil-transmitted helminthiases: number of children treated in 2011.Weekly Epidemiological Record, No. 14, 2013, 88, 145–152 22 February 2013 | Geneva¦ Schistosomiasis: number of people treated in 2011. Weekly Epidemiological Record, No. 8, 2013, 88, 81–88 11 January 2013 | Geneva¦ Monitoring and evaluation of preventive chemotherapy. Estimated number of people covered by preventive chemotherapy: update for 2010 and 2011. Weekly Epidemiological Record, No.2, 2013, 88, 17–28.

17. Ten majorconstraints and areas for strengthening for M&E of national NTD programs • Absence of long-term contract personnel or dedicated teams working exclusively in NTDs at national and/or regional levels. • Persistent delays with data transmission from peripheral to nationallevels, & regional level. • There is a need for improved transparency and uniformity of data, data sharing and dissemination. • Countries need support for data review and standardized analyses prior to making programmatic decisions. Systematic analysis of data should be carried out at the national level under guidance of Country offices and Regional offices. • There is a need to build M&E technical capacity at Country and Regional level, including provision of resources for staff and in-service training in the use of standardized tools. • Countries need to be provided withfinancial resources to support their coordination role to conduct national inter-sectoral workshops on M&E issues, and thereby strengthen national ownership. • Coverage assessments should be systematized in M&E processes, given that very few countries regularly conduct coverage surveys. • Sufficient technical and logistical resources need to be mobilized to support processes leading to the stopping of MDA and conducting post-MDA surveillance with sufficiently trained staff, tools, and funds. • Sustaining political commitmentfor NTDs is a perquisite for effective surveillance. • There is an immense need for establishing LF elimination verification process.

18. M&E for disease-specific indicators • Guideline for LF morbidity management and disability prevention (MMDP), including M&E indicators • Ongoing research/studiesfor improved and new diagnostic tools: • STH – use of multi-parasite PCR assays vs. Kato-Katz • SCH – use of CCA test with lower operational costs vs. Kato-Katz • Trachoma – antibody assay to determine programme end points • ONCHO – field-testing of OV-16 rapid test • LF - Biplex rapid test (Ov-16 + Wb123) for use in integrated assessments of ONCHO and LF co-endemic areas • Loa loa – Celloscope for identifying individuals with high counts • Multiplex platform for measuring antibodies for multiple NTDs. • Concurrent finding: high prevalence of Strongylodies of >80% in some areas – poses an ethical responsibility • Developed and published guidelines for LF morbidity management and disability prevention (MMDP), including M&E indicators • Ongoing operational research/studiesfor improved and new diagnostic tools: • SCH – use of CCA test with lower operational costs vs. Kato-Katz • STH – use of multi-parasite PCR assays vs. Kato-Katz • Trachoma – antibody assay to determine programme end points • ONCHO– field-testing of OV-16 rapid test • LF - Biplex rapid test (Ov-16 + Wb123) for use in integrated assessments of ONCHO and LF co-endemic areas • Loa loa – Celloscope for identifying individuals with high counts • Multiplex platform for measuring antibodies for multiple NTDs. • Concurrent finding: high prevalence of Strongylodies of >80% in some areas – poses an ethical responsibility

19. Questions: What is the strategy and appropriate threshold for preventive chemotherapy? Is ivermectin available at public health price?

20. Expert groups, NTD partners, WG meeting reports Reported on progress, and priority activities for 2014 (pgs. 14 – 16) • Mectizan donation programme • Children Without worms • Deworm the World • Schistosomiasis Control initiative • Centre for Neglected Tropical Diseases • Unable to attend – Trachoma Control Initiative • WG Meeting inputs from; • Access to quality assured medicines – focus on Severe Adverse Events • Investment for Impact • Capacity Strengthening • Monitoring Drug Efficacy

21. General recommendations • Address the persistent absence of dedicated NTD personnel at regional levels and in priority countries continues • Strengthen activities for ensuring data quality and facilitating use of data for decision-making in national programmes • Enhance the capacity of expanded RPRGs to review country readiness to conduct TAS and other disease-specific assessments. • Standardize practices and processes for data sharing between all NTD stakeholders should be should promoted & strengthened. • A strategic plan to guide the implementation and allocation of resources for M&E should be drafted (for phases -18%-64%-18%). • Clarify response mechanisms and strengthen capacity of national programmes for Severe Adverse Events reporting & management. • Support NTD programmes to harness the immense potential of mHealth technologies to collect and transmit data from the field, and even routine reporting of key indicators.

22. Specific recommendations: Request for STAG endorsements • Establish Working Group on Investment for Impactto which Expanded WG M&E will provide regular epidemiological data and input. • Convene a technical consultation to develop a body of evidence around the global distribution of Strongyloides and its importance, and potentially develop public health recommendations • Allow interim processesneeded to acknowledge the achievements of countries that have achieved the LF elimination goals. In the absence of definitive global guidance, expanded RPRGs should be permitted to provide this recognition to countries for their achievement of LF elimination goals. • Prioritize programme evaluations and ensure these are conducted on a periodic basis in order to further improve the management and effectiveness of national NTD programs • Development of a systematic process to evaluate new diagnostic tools for NTDs, to review their utility for programs, and to develop recommendations for programs on their use.

23. Monitoring & Evaluation of Preventive Chemotherapy- Focus on Monitoring Drug Efficacy Prof.MamounHomeida

24. Ivermectin -ONCHO Progress in 2013 • Identification of putative markers of low response; whole genome is available from IVM naïve/poor/good responders • sample repository (>3300) from different countries) • Epidemiological evaluation (22 foci, 304 villages, 9 countries) • In depth analysis of sites with unsatisfactory progress (5 sites, 3 countries) • Capacity building on the laboratory network Planned work • Development user-friendly software to follow-up progress towards elimination in countries

25. Ivermectin -LF Progress in 2013 • Progress towards how to test for drug resistance (Use of sentinel sites, number of infected subjects…) Planned work • Modelling predicting changes in prevalence during the implementation of elimination activities (alarm bell)

26. Benzimidazoles Progress in 2013 • Publication of the manual on a standardized protocol on drug efficacy • Development of the model predicting changes in STH prevalence Planned work • Assessment of efficacy of oxantel/pyrantel • Assessment of efficacy of papaya cysteine proteinases against T. suis • Introduction new technologies (FECPAK, diagnostics based on mobile application (ILab) • Development of video tutorials of operational procedures

27. Praziquantel Progress in 2013 • Assessment of efficacy of PZQ against Schistosoma spp. • Identification/modifying of OXA with increased efficacy across Schistosoma species • Identification of possible source of resistance to PZQ • Reduction in genomic diversity after treatment • Hybrids between human and animal schistosomes Planned work • Development model predicting epidemiological changes • Replicating the work on OXA on PZQ (identification of mode of action and develop methods to circumvent resistance)

28. Flubendazole Progress in 2013 • Review of the dossier of FLBZ • Development of an oral formulation of FLBZ • FLBZ toxicologically evaluated Planned work • Optimizing of oral formulation • Efficacy studies

29. THANK YOU FOR YOUR ATTENTION