Where we could be by 2015 and how to get there NTDs in Southern Sudan Where we could be by 2015 and how to get there Jan Kolaczinski

Parasite Disease (Common Name) Etiologic Agent Protozoan Human African Trypanosomiasis Trypanosoma gambiense T. rhodesiense Leishmaniasis Leishmania spp. Bacterial Buruli ulcer Mycobacterium ulcerans Leprosy Mycobacterium leprae Trachoma Chlamydia trachomitis Helminth (Worms) Onchocerciasis (River Blindness) Onchocerca volvulus Lymphatic filariasis (Elephantiasis) Wuchereria bancrofti Soil-transmitted helminths Ascaris lumbricoides Trichuris trichiura Hookworm Schistosomiasis (Bilharziasis) Schistosoma haematobium S. mansoni Loiasis Loa loa Dracunculiasis (Guinea Worm) Dracunculus medinensis Unknown Nodding Syndrome Unknown. Seems associated with onchocerciasis

Integrated NTD Control Intuitively appealing, because: Large areas of co-endemicity Safe and free/cheap treatment available Treatments can be co-administered using mass drug administration (MDA) Trachoma LF Schisto STH Oncho  Potential cost saving of up to 46% when compared to stand alone programmes Integration should not become the goal, but may provide the means to achieve them

Goals Disease Targeted Program Goal Trachoma Elimination of blinding trachoma as a public health problem by 2020 Onchocerciasis Establishment of community-based sustainable yearly treatment in areas with moderate/high transmission by 2010 Lymphatic filariasis Elimination as public health problem by 2020 Soil-Transmitted Helminths Regular treatment of 75% of at-risk school-age population by 2010 Schistosomiasis Elimination Table adapted from Brady et al. 2006, Trends in Parasitology 22

Drug Intervention Disease Targeted Drug regimen Age range targeted Trachoma Azithromycin & tetracycline 6 months – 80 years Onchocerciasis Ivermectin 5 years – 80 years Lymphatic filariasis Ivermectin + albendazole Soil-Transmitted Helminths Albendazole 6 years – 15 years Schistosomiasis Praziquantel ✔ Ivermectin + albendazole ✔ Lymphatic filariasis tends to be distributed over the largest geographical area Table adapted from Brady et al. 2006, Trends in Parasitology 22

Where should we be by 2015? Main graph from Ottesen et al. 2008, PLoS Negl Trop Dis 2: e317: Effect of MDA on Mf prevalence in all sentinel sites

How to get there? Complete LF mapping using integrated mapping approach (i.e. including schisto & STH) Strengthen community-based delivery (CDTI & guinea worm network) Use these to deliver drugs + complementary interventions for other NTDs

Conclusion Lymphatic filariasis elimination is the ideal driver for integrated NTD control: Provides clear goal achievable within 5 – 7 years Prospect of little to no further investment once elimination has been achieved Controls onchocerciasis, STH, lice and scabies Strengthens health systems in the process

Acknowledgements MoH-GoSS – Leadership, commitment, facilitation COMDIS/DfID – NTD Situation Analysis USAID/RTI – Current Funding of NTD Programme NGO Partners – CBM, The Carter Center World Health Organization Mectizan Donation Programme LSHTM/KEMRI – Operational Research Support