INTEGRATED CONTROL OF NEGLECTED TROPICAL DISEASES (NTDs) IN UGANDA 1 Dr. Ambrose Onapa NTDCP/RTI (ENVISION)

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NTDs targeted by NTDCP:- Bilharzias (Schistosomiasis) Intestinal Worms/STH Lymphatic Filariasis (LF) River blindness (Onchocerciasis) Trachoma 3

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NTD OVERLAP IN UGANDA 8

Mapping of NTDs NTDENDEMIC DISTRICTS (TF ≥10%) MAPPED USAID FUNDS OTHER SOURCES PRIOR TO 2007 STATUS OF MAPPING LF5414(2)DBL, WHOCOMPLETE ONCHO354WHO/APOC, TCC, COMPLETE SCHISTO6330SCI, DBLCOMPLETE STH11230SCI, DBLCOMPLETE TRACHOMA3529SIGHTSAVERS, LIONs ORIGINAL DISTRICTS COMPLETED 9

Magnitude of NTDs in Uganda NTD Total endemic districts for MDA (112) Population at risk (in millions)** Estimated infected population (in millions)** Lymphatic Filariasis Onchocerciasis Schistosomiasis STH Trachoma ** Figures change with re-mappings, re-districting

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Diseases: LF = Lymphatic Filariasis; STH = Soil Transmitted Helminths; Schisto = Schistosomiasis; Oncho = Onchocerciasis. Drugs: IVM = Ivermectin; ALB = Albendazole; PZQ = Praziquantel; AZ = Azithromycin Drug packages and staggering in integration 12

Achievements made:  Integrated tools and manuals developed, in use in districts  Rapid mapping completed in all originally targeted districts  Trachoma baseline surveys completed in all highly endemic districts  Scaled up PCT from 28 to 84 districts  NTD extensively supporting de-worming in districts during CDP  Support to MOH programs - equipment, communications, logistics  Impact assessments planned in some LF, Trachoma, Bilharzia districts  LF Transmission Assessment Surveys done in Amuria, planned in more districts  Baseline studies on blinding onchocerciasis done in Pader district  Comprehensive database on all 5 PCT NTDs in Uganda developed, shared  M and E incorporated into work plan for 2011/2012 (M and E Officer recruited) 13

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15 SAEs (Drugs)DISTRICTPATIENTOUTCOME Steven Johnson (Zithromax) Bugiri (Eastern)Female, 22 yearsAdmitted, discharged Anaphylaxis (PZQ) Dokolo (Northern)Male, 30 yearsAdmitted, discharged Urticaria, sepsis (IVM) Pader (Northern)Female, 15 yearsAdmitted, discharged Scrotal swellings (IVM) Pader (Northern)Male, 17 yearsAdmitted, discharged  Moderate Adverse Events: is a major concern, most victims do not seek treatment  SAEs surveillance not properly done / documented by districts VERY IMPORTANT TO DOCUMENT AND REPORT ANY SAEs ADVERSE EVENTS

Challenges faced in NTD implementation  The Program is complex  Currently supporting 82 districts, with 2-5 NTDs  Many diverse activities prior to, during and post - MDAs  Many challenges encountered, including:-  Delayed and / or inaccurate drug deliveries to districts - big issue  Timely collection, compilation and reporting of MDA results  Data: reliability, completeness and accuracy  Adverse events: some CMDs give cocktails leading to adverse events  Incentives: demands by ‘all’ continue to increase  Delayed implementation due to internal weaknesses in districts  Poor facilitation, lack of logistics (eg motorcycles) for NTD Focal Persons  Lack of disability / morbidity control – what next after taking drugs? 16

Challenges continued:  Social mobilizations inadequate: Local Govts lack capacities;  MoH is overloaded; inadequate staff  Creation of new administrative units – districts, HSDs, sub counties  Multiplier effect on resources required for implementation  Districts: have their own ways of doing things!  diversion / misuse of funds reported  delay to release funds already remitted to district accts  poor allocation of responsibilities eg COs i/c HUs as FPs  failure to recruit suitable Focal Persons  in some districts, DHOs are defacto Focal Persons 17

New “partnerships” in NTD Control  Sightsavers – especially trachoma elimination  Provided TEOs for all districts in Karamoja and Busoga (17 districts)  Supported IEC - social mobilization campaigns  Supported training of CMDs  SCI-ICOSA – to support bilharzia control in Islands and low transmission areas  Training of Laboratory and Clinical Officers  Provision of microscopes and reagents  Refining mapping - especially in Islands  Supporting MDA in districts within / bordering L.Victoria  2 nd MDA in districts with high re-infection rates  MPs of the New Parliament:- keen on NTD control and elimination  NTD presentation made to all Committee Chairs and Deputies – very well received  Presentation to Social Services Committee of Parliament  H.E. The President of Uganda – integrated launch of NTD, NDS etc control 18

Definition of Integration “Packaged treatment of multiple disease interventions to reduce the duplication of effort that occurs when the diseases are treated separately” The assumption is that integration will result in:  Efficiency √  Rapid scale up √  Cost-effectiveness √  Greater Health benefits √

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Thank you to the American people for their generous support to the NTD Control Program in Uganda through RTI International