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GHF2008 – PS34 – New Approaches to Field-based Malaria Treatment

Session Outline

Parallel session PS34, Wednesday, May 28 2008, 14:00-15:30, Room 17
Chair(s): Christian Lengeler, Epidemiology and Public Health, Swiss Tropical Institute, Switzerland 
Feasibility and Acceptability of Artemisinin-Based Combination Therapy for the Home Management of Malaria at Four African Sites
Ikeoluwapo Ajayi, Malaria Research Laboratories, College of Medicine, University of Ibadan, Nigeria
Reaching the Un-Reached in the Event of Severe Malaria in Under Five Children in a Rural District in Ghana
Margaret Gyapong, Dodowa  Health Research Centre, Ghana Health Service, Ghana
Intermittent Preventive Treatment of Malaria among Children (IPTc) in The Gambia and Ghana: How Different Delivery Strategies May Lead to Different Cost, Coverage and Equity Conclusions
Lesong Conteh, Swiss Centre for International Health, Swiss Tropical Institute, Switzerland 
Understanding and Improving Access to Malaria Treatment in Tanzania (ACCESS)
Manuel Hetzel, Research Scientist, Swiss Tropical Institute, Switzerland

Session Documents

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Session Report

Contributors: Suzie Abessolo (ICVolunteers)

The professor of epidemiology at the Swiss Tropical Institute, Christian Lengeler, introduced the session by asking "How can we improve and reach innovative ways of Malaria treatment?" This question was answered by four NGOs working in different African countries.

Ms. I. O. Ajayi, Department of Epidemiology, Medical Statistics and Environmental Health for Nigeria, presented the feasibility and acceptability of Artemisin-Based Combination (ACT) therapy for the home management of malaria at four sites in Africa. This study, funded by UNICEF, the UN Development Programme, the World Bank and the WHO/Tropical Diseases Research, was carried out in Nigeria, Uganda and two sites in Ghana representing different health system and epidemiological settings. The study was conducted in three phases: pre-intervention, intervention and finally monitoring and evaluation. The pre-intervention activities involved advocacy, community sensitization and mobilization, situation analysis and selection of drugs distributor. The intervention phase consisted of preparing training manuals and training key implementers, developing and executing Information Education and Communication (IEC) strategies, dispensing and using drugs at the community level. Monitoring and evaluation involves the recognition of early signs of malaria and prompt treatment by caregivers and community medicine distributors (CMD), adherence to treatment regimen by drug distributors and CMDs, danger identification signs and prompt referral, availability of drugs, adequacy and effectiveness of IEC messages. Some 20 000 fever episodes in young children were treated with ACT by CMDs in four sites. The range of children correctly treated is from 74% to 97%. These results provide evidence that ACT use can be successfully used in the home.

Ms. Margaret Gyapong, health researcher at Dodowa Health Research Centre, explained how to reach the unreached in the event of severe malaria in rural Ghana. The purpose is to make an effective drug available to caretakers as close to the patient's home as possible. Ninety percent of the deaths among African children are due to poor access to medication, cost of care and perceptions about disease causation. Patients with acute malaria, who are unable to take medication by mouth and are not at a health centre, can be given a Rectal Artesunate (RA) plus referral. The study showed a 25% reduction in mortality when the rectal formulation is given as pre-referral treatment at community level. Of the babies saved, 84% were administered the drug by their mothers. The study was conducted in 4 health centres, 6 community clinics and 3 private clinics serving a population of 100 000 people. More than 100 children less than 5 years old were selected for the study divided into 3 groups: Mother Caretaker (MUM), Community Directed (COM), and Health System (MOH).

All the caretakers gave informed consent and 85% of the children received accurate dosages. Half of the recruited children were sent to the Drugs dispenser and over 80% of caretakers went to a health facility within 24 hours. Further education is needed to reduce the almost 20% who did not comply with referral advice (www.ghanahealthservice.org).

Ms. L. Conteh from the Swiss Tropical Institute explained the use of intermittent preventive treatment of malaria among children (IPTc) in Gambia and Ghana: how different delivery strategies may lead to different coverage, cost and equity. Intermittent preventive treatment is administered to the population at risk at a specified time, limiting morbidity and preventing mortality. The study randomly assessed three rounds of three doses during September, October and November 2006 in Gambia. An average of 12 329 children were enrolled and received IPTc, delivered by clinic or volunteer health workers who trekked in. However, in Ghana, four rounds of 3 doses were distributed in May, June, September and October 2006. Community-based volunteer or government health workers delivered IPTc to 1039 children enrolled in the study. Preliminary results show that IPTc can be a cost effective intervention in reducing malaria morbidity and mortality in areas with a high level of seasonal malaria. The costs of community health workers delivering IPTc are driven by the drugs costs, delivery of drugs and supervision. Preliminary findings suggest that delivering IPTc via community health workers does not appear to exclude certain socio-economic status. More studies are needed to enlighten the relationship between equity outcomes and cost effectiveness ratios of different delivery strategies.

Mr. Hetzel, from the Novartis Foundation for Sustainable Development in Switzerland, summarized the improving access to malaria treatment in Tanzania due to the Access programme. The Access project was carried out between 2003 and 2007 in two rural districts in Tanzania to improve the delivery of quality health care using malaria as a tracer condition. This was achieved through three complementary interventions: 1) social marketing; 2) improvements in quality of public health care services through training and supervisory support; 3) the development of high-quality commercial drug outlets. Semi-quantitative cross-sectional community surveys were used to investigate disease perception and treatment seeking behaviour, completed by quantitative and qualitative studies on drug availability and quality of care. Mortality was assessed longitudinally using a demographic surveillance system. The outcomes show that social marketing works. The quality of public health care is poor and represents the biggest obstacle to appropriate treatment. There are limited resources to support and strengthen entire health systems. The commercial drug sector is an essential component of care delivery in resource-poor countries and its quality can be improved.

Following the presentations, discussion centred on some related questions. What level of knowledge is required for community health workers? Ms. Ajayi answered that primary education is sufficient. How do we inform mothers about the preventive treatment? Ms. Conteh explained that there are now staff in the health centres tasked with getting the message out to the population.

GHF2008 – PS36 – Selected Case Studies on Neglected Diseases

Session Outline

Parallel session PS36, Wednesday, May 28 2008, 11:00-12:30, Room 17
Chair(s): Niklaus Gyr, Director of the Academy of Swiss Insurance Medicine of the University Hospital in Basel, Switzerland
Clinical Research on Diabetes Mellitus and Other Diseases Related to Lifestyle Changes
Azad Khan, Diabetic Association of Bangladesh, Bangladesh
Contribution for Research in the Eradication of Leprosy
Alphonse Um Boock, Regional Bureau for Aid to Leprosy Sufferers, Emmaüs-Suisse, Cameroon 
Hurdles Faced in Implementing Quality Clinical Research in Sleeping Sickness (Human African Trypanosomiasis) in the Democratic Republic of Congo (RDC)
Constantin Miaka Mia Bilenge, National Counsellor on Sleeping Sickness and Researcher, Ministry of Health, Democratic Republic of Congo

Session Documents

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Session Report

Submitted by: Lwiise Swai (ICVolunteers)

This session on case studies on neglected diseases was introduced by Dr. Nikaus Gyr, Director of the Academy of Swiss Insurance Medicine of the University Hospital in Basel, Switzerland. The two key speakers were Mr. Bilenge, the National Counsellor on Sleeping Sickness and research with the Ministry of Health of the Democratic Republic of Congo (DRC), and Professor Azad Khan from the Diabetic Association of Bangladesh. The third speaker, Mr. Boock, the Regional Bureau for Aid to Leprosy Sufferers, Emmaus-Suisse in Cameroun, was unable to attend the forum.

Case Study # 1:  Hurdles faced in implementing quality clinical research in Human African Trypanosomiasis

Mr Bilenge presented the challenges faced in implementing quality clinical research for Human African Trypanosomiasis (HAT), also known as sleeping sickness, in the Democratic Republic of Congo (DRC). Currently, the disease affects thirty six sub-Saharan African countries. There exist two forms of HAT: The chronic form that affects West & Central African countries and lasts for years, and the acute form, which affects countries in East Africa and lasts for a maximum of six months. Mr Bilenge went on to explain how in the case of the DRC, the main concern is the scarcity of treatment for more than twelve million people exposed to the disease.  In order to reach the exposed population nationwide, there's an urgent need for trained health professionals. Before independence in 1960 there were 200 mobile & trained teams for a population of forty million; currently there are thirty eight for a population of sixty million!  Another concern that was brought up by Mr. Bilenge was how to get patient documentation for the trials, not only due to the lack of workforce and resources to reach far-fetched regions, but also the fact that its difficult to obtain information from the population as this is not very well accepted culturally. With the collaboration of partners such as the Swiss Tropical Institute (STI), Antwerp Tropical Medicine Institute (ATMI) and the World Health Organization (WHO), as well as a number of NGOs, there are some improvements in terms of the number of trained staff, health care centres and people documented and treated with HAT in the DRC, as well as neighbouring countries.

Case Study # 2:  Clinical research on Diabetes Mellitus and other disease related to lifestyle changes

Professor Khan presented the case of how change in life-style is also changing the disease pattern/increasing the number of cases of Non-Communicable diseases (NCDs) such as heart diseases, cancer, chronic respiratory diseases and also diabetes. NCDs represent approximately 60% of all deaths in the world (2005 statistics). Prof. Khan gave examples of how lifestyle changes, such as driving instead of walking, dietary changes towards fast foods, sitting in front of TV/computer screens instead of playing or working outside, have resulted in a general deterioration in health and an increase in the number of cases of the diseases mentioned above. Diabetes is considered a world epidemic. Prof. Khan shared the latest statistics: a predicted global increase of 72% by 2025 and an increase of 347% in Bangladesh alone. Not long ago, diabetes was considered to be a disease which mainly affected people in industrialized countries; however that trend is shifting due to the lifestyle changes cited above. Having said this, diabetes can be prevented in a number of ways.  The Diabetic Association of Bangladesh (DAB) runs a mass awareness programme on the 28th Feb. of every year. Events include things such as rallies, seminars, awards ceremony for diabetes patient able to control the disease, screenings at public venues etc.  Awareness centres are being erected at public places such as airports, bus terminals etc. Employers are being encouraged to incorporate diabetes prevention and control programmes in the workplace.   Bangladeshi folk singers and film stars are also being used to pass on the message that a long and healthy life comes from healthy eating and exercise.

GHF2008 – PS35 – Clinical Research on Infectious Diseases

Session Outline

Parallel session PS35, Wednesday, May 28 2008, 11:00-12:30, Room 16
Chair(s): Marcel Tanner, Director, Swiss Tropical Institute, Switzerland
Clinical Research on Infectious Diseases: Tuberculosis
Michael Grobusch, Professor, Division of Clinical Microbiology and Infectious Diseases, NHLS and University of the Witwatersrand, South Africa 
Establishing a Malaria Clinical Research Site in Africa: Experiences from Bagamoyo, Tanzania
Salim Abdulla, Ifakara Health Research and Development Centre, United Republic of Tanzania 
HIV in Bangladesh: An Emerging Epidemic
Tasnim Azim, Laboratory Sciences Division and HIV Programme, ICDDR,B, Dhaka, Bangladesh 

Session Documents

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Session Report

Contributors: Ann Galea (ICVolunteers)

Photo © V. Krebs, ICVolunteers.org

Research is generating sound evidence on the treatment and prevention strategies for the three diseases of poverty - namely tuberculosis, malaria and HIV/AIDS - thanks to a number of partnerships that already exist between developed and developing countries. While innovation and implementation studies attract significant funding, clinical research on validation needs more support. Descriptive research can make a significant contribution to these important diseases. Efforts must be made to resist studies focusing research only in the 'easy areas' and for partners to take the 'hit and run' approach. In certain areas where research can be more difficult, such as multi-drug resistant tuberculosis (MDR-TB), clinical research can start 'from scratch' and be simply based on clinical observations.

The worsening epidemiological situation in South Africa, the concurrent humanitarian issues and the significant challenges that need to be faced on the ground were addressed by Prof. M. P. Grobusch (Infectious Disease Unit, Division of Clinical Microbiology and Infectious Diseases, NHLS and University of the Witwatersrand, Johannesburg, South Africa). Ranked as 7th on a global scale for Tuberculosis Incidence, it is estimated that 95% of tuberculosis cases in South Africa are co-infected with HIV. In a setting where public health service needs drastic improvement and a health system that is still rooted in the original designs of the pre-apartheid era, the tuberculosis control programme cannot keep up with the sheer number of patients. The recent reports of MDR-TB and the extensively drug resistant tuberculosis (XDR-TB) "outbreak" in South Africa reported in 2006 (Gandhi et al, Lancet, 6.11.06) bring to the front major faults in the system especially with reference to inadequate hospital facilities for isolation and infection control, ineffective planning and poor information systems, prolonged laboratory turn around time and poor defaulter tracing. The Sizwe Tropical Diseases Hospital in Guateng was changed into an exclusive MDR-TB hospital in an effort to improve the prognosis of MDR-TB and XDR-TB patients. Encouraging treatment results were observed from clinical care which later facilitated cutting edge clinical trials on novel second line anti-TB drugs. Treatment regime and duration for XMDR-TB is often based on empirical decisions and ethical and moral considerations concerning enforced treatment and isolation important. The unique problems of attracting and retaining staff to work at the Sizwe hospital such as the history of violent behaviour among patients, some of whom are ex-detainees, as well as the high HIV infection rate among the potential pool of health care workers for whom such work is contra-indicated.

The establishment of Malaria clinical care research sites in Bagamayo, Tanzania, was the focus of the talk by Salim Abdulla, (Ifakara Health Research and Development Centre, Bagamayo, Tanzania). This study was set against a background of much stakeholder interest for the generation of new drugs and vaccines against malaria. Lacking a strong health infrastructure, significant external investment is needed to establish and maintain such sites. The paucity of clinical research training among medical graduates, the ethics of community involvement and the importance of maintaining the service to the community once the research is complete are important considerations. The experience from this site was generally very favourable. The quality of care to the community improved, the project was found to have a good acceptability among the community with high community participation. The main challenge was to maintain the high quality of the service that was provided after the research funds dried up. Case definitions and harmonisation of malaria parasite quantification by blood slide reading ensured consistency of results.

Practical implications are:

  • The possibility of networking of multiple sites to avoid duplication.
  • The potential of such centres to be used for research into other common diseases such as TB and HIV.
  • The movement away from "research site" thinking and on to "centre creation" to have a longer lasting application.

The emerging problem of HIV infection in Bangladesh was presented by Tasnim Azim (Laboratory Sciences Division and HIV Program, ICDDR,B, Dhaka, Bangladesh). While sharing much of its border with India and India's high HIV rates, HIV is still an emerging problem in Bangladesh. The total number of people living with HIV in Bangladesh in 2007 is reported to be 1207 and it is estimated that HIV prevalence among high risk groups is still less than 1 %. Infection remains concentrated in specific areas especially in Dhaka. There are two main risk groups, namely intravenous drug users and returning migrant workers who acquire the infection while working abroad often as contract workers in the Middle East.

Important issues come to light

  • Many intravenous drug users (IVDU) share needles and the limited needle exchange programme needs to be fully implemented to cover all days of the week including weekends.
  • The HIV strains among the two groups remain separately distinct but there is a fear that this will follow a similar course to that which was observed in other countries such as Thailand.
  • Homelessness among IVDU increases the risk of being infected with HIV and rates observed so far show a five-fold difference from other drug users.
  • Services outside of Dhaka are not available and the few scattered cases in rural areas can not be reached.
  • Anti-retroviral drugs are still not freely available and only 26% of patients are receiving some form of therapy.
  • Three out of 18 strains tested have shown drug resistance but this could be related to the small sample size and trends need to be observed closely.
  • The migrant worker group constitutes workers who are deported because of HIV positive tests while working in other countries. These often get infected through heterosexual spread and not because of intravenous drug abuse.
  • The data that is available does not include the below 15 age group, but intravenous drug use in the young is not a common problem in Bangladesh.
  • The drug regime used is that recommended by WHO where three drugs are given if the CD4 count is less than 200. Other countries are in fact using more aggressive standards.

GHF2008 – PS30 – Neglected Disease: Improving Patient Access to New Diagnostics

Session Outline

Parallel session PS30, Tuesday, May 27 2008, 16:00-17:30, Room 15
Chair(s): François Chappuis, Lecturer, Division of International and Humanitarian Medicine, Department of Community Medicine and Primary Care, University Hospitals of Geneva, Switzerland
Obstacles to Using Eflornithine on a Large Scale: Measures to Facilitate the Role of Each Stakeholder in the Field of DRC PNLTHA
Constantin Miaka Mia Bilenge, National Counsellor on Sleeping Sickness and Researcher, Ministry of Health, Democratic Republic of Congo 
Fighting Neglected Diseases: The Contribution of Sanofi-Aventis
Mireille Cayreyre, Director of Neglected Diseases and Central Nervous System, Access to Drugs, Sanofi-Aventis, France 
Neglected Diseases: Achievements and Challenges to Ensure Drug Access for NTDs: The Example of African and American Trypanosomiasis and Leishmaniasis
Jorge Alvar, Medical Officer, Control of Neglected Tropical Diseases, Communicable Diseases Cluster, WHO, Switzerland 
How Product Development Partnership Could Catalyze Needs-Driven Research and Bridge Gaps
Bernard Pecoul, Executive Director, Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland 

Session Documents

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Session Report

Contributors: Suzie Abessolo (ICVolunteers), Kate Brown (ICVolunteers)

M. F. Chappuis from Médecins Sans Frontières (MSF) introduced this session dedicated to the improvement of access to drugs and diagnosis. Four key speakers gave an overall picture of access to the diagnosis of neglected diseases: M. J. Alvar from the Neglected Diseases department of the World Health Organization (WHO); M. Bilenge from the National Human African Tripanosomiasis (HAT) programme, Democratic Republic of Congo (DRC) Brasavil; Ms. Cayreyre from the private medical company Sanofi-Aventis and M. Pecoul from the NGO Drugs for Neglected Diseases Initiative (DNDI). They defined what the tropical diseases and problems issues are such as lack of drugs, diagnosis and needs for sustaining progress. 

Mr. J. Alvar, in charge of the Control of Neglected Tropical Diseases (NTDs) at WHO, introduced his presentation by explaining how to recognize which tropical diseases are neglected. Examples of such diseases are Tripanosomiasis and Leishmaniasis. They are found specifically in poor countries, in the poorest populations and, most of the time, in the rural populations who don't have access to medication and health centres. Approximately one billion people are affected by more than one NTD. WHO has developed a Global Plan with nine strategies to combat NTDs, one of which is to ensure free and timely access to high-quality medicines and diagnostic and preventive tools. To achieve their objectives it is necessary to develop innovative and intensified disease management, increase preventive chemotherapy, transmission control and integrated Vector Management. It is crucial to decrease the cost of drugs (cost-effectiveness) and the most important of all is the availability and affordability of drugs.

The goals from this year to 2015 are to prevent, control, eliminate or eradicate neglected tropical diseases. The management of existing tools is very important in order to decrease treatment failures and resistant cases. A big gap remains between research and control. New strategies need to be identified. During, the last ten years, access to drugs for some of the most neglected diseases has been improved. (www.who.int/neglected_diseases/en/)

Mr. Miaka Mia Bilenge, the DRC National programme Advisor, presented a governmental approach to provision of medication, specifically Eflorithine, to people with sleeping sickness. The Republic of Congo is a huge country with a fragile political situation due to conflict and transportation difficulties. Health care components include: health education, preventive health care, environmental and family health. The organisation and control structure is divided into three levels: the National Level management in Kinshasa; the Provincial level which implements the strategic plans set by Kinshasa in their 515 health districts; and the Basic level of health centres, with around 5000 staff. In some areas the DRC Human Trypanosomiasis programme uses Eflornithine as a first line drug. This drug is taken for two weeks, four times a day, and needs to be administered with the support of excellent nursing care, well trained staff in the health centres and functioning logistics from WHO abroad and in the country. The improvement needed is a strong partnership and high level of commitment, mutual communication and close follow up. (http://www.minisanterdc.cd/pnltha.php)

Ms. M. Cayreyre, Marketing Director of Medication Access at Sanofi-Aventis, a socially responsible company, explained private sector activity. Sanofi-aventis is committed to an active role in access to medicines, fighting against some of the most neglected diseases of the developing world. Their strategy is threefold: a portfolio dedicated to diseases, the expertise of an international pharmaceutical company in terms of good quality manufacturing, and willingness to work in partnership with different partners (NGOs, national programmes, international organisations). The main areas covered are: preferential pricing (no profit-no loss), improvement of existing drugs, information, education and communication. They are present in seven priority areas: malaria, tuberculosis, sleeping sickness, leishmaniasis, epilepsy, mental health and vaccines. Between 2001 and 2006 more than one million vials were distributed, fourteen million tests performed and, according to WHO, 110,000 lives saved. Sanofi expect to consolidate these results and to contribute for the future with the hope of better products and continuous efforts of all the actors involved. (www.sanofi-aventis.com)

To conclude, M. B. Pecoul the Executive Director of DNDI presented the point of view of their NGO. Created in 2003, DNDI have seven founding partners: the Indian Council of Medical Research (ICMR), the Kenya Medical Research Institute (KEMRI), the Malaysian MOH, the Oswaldo Cruz Foundation, Brazil, Médecins Sans Frontières (MSF), the Institut Pasteur France, WHO/TDR (permanent observer). The vision is a collaborative, patients' needs-driven, virtual, non-profit drug research and development (R&D) organisation to develop new treatments against the most neglected communicable diseases. The primary objective is to deliver 6-8 new treatments by 2014 for leishmaniasis, sleeping sickness, Chagas diseas and malaria, to establish a strong portfolio that addresses patients' treatment needs. The secondary objective is to use and strengthen existing capacity in disease-endemic countries via project implementation. Two of the key issues are the development of new drugs for neglected diseases and to advocate for increased public responsibility. Even with current R&D, the need for new drugs is far from being addressed for the kinetoplastid diseases. It is important to seek pragmatic partnerships to deliver new field-adapted drugs for most NTD. M. Pecoul highlighted the need to deliver products to patients and to ensure that drugs are affordable and access is equitable.

After the presentations, the speakers were congratulated on the good results obtained in the past few years. One relevant question was about the partner chosen and medications under patent. Ms. Cayere observed that medication is chosen which is no longer subject to patent protection.

GHF2010 – PS34 – HIV/AIDS Programmes: Access, Care & Funding

Session Outline

Parallel session PS34, Monday, April 19 2010, 16:00-17:30, Room 4
Chair(s): Alexandra Calmy, Scientific Chief Resident, Department of Internal Medicine, Division of Infectious Diseases, HIV/AIDS Unit, Geneva University Hospitals, Switzerland, Gorik Ooms, Researcher, Department of Public Health, Institute of Tropical Medicine Antwerp, Belgium
Effects of Global Health Initiatives Funding for HIV on South African Health Systems
Thubelihle Mathole, School of Public Health, University of Western Cape, South Africa
Backtracking on International Funding for HIV/AIDS Treatment: Consequences in Several African Countries
Mit Philips, Analysis and Advocacy Unit, Médecins sans frontières, Belgium
UNITAID's Medicines Patent Pool Initiative
Ellen 't Hoen, Senior IT Advisor, UNITAID, Switzerland

Session Documents

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Session Report

Submitted by: Anne Descours (ICVolunteers)

Photo by V. Krebs, ICVolunteers.org

Funding of anti-retroviral (ARV) treatments for HIV in developing countries is decreasing. New initiatives are needed to continue the significant efforts that have been made in the last years to fight against HIV and AIDS. The UNITAID Medicines Patent Pool Initiative proposes an innovative collaborative management structure for patents to improve the availability of new and more efficient ARV drugs.

Mit Philips represents the non-governmental organisation Médecins Sans Frontières (MSF) which has been active in the field of HIV for several years. After a period of significant funding for the prevention, treatment and care of AIDS, Mr Philips reports that MSF is observing a general flattening of financial support in this area. The main funding agencies have tended to shift their interest from anti-HIV treatments to other health issues or health systems support, putting these in competition with AIDS. Fighting AIDS has already cost the funding agencies a great deal, because of the price of treatments, and international public opinion is now more disposed to support prevention rather than treatment. The financial crisis has also reduced total funds available.

All donors expect the Global Fund to Fight AIDS, Tuberculosis and Malaria to step in to make up the shortfall, but there is no certainty that it will. The consequences for patients are dramatic. Patients are initiating their treatment at a more advanced stage of the disease, there are treatment interruptions due to supply difficulties, people do not trust the programmes as much as before and there is a loss of the benefit of high anti-retroviral coverage. As a result, there is a negative impact on HIV transmission, on mortality rates and the prevalence of tuberculosis has increased. Whereas the World Health Organization recommends earlier treatment, in the field there is a clear backlash against funding patient treatment.

ARV started very late in the developing world, but tremendous progress has been made in the last decade thanks to significant funding and to generic manufacturers in India lowering considerably the price of ARV treatment. However, in 2005, a new patent policy started in India that increased production costs and reduced competition.

Ellen t’Hoen, from UNITAID, told the meeting that UNITAID’s Medicines Patent Pool Initiative is an innovative project that aims to promote wider availability of new and more efficient anti-retroviral therapies in low and medium income countries.

The Initiative proposes a fair deal to leading pharmaceutical companies and generic manufacturers from southern countries. On a voluntary basis, the top pharmaceutical companies will put their ARV drug patents in a patent pool that will be available for generic manufacturers against licenses. Royalties based on product sales will be paid by the latter to big companies. The main manufacturers active in HIV medicine production have expressed strong interest, but the modalities have still to be discussed. The Patent Pool is expected to be launched in 2010 and will be public health driven and focused on developing countries. The main goals are to lower the cost of therapy, to broaden the set of first line fixed-dose triple therapy and to make second and third line therapies more widely available. It will also be useful to develop products for markets that do not exist in developed countries such as formulations for paediatric use or heat-stable compounds. This is the first initiative of this kind which is clearly oriented to the market. The key pharmaceutical companies will only accept if the royalties are high enough which means that there must be enough end-buyers. The ability of southern countries to buy new and efficient treatments will thus still rely on funding, but also on the will of patent holders and generic manufacturers to collaborate.

GHF2010 – PS29 – Partnering Globally for Safer Care

Session Outline

Parallel session PS29, Monday, April 19 2010, 16:00-17:30, Room 2
Chair(s): Didier Pittet, Director Infection Control Programme, Geneva University Hospitals and University of Geneva; External Lead, Global Patient Safety Challenge, World Health Organization, Switzerland
Summary: Patient safety is critical for effective health systems in both developed and developing countries, as no country has yet solved the entirety of its patient safety issues. Clearly, there is a need to partner globally for safer care. This session offers an in-depth look at patient safety action at the global, regional, and country levels. In particular will be articulated the crucial steps in securing political commitment for patient safety. Use of 12 key patient safety action areas as an entry point to improve systems in the African Region will provide a case study and key WHO programmes on patient safety will be introduced. Finally, experiences from African countries will be given the floor and leadership of the Geneva University Hospitals in patient safety highlighted.
African Partnerships for Patient Safety: Enhancing Patient Safety Across Continents 
Shams Syed, Programme Manager, African Partnerships for Patient Safety, World Health Organization, Patient Safety, IER, Switzerland
Reducing Healthcare-Associated Infection Worldwide: Lessons Learned from the WHO First Global Patient Safety Challenge 
Benedetta Allegranzi, Deputy Lead, 'Clean Care is Safer Care', World Health Organization, Patient Safety, IER, Switzerland
Injection Safety: A Key Component to Achieving Primary Healthcare
Selma Khemassi, Injection Safety & Related Infection Control, Safe Injection Global Network, (SIGN) Secretariat, HSS/EHT/DIM, World Health Organization, Switzerland
Crisis of Ignorance or Inaction: Lessons Learned from a Study on Healthcare Waste Management Practices Nigeria 
Emmanuel Okechukwu, President, Action Family Foundation, Nigeria
APPS-Senegal: The Story So Far
Ndèye Méry Dia Badiane, APPS focal point, Senegal (via videoconference)
APPS-Cameroon: The Story So Far 
Vincent Djientcheu, APPS focal point, Cameroon
APPS-Mali: The Story So Far
Loséni Bengaly, APPS focal point, Mali (via videoconference)
Closing Remarks
Bernard Gruson, Chief Executive Officer, Geneva University Hospitals, Switzerland

Session Documents

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Session Video

This session is available to watch using Dudal. To watch it you will need to have Java installed on your computer.

Session Report

Submitted by: Caroline Pepek (ICVolunteers); Contributors: Emma Greenaway (ICVolunteers), Josefine Ridderstrale (ICVolunteers)
alaria remains a killer disease with nearly 1 million people losing their lives every year. A girl with a mosquito net in Potou Niayam, Senegal. Photo: Maggie Hallahan/Olyset Nets

In the normal course of events, military and political alliances have often been a primary source of security for growing nations; yet now within our globalised culture, it is essential for nations to make international social connections. Accordingly, the union of nations can be achieved through collaborative medical learning based on the desire to improve patient safety. The international partnership of African nations and the United Kingdom, in particular, has proved incredibly successful in motivating participating nations to improve their patient safety policies.

In September 2008, the African Partnership for Patient Safety (APPS), part of the World Health Organization (WHO), established twelve action areas in various regions to set about creating and sharing a variety of solutions to problems with patient safety. Working in tandem with a number of European hospitals, the APPS focused on collaboration, strengthening partnerships and improving patient safety on both an individual and national level.

From the outset, the goal of these international partnerships was to reduce the risk of harm for patients as well as making healthcare practices safer for both patients and staff. APPS operates on the premise that the most important dimension in partnership is the recognition that co-development can improve the situation for both parties. The founders believe working within a partnership-oriented structure has the capacity to make a real difference.

As outlined during the session Partnering Globally for Safer Care, the need for an international partnership for patient security is growing. Shamis Syed, Programme Manager for APPS, explained the background behind the need for these collaborations. His definition of the problems surrounding patient security, “the avoidance, prevention and amelioration of adverse outcomes or injuries stemming from the process of health care”, clearly outlines the stresses forced on non-cooperative hospital bodies. However, through the APPS model, the partnerships allow for a free transfer of ideas, resulting in a more efficient and concerted drive towards enhancing the quality of these hospitals.

Attainable goals for APPS include the production of guidelines for patient safety and the implementation of training sessions. Mr Syed noted that these programmes have been incredibly successful in Mali, where professionals have been trained to operate new medical equipment.

Bendetta Allegranzi, Deputy Lead for the ‘Clean Care is Safer Care’ programme at the WHO, focused on patient safety with regard to infections. Although primarily focused on the spread of infectious diseases, the promotion of locally fabricated alcohol-based hand rub plays a major role in her programme. As the risk of infection is between 2 to 20 times higher in developing countries, there must be continued dedication to promotion of patient safety in these countries in order to reduce these figures.

Although Ms Allegranzi encourages hand and infection sanitisation, her work, along with the work of the other participating organisations draws attention to the need to promote patient and citizen safety in respect to more lethal diseases. HIV/AIDS, malaria and tuberculosis are major diseases which kill millions of global citizens every year and more action can be taken to prevent the spread of such diseases. Ms Allegranzi was emphatic in her call for the mobilisation of home governments in the face of these diseases, providing tools and technology to protect their own populations.

Didier Pittet, the Director of the Infection Control Program of Geneva University, expanded on the idea saying that it is essential for hospitals and governments to provide the proper tools to implement action in different cultures according to that culture’s priorities.

 

Prevalence and Re-Infection Rates of Soil Transmitted Helminths among School Children in Ardokola, Nigeria

Author(s) Innocent Vakkai1, C.L. Ejembi2, P. Aboa3
Affiliation(s): 1Ministry of Health Taraba State Nigeria, Jalingo, Nigeria, 2Ahmadu Bello University, Zaria, Nigeria, 3University of Port Harcourt, Choba, Rivers State, Nigeria
1st country of focus: Nigeria
Relevant to the conference theme: Communicable chronic diseases
Summary (max 100 words): The Prevalence and re-infection rates of soil transmitted helminths was high among school children, therefore regular deworming of school children every six months in endemic communities is required.
Background (max 200 words): Soil transmitted heminths has been a major cause of morbidity and mortality among school children in many developing countries including Nigeria. It affects the develoment of school age children and developing countries carry a greater share of the global burden of this disease than developed countries. This situation requires public health attention.
Objectives (max 100 words): The objectives of the study are 1) To determine the baseline prevalence of soil transmitted helminths among school children in Ardokola Local Government Area of Taraba State. 2) To determine the rate of re-infection with soil transmitted helminths among the studied school pupils at one, three and six months intervals. 3) To recommend periodic deworming of school children for the control of soil transmitted helminths among pupils.
Methodology (max 400 words): The study was a field interventional study. A total of 365 primary school pupils were selected using a multistage sampling method. Stool specimens were collected and the prevalence of soil transmitted helminths was diagnoised and determined. Albendozole 400mg was given as an intervention, the number of pupils cured were established with those cured followed up at one ,three and six momths interval to determine rate of re-infection.
Results (max 400 words): The prevalence of soil transmitted helminths was 64.4% at base line among school pupils with a cure rate of 88%. The re-infection rates  were 11.1%, 31.7% and 58.3% at one, three and six months interval.
Conclusion (max 400 words): The prevalence of soil transmitted helinths was high amomg school children in Ardokola Local Government Area of Taraba State and the rate of re-infection was highest after six months(58.3%) hence the need for periodic deworming every six months within endemic communities.

Teenager to Teenager – Improving Knowledge, Community Empowerment and Condom Use for STI’s/HIV/AIDS Prevention: Pakistan

Author(s): Zia Ahmad1, M. Munir1
Affiliation(s): 1PLUS Ngo, Muzaffargarh, Pakistan
1st country of focus: Pakistan
Relevant to the conference theme: Vulnerable groups
Summary (max 100 words): The training of adolescents as peer educators is recommended.  Ours being an Islamic society, public health information should be given to youth in a way that does not challenge local norms and values.  Problem-based learning and participatory education for improving knowledge and condom use and community-based interventions should be considered for STIs/HIV/AIDS prevention.
Background (max 200 words): Pakistan, the second most populous Muslim nation in the world, has started to finally experience and confront the HIV/AIDS epidemic. The country had been relatively safe from any indigenous HIV cases for around two decades, with most of the infections being attributable to deported HIV positive migrants from the Gulf States. However, the virus finally seems to have found a home-base, as evidenced by the recent HIV outbreaks among the injection drug user community. Extremely high-risk behavior has also been documented among youth (school going and out of school). The weak government response, coupled with the extremely distressing social demographics of this South-Asian republic, also helps to compound the problem. The time is ripe to take the appropriate measures to curtail further spread of the disease. If this opportunity is not utilized right now, it will be harder later on.
Objectives (max 100 words): Islamic charities provide health, education and social services to millions of people in Pakistan, but in Pakistan sexuality remains a taboo topic. The strong hold of religious leaders on socio-cultural community patterns (attitudes with extremism). Currently the prevailing culture considers it vulgar and immoral to talk about sex. The use of words such as STIs and HIV/AIDS are conceived of as symbols of sexual delinquency.
Methodology (max 400 words): Through a questionnaire on knowledge, attitude, behavior and practices related to STIs/HIV/AIDS, data were collected from 1200 male religious students and religious scholars from randomly selected Islamic religious centers. Baseline knowledge, attitude, and acceptability of the concept were assessed.
Results (max 400 words): According to KABP study 70% students have friends of the opposite sex and due to strong religious values and restriction 30% have no friendship with anyone from the opposite sex. Regarding the experience of sex, 40% had kissing and only 18% had intercourse. During intercourse only 3% used condoms. 42% consider that condoms were used only for family planning purposes. 56% answered that during intercourse condom use reduced sexual pleasure and enjoyment. 32% youth use drugs and 38% did not know about STDs and HIV/AIDS. General discussions were also started with four Maderssas students and their teachers. These meetings addressed the sensitization of religious scholars to the issue of HIV/AIDS and highlighted the role of Maderssas in STIs and HIV prevention.
Conclusion (max 400 words): The training of adolescents as peer educators is recommended.  Being an Islamic society, such information should be given to youth in a way that does not challenge local norms and values.  Problem-based learning and participatory education for improving knowledge and condom use and community-based interventions should be considered for STIs/HIV/AIDS prevention.