AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC)
REPORT OF THE THIRTIETH SESSION OF THE TECHNICAL CONSULTATIVE COMMITTEE (TCC)
Ouagadougou, 8-13 MARCH 2010
DIR/COORD/APOC/REP/TCC30 06/08/2010
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TABLE OF CONTENTS
ABBREVIATIONS/ACRONYMS .............................................................................................................. IV
OPENING: AGENDA ITEM 1 ..................................................................................................................... 1
ADOPTION OF THE AGENDA: AGENDA ITEM 2 ..................................................................................... 2
INFORMATION ........................................................................................................................................ 3
CSA: MATTERS ARISING FROM THE 126TH AND 127TH CSA SESSIONS: AGENDA ITEM 3.................. 3
JAF: MATTERS ARISING FROM THE 15TH SESSION: DECISIONS: AGENDA ITEM 4............................. 3
NGDO: MATTERS ARISING FROM THE 34TH SESSION: AGENDA ITEM 5 .............................................. 3 TCC: FOLLOW UP OF THE KEY RECOMMENDATIONS OF THE TWENTY NINTH TCC SESSION: AGENDA ITEM 6 ....................................................................................................................................... 4
SPECIAL SESSION ON ELIMINATION OF O. VOLVULUS INFECTION: AGENDA ITEM 7 .............. 5
Session 1: INFORMAL CONSULTATION ON ELIMINATION OF ONCHOCERCIASIS TRANSMISSION WITH IVERMECTIN TREATMENT AND CONCEPTUAL FRAMEWORK OF ELIMINATION....................................................................................................................................5 Session 2: RESULTS OF THE FIRST ROUND OF EPIDEMIOLOGICAL EVALUATIONS OF PROGRESS TOWARD ELIMINATION ENDPOINTS AND IMPLICATIONS FOR APOC STRATEGY .................................................................................................................................................6
Session 3: TRANSMISSION ZONES. ............................................................................................ 7 Session 4: DISTRIBUTION OF LOIASIS, REVIEW OF APOC'S PLAN FOR FURTHER RAPLOA SURVEYS AND COMPREHENSIVE ANALYSIS OF LOA LOA DATA ............................8 Session 5: OTHER ISSUES OF IMPORTANCE FOR ELIMINATION. ............................................9
STRATEGIC AND TECHNICAL ISSUES............................................................................................... 10
COUNTRY VISIT BY TCC MEMBERS: AGENDA ITEM 8 ....................................................................... 10 TASK FORCE ON THE REVIEW OF THE TECHNICAL REPORTS (NIGERIA). SUMMARY OF 7TH, 8TH AND 9TH YEAR TECHNICAL REPORTS: AGENDA ITEM 9............................................................... 11
MACROFIL AND RESEARCH: AGENDA ITEM 10 .................................................................................. 11
REVIEW OF OPERATIONAL RESEARCH: AGENDA ITEM 11................................................................ 13 CO-IMPLEMENTATION: ACHIEVEMENTS AND CHALLENGES IN CDTI PROJECTS IN NIGERIA: AGENDA ITEM 12 ................................................................................................................................... 15
MULTI-COUNTRY STUDY ON SOCIAL BENEFITS IN CDTI: AGENDA ITEM 13 .................................. 16
STUDY OF BLACKFLY MOVEMENTS: RESULTS AND RECOMMENDATIONS: AGENDA ITEM 14.... 17
MANAGEMENT OF THE APOC TRUST FUND .................................................................................... 17
REPORT ON THE FINANCIAL MANAGEMENT OF APOC FUNDED PROJECTS: AGENDA ITEM 15 .. 17 REPORT ON THE FINANCIAL REVIEW BY APOC MANAGEMENT OF 1ST, 2ND, 3RD, 4TH, 5TH, 6TH, 7TH, 8TH, 9TH, 10TH, 11TH AND 12TH YEAR PROGRESS REPORTS AND SUBSEQUENT YEAR BUDGETS: AGENDA ITEM 16............................................................................................................... 18 REVIEW OF NEW PROJECT PROPOSALS AND 1ST, 2ND, 3RD, 4TH, 5TH, 6TH, 7TH, 8TH, 9TH, 10TH, 11TH AND 12TH YEAR ANNUAL TECHNICAL REPORTS ON THE IMPLEMENTATION OF CDTI AND VECTOR ELIMINATION PROJECTS. RECOMMENDATIONS ON THE 2ND, 3RD, 4TH, 5TH, 6TH, 7TH, 8TH, 9TH, 10TH AND 11TH YEAR IMPLEMENTATION OF PROJECTS: AGENDA ITEM 17.................. 19
ANGOLA ................................................................................................................................................ 19
Moxico I CDTI project (Angola) 3rd year Annual Technical Report ...............................................19
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BURUNDI ............................................................................................................................................... 20
Bururi CDTI Project (Burundi) 4th year Annual Technical Report ................................................20 Cibitoke and Bubanza CDTI Project (Burundi) 5th year Annual Technical Report ......................20 Rutana CDTI Project (Burundi) 4th year Annual Technical Report ................................................21
CAMEROON .......................................................................................................................................... 21
Adamaoua I CDTI Project (Cameroon) 5th year Annual Technical Report ...................................21 East Province CDTI Project (Cameroon) 5th year Annual Technical Report ................................22 Far North Province CDTI Project (Cameroon) 5th year Annual Technical Report ......................22 Littoral I CDTI Project (Cameroon) 5th year Annual Technical Report .........................................23 South CDTI Project (Cameroon) 5th year Annual Technical Report ...............................................23 NOTF/HQ (Cameroon) 11th year Annual Technical Report .............................................................24
CONGO................................................................................................................................................... 24
Congo CDTI Extension Project (Congo) 6th year Annual Technical Report..................................24
DEMOCRATIC REPUBLIC OF CONGO (DRC) ................................................................................. 24
Butembo-Beni CDTI Project (DRC) 3rd year Annual Technical Report........................................24 Ituri CDTI Project (DRC) 3rd year Annual Technical Report .........................................................25 Kasongo CDTI Project (DRC) 4th year Annual Technical Report ..................................................26 Lubutu CDTI Project (DRC) 3rd year Annual Technical Report......................................................26 Masisi-Walikale CDTI Project (DRC) 1st year Annual Technical Report (re-submission)..........27 Masisi-Walikale CDTI Project (DRC) 2nd year Annual Technical Report (re-submission).........27 Masisi-Walikale CDTI Project (DRC) 3rd year Annual Technical Report......................................27 Katanga-Nord CDTI Project (DRC) 4th year Annual Technical Report .........................................27 Rutshuru-Ngoma CDTI Project (DRC) 4th year Annual Technical Report. ...................................28 Tshopo CDTI Project (DRC) 6th year Annual Technical Report......................................................28 Sankuru CDTI Project (DRC) 6th year Annual Technical Report ....................................................28
COTE D'IVOIRE .................................................................................................................................... 29
Côte d’Ivoire CDTI Project 2nd year Annual Technical Report. ......................................................29
ETHIOPIA............................................................................................................................................... 30
East Wollega CDTI Project (Ethiopia) 5th year Annual Technical Report.....................................30 Gambella CDTI Project (Ethiopia) 5th year Annual Technical Report ...........................................30 Illubabor CDTI Project (Ethiopia) 6th year Annual Technical Report............................................31 Jimma CDTI Project (Ethiopia) 6th year Annual Technical Report.................................................31 Metekel CDTI Project ( Ethiopia) 5th year Annual Technical Report .............................................32 West Wollega CDTI project (Ethiopia) 5th year Annual Technical Report.....................................32
GHANA................................................................................................................................................... 33
Ghana 1st Year Annual Technical Report ...........................................................................................33
LIBERIA ................................................................................................................................................. 33
South-East CDTI Project (Liberia) 4th year Annual Technical Report. .........................................33 South-Western CDTI Project (Liberia) 4th year Annual Technical Report.....................................33
NIGERIA................................................................................................................................................. 33
Akwa Ibom State CDTI Project (Nigeria) 2nd year Annual Technical Report (re-submission) ..34 Akwa Ibom State CDTI (Nigeria) Project 6th year Annual Technical Report. ...............................34
SIERRA LEONE..................................................................................................................................... 34
Sierra Leone 4th Year Annual Technical Report ...............................................................................34
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TANZANIA ............................................................................................................................................ 35
Morogoro Focus CDTI Project (Tanzania) 5th year Annual Technical Report ............................35
SUMMARY OF 7TH, 8TH, 9TH AND 10TH ANNUAL YEAR TECHNICAL REPORTS .............................. 35
CENTRAL AFRICAN REPUBLIC (CAR) ............................................................................................ 35
CAR 8th year Annual Technical Report ................................................................................................35
CHAD...................................................................................................................................................... 36
Chad 10th year Annual Technical Report ...........................................................................................36
CONGO................................................................................................................................................... 36
Congo CDTI 9th year Annual Technical Report ...............................................................................36
DEMOCRATIC REPUBLIC OF CONGO (DRC) ................................................................................. 37
Ueles CDTI Project (DRC) 7th year Annual Technical Report.........................................................37
EQUATORIAL GUINEA ....................................................................................................................... 37
Bioko CDTI Project (Equatorial Guinea) 8th year Annual Technical Report ...............................37
ETHIOPIA............................................................................................................................................... 38
Kaffa Shekka CDTI Project (Ethiopia) 8th year Annual Technical Report .....................................38 Bench-Maji CDTI Project (Ethiopia) 7th year Annual Technical Report........................................38 North Gondar CDTI Project (Ethiopia) 7th year Annual Technical Report ...................................39
LIBERIA ................................................................................................................................................. 39
Lofa, Bong, Nimba and Montserrado counties 8th year Annual Technical Report........................39
MALAWI ................................................................................................................................................ 40
Malawi Extension CDTI Project 10th year Annual Technical Report .............................................40 Thyolo and Mwanza CDTI Project (Malawi) 10th year Annual Technical Report.......................40
TANZANIA ............................................................................................................................................ 40
Ruvuma CDTI Project (Tanzania) 8th year Annual Technical Report.............................................40 Tanga CDTI Project (Tanzania) 8th year Annual Technical Report................................................41 Mahenge CDTI Project (Tanzania) 10th year Annual Technical Report, .......................................41 Kilosa CDTI project (Tanzania) 7th year Annual Technical Report, ...............................................41
ANY OTHER BUSINESS: AGENDA ITEM 18........................................................................................ 42
DATE AND PLACE OF THE NEXT TCC MEETINGS: AGENDA ITEM 19.......................................... 42
CLOSURE OF THE MEETING: AGENDA ITEM 20.............................................................................. 43
ANNEX 1: LIST OF PARTICIPANTS .................................................................................................................. 44 ANNEX 2: PROVISIONAL ANNOTATED AGENDA ..................................................................................... 49 ANNEX 3: CONCEPTUAL FRAMEWORK FOR ELIMINATION OF TRANSMISSION OF ONCHOCERCIASIS ................................................................................................................................................ 53 ANNEX 4: IMPLEMENTATION OF TCC 30 RECOMMENDATIONS AND SUGGESTIONS ............... 54
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ABBREVIATIONS/ACRONYMS AAF Administrative & Finance Assistants ABR Annual Biting Rate AfDB African Development Bank APOC African Programme for Onchocerciasis Control ATO Annual Treatment Objective ATP Annual Transmission Potential CBO Community-Based Organisation CDD Community-Directed Distributor CDI Community-Directed Intervention CDTI Community-Directed Treatment with Ivermectin CEMV Centre d’Entomologie Médicale et Vétérinaire CHI Community Health Implementers CMFL Community Microfilarial Load CSM Community Self Monitoring DBL Danish Bilharzia Laboratory GPELF Global Programme for Elimination of Lymphatic Filariasis HKI Helen Keller International DEC Diethylcarbamazine DMO DRC
District Medical Officer Democratic Republic of Congo
EMEA European Medicines Evaluation Agency ECOWAS Economic Community of West Africa States FLHF Front Line Health Facility FCT Federal Capital Territory HR Human Resource HSAM Health Education Sensitization Advocacy Mobilization HQ Headquarters HW Health worker ICTC International Coalition for Trachoma Control IEC Information, Education, Communication INSP Institut National de Santé Publique de Cote d’Ivoire. IPM Independent Participatory Monitoring IRSP Institut Régional de Santé Publique JAF Joint Action Forum LF Lymphatic Filariasis LGA Local Government Area LOCT LGA Onchocerciasis Control Team LTS Lohmann Therapy Systems MCD Médecins Chefs de District MDP Mectizan® Donation Program MF Microfilaria MOH Ministry of Health MOHSW Ministry of Health and Social Welfare NGDO Non-Governmental Development Organization NOCP National Onchocerciasis Control Programme NOTF National Onchocerciasis Task-Force NTD Neglected Tropical Diseases PAB Plan of Action and Budget PNLO Programme Nationale de Lutte Contre l’Onchocercose PHC Primary Health Care RAPLOA Rapid assessment procedure of Loa loa REA Rapid Epidemiological Assessment SAE Severe Adverse Events SCI Special Country Initiative
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SHM Stakeholder Meeting SIZ Special Intervention Zone SSI Sight Savers International SWAP Sector-Wide Approach (health) SWOT Strengths Weaknesses Opportunities and Threats TBR Threshold Biting Rate TCC Technical Consultative Committee (of APOC) USAID United States Agency for International Development UTG Ultimate Treatment Goal VAS Vitamin A Supplementation WHO AFRO Regional Office of the WHO Africa Region WHO/NTD Neglected Tropical Diseases – department within WHO cluster of
communicable diseases (WHO/NTD) WV World Vision
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OPENING: Agenda Item 1 1. The Director of APOC, Dr Uche Amazigo warmly welcomed all participants and acknowledged the presence of Professor A. Abiose, chair of TCC, Dr Djamila Cabral, WHO representative to Burkina Faso, Dr A. Kabore, former Director of APOC, Dr A. Sékétéli, Dr B. Boatin, former Director of OCP, Professor M. Homeida, Professor E. Braide, Dr Bokar Touré, Director of IST, Professor P. Diggle, Lancaster University, Dr K. Awadzi, Dr J.H.F. Remme, and Professor Evariste Mutabaruka, Director of MDSC. The presence of Dr Andy Tembon, representing the World Bank, and the WAHO representative, Dr Sacko, was also recognised. The first two days of the session would be devoted to deliberation on elimination of onchocerciasis transmission in Africa. 2. In February 2009 an informal consultation meeting on Elimination of Onchocerciasis Transmission with Current Tools in Africa – “Shrinking the Map”, was hosted by APOC, co-funded by APOC, MDP and the Bill & Melinda Gates Foundation. The report of the meeting was the main working document of the special session on elimination. In the September 2009 29th TCC meeting it was decided to set aside two days in the current TCC meeting to deliberate further on the feasibility of elimination. Dr Amazigo underscored that the achievements made so far by APOC result from engaging communities in a lead role. A TDR study on the CDTI strategy led to its adoption and approval as APOC’s main method for the control of onchocerciasis by JAF in 1997. The results of onchocerciasis control in 2008 and 2009 justified APOC’s trust in engaging the communities as they have never failed APOC and have formed links strengthening national health systems.
3. Since 1984, when ivermectin was discovered, up to 1995, when APOC was launched, ivermectin has been found to be effective for the control of onchocerciasis as a public health problem. It was also known that ivermectin reduces but does not stop transmission. The objective of APOC at its inception was to control onchocerciasis by establishing sustainable treatment in all meso- and hyper-endemic onchocerciasis zones. Whether elimination was possible was unanswered for two decades but programmes in America and Africa have shown that the strategy can eliminate the disease. This led to a new objective for APOC - to provide guidelines for stopping treatment and determining when treatment can be stopped – this objective was approved by JAF in 2007 and had major implications for APOC operations. The implementation of this new objective implied new activities, notably development of diagnostics and investment in research and documentation of APOC operations. The critical issues and questions being addressed at this meeting, which follow, arose from this new objective:
(i) A definition of elimination; (ii) The criteria necessary for establishing elimination; (iii) What are the guidelines for what has to be accomplished? (iv) Should APOC change its overall objective from control to elimination? If yes.... (v) What strategy should APOC adopt and how applicable would this be for
onchocerciasis endemic communities?
4. It would also be helpful if TCC deliberates on co-implementation. JAF asked APOC to undertake co-implementation in 2005. Subsequently, two country programmes have been undertaking larger scale co-implementation; there has been some fragile progress in this area but much remains to be done. APOC Management has received reports that some communities do not receive their drugs on time due to challenges faced by co-implementation. Countries also need clear guidelines on what APOC will and will not fund. A challenge is to successfully co-implement control of other NTDs without distracting projects from their goal of controlling onchocerciasis. 5. Dr Amazigo thanked all participants for their continued support and reiterated that the meeting could be a historic turning point for APOC, and the poorest of Africa’s communities. A full list of participants is appended as Annex 1.
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6. Former Director of OCP, Dr Boatin, conveyed greetings from Dr Y. Dadzie, former OCP/APOC Director to TCC members. He reminded TCC that vector control carried out by the Onchocerciasis Control Programme had been very successful in West Africa, before being replaced by Ivermectin treatment and the associated challenges of delivery – this proved to be an effective drug for morbidity control and could be used to reduce, but not stop, transmission. It now appears that ivermectin was having more impact than was known at the time and that transmission may be interrupted following long-term treatments of at risk populations, leading to the possibility of elimination of infection. The current TCC meeting had the people and the task to develop the best strategy for this. Dr Boatin thanked Dr Amazigo for the kind invitation to attend the meeting. 7. Former Director of APOC, Dr A. Sékétéli informed TCC of the outcome of a mission to Benin to conduct training of trainers on the CDTI strategy for APOC, intended to promote the inclusion of this strategy in the curricula of the University Medical Faculty and Nurses training school as this would contribute to the sustainability of the strategy for delivery of health interventions. Referring to elimination of infection and interruption of transmission of onchocerciasis, Dr Sékétéli emphasised that this required scientific field evidence. He emphasised the need to find a means of structuring and channelling the mass of empirical data collected from the field so that it could be used appropriately to clarify APOC’s approach. 8. Professor Adenike Abiose, Chair TCC, welcomed Dr Cabral, the WHO representative to Burkina Faso, Dr Touré, Director of IST, Dr Amazigo, Director of APOC, Professor Mutabaruka, Director of MDSC, Dr Tembon, World Bank representative and the representative of WAHO, TCC members and other participants to the 30th session of TCC. Professor Abiose particularly welcomed the ‘elders’ of onchocerciasis – Dr A. Kabore, former DDC WHO/AFRO, Dr Sékétéli, former APOC Director, Dr Boatin, former OCP Director, Professors Homeida and Braide, former TCC Chairs, and other scientists Dr H-P. Duerr, Prof P. Diggle, Michelle Murdoch, Dr Remme and others who have played key roles in onchocerciasis control. TCC particularly appreciated their presence to discuss the 2009 informal consultation on elimination of onchocerciasis and subsequent follow-up actions. The September 2009 TCC meeting made recommendations that will be addressed during this two day meeting. The request by countries for guidelines on when and where to stop treatment, and the shift from control to elimination would be addressed among others, so as to guide APOC, member countries and partners. Other strategic and technical issues including co-implementation would also be discussed. 9. The WHO Representative to Burkina Faso, Dr Djamila K. Cabral, acknowledged the Chair of TCC, Professor Abiose, Dr Touré, Director of IST, Directors of APOC and MDSC, WAHO, World Bank, TCC, and others. Observing that the role of TCC is to provide support to WHO in successfully implementing the APOC programme, Dr Cabral pointed out that among the major topics on the agenda, elimination of onchocerciasis infection and interruption of transmission where feasible was a key issue. The rapid mapping of onchocerciasis by APOC is an important exercise providing additional data enabling transmission zones within which ivermectin treatment is required to be identified, thus enabling partners to ‘shrink the map of onchocerciasis in Africa’. APOC’s experience in areas of co-endemicity with Loa loa is important in relation to co-implementation of control of other NTDs and delivery of other health commodities. APOC has therefore undertaken Loa loa mapping in areas not covered by CDTI. Dr Cabral hoped that macrofilaricides would be found that will contribute to the speedy elimination of onchocerciasis. In her closing remarks, Dr Cabral commented that a successful outcome would contribute to a better quality of life for millions of African people in poor rural communities. Noting that it was the International Women’s Day, she wished African women a bright future in which they would have access to all basic human rights. The meeting was then declared open. Adoption of the agenda: Agenda Item 2 10. The agenda was adopted without any changes. The final agenda is appended as Annex 2.
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INFORMATION CSA: Matters arising from the 126th and 127th CSA sessions: Agenda Item 3 11. Dr Yameogo reported on the CSA 126th session held from 21-23 October 2009, at the World Bank, Paris, France and the CSA 127th session held from 9-10 December 2009, in Tunis, Tunisia. Main points arising from discussions of the two meetings were as follows:
(i) For the first time, a biennial budget (2010-2011) was endorsed by CSA and
presented to JAF15 for adoption; (ii) The supplementary addendum to the Plan of Action and Budget (2008-2015)
was also endorsed by CSA for presentation to JAF15, which encouraged APOC to submit a comprehensive document to JAF16, 2010 in Abuja, Nigeria;
(iii) Following a decision of JAF15 to commission a mid-term evaluation of APOC in 2010, CSA would develop Terms of Reference (TOR), underlining the core activities for evaluation which would be circulated among the various stakeholders. The evaluation will be conducted by an independent firm;
(iv) It was concluded that the JAF working languages would be English and French with simultaneous translation into Spanish;
(v) The CSA also discussed and supported a shift towards elimination where feasible.
JAF: Matters arising from the 15th session: Decisions: Agenda Item 4 12. TCC was informed that JAF15 was a great success. During the opening ceremony, a short film was shown in tribute to the late Robert McNamara, former President of the World Bank, and to others who have worked hard to contribute to River Blindness control. In the film, the current President of the World Bank, Mr Robert Zoellick, reaffirmed the Bank’s commitment and continuing support to APOC. 13. JAF commended APOC's shift towards elimination of infection and interruption of transmission where feasible, and encouraged APOC to investigate alternative strategies to accelerate progress towards this objective in trouble spots; JAF also endorsed further mapping to identify transmission zones and possible additional target zones for treatment. 14. Within the framework of co-implementation, JAF decided that APOC and the World Bank should take the lead with regards to cost-benefit analyses, comparative costing on a disease-by-disease basis and also for multi-disease interventions. NGDO: matters arising from the 35th session: Agenda Item 5 15. The 35th session of the NGDO Coordinating Group for Onchocerciasis Control that took place from 4-5 March 2010, in Ouagadougou, Burkina Faso had representatives of 12 member organisations (Charitable Society for Social Welfare, Christoffel-Blindenmission, Helen Keller International, Light for the World, Mectizan Donation Program, Mission to Save the Helpless, Organisation pour la Prévention de la Cécité, Schistosomiasis Control Initiative, Sightsavers, the Carter Center, United Front Against River blindness and US Fund for UNICEF) 1 Associate member (International Agency for the Prevention of Blindness) and 1 observer organisation (World Vision Angola). Representatives from IMA Global Health, Lions Clubs International Foundation, Malaria Consortium, Merck & Co., Inc and the Liverpool Centre for Neglected Tropical diseases were unable to attend the meeting.
16. The Group noted with concern the inability of some members to continue providing financial support to CDTI projects, particularly in the DRC. A small group, comprised of Chad MacArthur, Frank Richards, Michael Kirumba and Tony Ukety were therefore tasked to develop an approach for early detection of potential funding gaps and to identify projects that are vulnerable to disruption and require priority support. The Director of APOC encouraged the Group to explore the
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possibility of using the APOC Trust Fund to enable NGDOs to support such vulnerable priority CDTI projects for a limited period, subject to CSA approval. Members were also made aware of overhead costs of 7.5% for the support of NGDOs at the country level as agreed during the 3rd session of the JAF under section 9.1 page 10. 17. In order to avoid multiple donors funding NTD mapping and baseline data collection in the same area, it was suggested that all the relevant partners (APOC, MDP, NTD/AFRO, NOTF and NGDOs) should be informed each time a new proposal was approved.
18. The NGDO Group commended APOC Management for the excellent report of the 6th meeting of the national task force published in the Weekly Epidemiological Record (WER) of 22 January 2010. However, in future, the Group requested that the role of the NGDO Group be acknowledged by listing the names of all NGDO in a footnote. APOC Management was encouraged to share the draft of subsequent reports with the Technical Consultative Committee for comments. The group suggested that future WER reports should reflect the outcomes of JAF, rather than NOTF, meetings as this would be a more powerful advocacy document.
19. Following a publication in the scientific literature claiming widespread ivermectin resistance, the NGDO Group recommended that TCC review the article, which reported the impact of an existing drug known as "Closantel" against O. volvulus and considered issuing a statement of clarification. 20. TCC subsequently recommended that a small group would review the article and give feedback. APOC/TCC should then respond to the article in the same journal expressing APOC’s view concerning the statement on apparent resistance to ivermectin referred to in the article. TCC: Follow up of the key recommendations of the Twenty Ninth TCC session: Agenda Item 6
21. Actions indicated below have been initiated or completed by APOC Management as a follow-up to TCC29 recommendations (the full presentation of the implementation of TCC29 recommendations is attached as Annex 3).
(i) Regarding strategy and technical issues related to the curriculum and training module on the CDI strategy developed for Faculties of medicine and nursing schools, a ‘training of trainers’ (ToT) was carried out at the IRSP/Benin by a former APOC Director and other facilitators. A synopsis of a CDI book has been prepared and authors are being identified;
(ii) All recommendations from the country visits to Malawi, Tanzania, Ethiopia, Burundi, Congo, and Cote d'Ivoire were implemented;
(iii) On the issue of the Task Force review Committee (TRC), with regards to Uganda, APOC management informed TCC that APOC had funded the setting up of the TRC and the first meeting was planned for April 2010;
(iv) APOC management informed TCC that the revised format for Annual Technical Reports was presented to the last NOTF meeting and forwarded to all countries for pre-testing.
22. TCC recommended that APOC should undertake a study on the economic benefits of co-implementation. Further discussions were held on joint TCC/World Bank collaboration to undertake the study which was proposed by TCC29.
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Special Session on Elimination of O. volvulus infection: Agenda Item 7 Section 1: INFORMAL CONSULTATION ON ELIMINATION OF ONCHOCERCIASIS TRANSMISSION WITH IVERMECTIN TREATMENT AND CONCEPTUAL FRAMEWORK OF ELIMINATION 23. Professor Homeida presented to TCC a short definition of elimination specifically adopted for the African context as, 'Reduction of O. volvulus infection and transmission to the extent that interventions can be stopped, but post intervention surveillance is still necessary’ and the four elements of the operational definition as 1) Interventions in a defined geographical area have reduced O. volvulus infection and transmission to a point where the parasite population is believed to be irreversibly moving to its demise/extinction ''below breakpoint''. 2) Interventions at that point have been stopped. 3) Post intervention surveillance for an appropriate period has demonstrated no recrudescence of transmission to a level suggesting recovery of the O. volvulus population and 4) Additional surveillance may be necessary, for timely detection of reintroduced infection from other areas. 24. A transmission Zone was defined as a geographical area, in which transmission of O. volvulus occurs by locally breeding vectors. This zone can be regarded as a natural ecological and epidemiological unit for interventions. Closed transmission zones are those in which in- or out-migration of infected humans or flies is a relatively rare event that has little impact on transmission. 25. Following the presentation discussions were centred on the following:
1) Elimination of O. volvulus infection and transmission. In view of the available evidence that elimination is possible, APOC should initiate the elimination process in selected foci that meet the criteria for elimination. APOC should support countries to intensify control activities in all other sites.
2) Short definition: The TCC discussed the proposed short definition at length. Issues
raised include the need not to lose focus on control, which is the mandate of APOC. The TCC members agreed to change the term ‘short definition’ to ‘general definition’. • General definition: The reduction of infection and transmission to the extent that
interventions can be stopped, but post-intervention surveillance is still necessary.
TCC stressed that the definition be retained but it should be accompanied by clear guidelines to be used by countries.
3) Operational definition: The four elements of the operational definition were also
considered at length: (i) Interventions have reduced O. volvulus infection and transmission below the
point where the parasite population is believed to be irreversibly moving to its demise/extinction in a defined geographical area;
(ii) Interventions have been stopped; (iii) Post-intervention surveillance for an appropriate period has demonstrated no
recrudescence of transmission to a level suggesting recovery of the O. volvulus population; and
(iv) Additional surveillance is still necessary for timely detection of recurrent infection, if a risk of reintroduction of infection from other areas remains.
The TCC members agreed to retain the operational definition as presented in the report of the informal consultation.
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4) Elimination criteria and thresholds: The TCC members made reference to the presentation made by Dr. Remme on current evidence and critical issues that provided some thresholds that could be used as a basis for elimination. The following criteria were proposed for site selection [(i) to (iii)] and for deciding that elimination is being achieved [(iv) and (v)]:
(i) Pre-control endemicity, (ii) Therapeutic coverage (over 80%), (iii) Duration of treatment, (iv) Prevalence of mf (<0.5% in 90% of villages and <5% in all villages); and (v) Rate of flies with L3 in the head <0.5% per 1000 flies.
TCC acknowledged that these are provisional indicators that should be further refined by the Programme as necessary.
5) Conceptual framework: The conceptual framework contained in the Report of the
Informal Consultation distinguishes 4 phases of elimination programmes that differ with respect to transmission and needs for interventions and surveillance. Phase 1 – interventions lead to a reduction in transmission but transmission still continues. Phase 2 – transmission is negligible or zero, but interventions must continue. Phase 3 – parasite numbers are very low to the extent that residual transmission is insufficient for the parasite population to survive; possibly remaining parasites have too low a chance of successful reproduction and eventually the parasite population becomes extinct. Phase 4 – after achieving elimination, a routine surveillance system should be established for timely detection of the possible reintroduction of infection from other areas where the infection still occurs.
26. TCC Decision on the conceptual framework: After extensive discussions, the TCC agreed to merge Phase 1 and 2 because the two are on a continuum that eventually leads into the phase where residual transmission is insufficient (the revised conceptual framework is attached as Annex 3.
27. Other recommendations:
Given the need to generate further evidence to support the proof of principle/concept of elimination there is a need to establish a coordination entity to support countries post-APOC. This entity will be responsible for the various preparatory activities including studies (epidemiological, entomological and community-based) that would be necessary to inform the elimination process. This proposal should be brought to the attention of the CSA by APOC management. The shift of paradigm from control to elimination will have programmatic implications for the countries and NGDOs and this should be brought to the attention of the NGDO Coordination Group and Governments.
Session 2: RESULTS OF THE FIRST ROUND OF EPIDEMIOLOGICAL EVALUATIONS OF PROGRESS TOWARD ELIMINATION ENDPOINTS AND IMPLICATIONS FOR APOC STRATEGY
28. The group was presented with two sets of data by Dr J.H. Remme on behalf of APOC. The first set was an update of the results published in 2009 (Diawara et al., 2009) on a long-term study carried out in three onchocerciasis foci of Mali and Sénégal (ex-OCP area), Guinea-Bissau study to be added include the reference for the Guinea Bissau observations which concluded to “the elimination of onchocerciasis “after 14-16 years of ivermectin treatment alone, and absence of recrudescence of the infection in man and vectors after a 2-year period of interruption of treatment and continued surveillance. The detailed protocol was described, with indicators used and their critical values. 29. The second set consisted in the preliminary characterization of the present epidemiological pattern in nine APOC onchocerciasis foci (Boki and Akampa in Cross River, Taraba, Kogi and Kaduna -Nigeria; Bebedja and Danamadji in Chad; Nebbi in Uganda and Mahenge in Tanzania) where the elimination of infection may appear to be a realistic target; these foci were selected on the basis of strict criteria, among which major ones are the existence of pre-control data, implementation
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of at least ten years of regular ivermectin treatment, good coverage and recent results showing that the APOC criteria for “elimination of onchocerciasis infection as a problem of public-health“ have been attained. Through the measurements of parameters of infection in man it appeared that the nine foci can fit into three categories roughly defined according to their progress towards elimination, ranging from situations of probable interruption of transmission to situations of apparent proximity of elimination and situations of prospects for elimination only presumable through trends of infection parameters decline.
30. This study responded exactly to a major recommendation of the informal consultation on elimination of onchocerciasis transmission which was held in Ouagadougou in February 2009. The Group commended the APOC Team for this quick response and remarkable achievement; it welcomed with much satisfaction the information that the data found in a second group of 15 other villages already selected along the same criteria in the APOC area would be soon subjected to the same analysis during 2010. TCC Recommendations:
1) Results of the Sénégal-Mali study, awaiting conclusion of the 3-year surveillance period, should be utilized on a provisional basis as a reference for the classification of selected villages into four categories. The fourth category, which could be subdivided, is comprised of villages which will not have reached the criteria of elimination of onchocerciasis as a Public Health problem, but they will not show indication of progress towards elimination. The first three categories are as referred to in paragraph 24:5
2) Guidelines for monitoring progress towards elimination, still taking advantage of the Mali-Sénégal study, should be defined for each of the categories. It was agreed that in all foci, exercises of elimination of the extent of the identified foci be undertaken, that systems (networks) for monitoring the entomological and epidemiological situations be installed, and that interruption of treatments when passing to the surveillance phase be preceded by an appropriate consultation of the communities and local stakeholders. Other necessary actions should be identified and defined.
3) Such actions would need appropriate tools which may not exist and would have to be developed, or exist but should be adapted and improved: e.g. techniques capable of replacing calibrated skin-snips in mass campaigns, tools for detection of low level of residual or recrudescent infections in man, treatment approaches that could expedite extinction of lowered infections.
4) The Group made a special statement on the urgency for manufacturers and WHO-TDR to remove obstacles to the operational availability of an improved DEC patch-test which have been under study for years.
5) The group stressed also that with the possibility of having very low break point and large densities of vectors in post-control situations, it is necessary to collect information on the identification, biting densities, possible migratory behaviour, etc. of blackflies species in the APOC areas, together with capacities of measuring low level infectivity rates in their populations (improved pool-screening techniques).
6) Considering the remarkable development of computerized and integrated mapping the collection of physical data related to populations and history of treatment should be collected whenever and wherever possible.
7) Finally the Group emphasized that the time allocated to the Programme from now to 2015 is short considering the time requested for complete study of the potential for elimination in a given focus (including the period of surveillance preceding certification) and it urges APOC to elaborate study protocols and research on development-validation of tools.
Session 3: TRANSMISSION ZONES.
31. APOC management has pooled within a common database all REMO data. To date, >13,000 villages have been surveyed and >478,000 persons examined for the presence of nodules. Following the acquisition of new GIS tools a critical review of all REMO data and maps using krigging analysis was carried out during a special workshop which was held in Ouagadougou from 8-12 February 2010. This work will permit a better delineation of CDTI priority areas in the context of elimination onchocerciasis transmission where feasible Mr Zoure and Dr Remme made presentations on this subject. APOC management gave new information for conducting REMO activities. APOC
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management has pooled into a common database...This information will allow the preparation and creation of a common database. A critical review of various results was given on the occasion of a specific workshop which was held in Ouagadougou 8-12 Feb. 2009. To date, 13,000 villages have been surveyed and 478,000 persons examined for the presence of nodules. This work will permit the preparation of a map of projects throughout the continent.
32. The transmission zone can be defined as being “a geographical area where the transmission of O. volvulus is due to local vectors”. That poses two major challenges:
(i) the identification of zones in which one may move from control to elimination (taking account of the changing paradigm of APOC);
(ii) The problem that exists at the trans-boundary level. 33. The difficulty of delimiting a transmission zone was described using examples of Malawi, Burundi, DRC and Nigeria. 34. Following the presentations, discussions recognised the need for entomological studies (identification and mapping of vector species) and the need for a better knowledge of the distribution of the disease (supplementary epidemiological studies).
TCC recommendation to APOC management:
1) To carry out REMO surveys in areas where the prevalence of disease is not well known and extend the surveys to cross-boundary areas, as appropriate;
2) To initiate and or refine studies on the distribution (including movements or migrations) of different Simulium species, notably in Central Africa and East Africa. These data are required in order to delineate the transmission foci. TCC set up a sub-group to develop and follow-up this work; this sub-group will be assisted by external expertise (MDSC, Noguchi Institute, and East African Institutes.
Session 4: DISTRIBUTION OF LOIASIS, REVIEW OF APOC'S PLAN FOR FURTHER RAPLOA SURVEYS AND COMPREHENSIVE ANALYSIS OF LOA LOA DATA Update on RAPLOA Mapping techniques
35. Dr Noma presented the latest RAPLOA surveys undertaken in CDTI zones and, for Sudan and Equatorial Guinea, outside zones under CDTI. These have been conducted to determine the zones that are at risk in programmes for control of lymphatic filariasis. Currently, 3,619 villages have been surveyed in the following countries: Angola, Cameroon, Ethiopia, Equatorial Guinea, Nigeria, Republic of Congo, DRC and Sudan. The data obtained was subjected to geo-statistical analysis (krigging), using ARCGIS 9.3 GIS software. The results obtained by APOC management enabled a map to be produced covering all zones under CDTI and showing the prevalence of loiasis as evaluated using RAPLOA.
36. TCC was pleased that is has been possible to undertake these analyses and congratulated APOC management for these very important results both for APOC and GAELF. It is foreseen that other RAPLOA surveys will be undertaken with APOC being responsible for putting this in place to assist the control of lymphatic filariasis outside the CDTI zones. 37. Professor Peter Diggle, from the University of Lancaster (UK), presented the principles and results of analyses that he has led for several years, with his team, in relation to RAPLOA. The objective of these geo-statistical analyses is to construct a map describing the probability that a given zone presents a prevalence of microfilaraemia of Loa loa greater than 20%. This threshold has been defined as the one above which TCC and MDP recommendations must be applied to limit the impact of post-Mectizan SAEs. These maps must equally serve to identify zones where supplementary RAPLOA surveys must be carried out to identify the level of risk of SAEs in the community.
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38. Professor Diggle demonstrated the ARLAT software, which was developed for analysing these data. Currently, the analyses of Professor Diggle have only been carried out on a portion of the RAPLOA data. APOC management has provided Prof. Diggle with the complete available database of RAPLOA and a re-analysis of the whole data must be carried out rapidly. TCC is happy with the exemplary collaboration between APOC and the University of Lancaster. 39. TCC debated the question of determining the degree to which the endemicity of Loa loa could interfere with the strategy of elimination of onchocerciasis. TCC was convinced that the basic principle of only treating by CDTI in meso- and hyper-endemic areas for onchocerciasis especially where Loa loa is co-endemic must be maintained. No CDTI treatment should be undertaken in areas hypo-endemic for onchocerciasis even if that is likely to accelerate the elimination of onchocerciasis where loiasis is co-endemic. Dr. Ogoussan reminded TCC that MDP still limits the provision of Mectizan to populations of villages that were meso- or hyper-endemic where loiasis is co-endemic with onchocerciasis.
40. TCC also noted that the krigging analyses of REMO data had revealed in zones endemic for loiasis, the existence of zones meso or hyper-endemic for onchocerciasis which are not included in CDTI projects. TCC considers that these pockets of limited size must be treated with Mectizan but that appropriate precautions must be taken in these zones where they are treated for the first time. A certain proportion of the population in those zones may perhaps present high microfilarial loads of Loa loa.
Session 5: OTHER ISSUES OF IMPORTANCE FOR ELIMINATION.
41. Other issues arising from the report of the informal consultation on elimination included:
1) Leadership: TCC noted the need to strengthen countries leadership role in moving
towards elimination, and recommended that WHO advocates for governments to provide sustained support. The critical programmatic issues to be considered included the development of an elimination plan, increased and sustained financial support, ensuring a strong leadership structure.
2) Defining the roles of other partners: TCC recognised the need to bring all key partners
(National coordinators, NTD Heads, DPHC, the NGDOs and Communities) on board early and define roles and responsibilities.
3) Feasibility studies for elimination: TCC called for complementary studies on the
following aspects: i) Epidemiological, ii) Entomological, iii) Community level studies iv) Multi-country studies to assess twice yearly versus annual treatment.
TCC noted the need for APOC to build capacity at the country level.
4) Defining transmission zones: The following scenarios were considered: (i) The need for ivermectin treatment in isolated foci, especially those that pose
a threat to neighbouring hyper or meso-endemic areas where treatment is taking place;
(ii) Areas with Loa loa but hypo-endemic for onchocerciasis are not eligible for ivermectin distribution but treatment can be arranged on a case by case basis.
5) Diagnostic tools: TCC noted that the sensitivity and specificity of available tools remain
a concern. There is a need for continued search for new diagnostic tools.
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6) Co-implementation with LF: The need to provide guidance to countries co-implementing onchocerciasis control with Lymphatic Filariasis and other interventions was noted by TCC. Countries require guidance on how to address delays in supply of commodities joint applications, inventory management, storage and record keeping, the need for modification of MIS forms and effective coordination at country level.
7) Reflection of the NGDO group on elimination: TCC noted concerns related to the
need for increased collaboration among NGDO partners in view of the shift from control to elimination. This is particularly so because of the anticipated increased financial implications.
STRATEGIC AND TECHNICAL ISSUES Country visit by TCC members: Agenda Item 8 42. Drs Johnson Ngorok and Peter Enyong visited Nigeria from 7th to 22nd November 2009. The objectives of the visit were to support NOTF Nigeria in the implementation of CDTI projects, advise on the sustainability of CDTI projects and to advocate for increased government financial contribution to CDTI activities. The TCC team visited Niger, Kogi, Cross River, Akwa Ibom, Benue, Enugu and Imo States. The report of the visit to Niger state was presented to TCC by Dr Ngorok. 43. TCC commended the detailed report and endorsed the following recommendations. On improving CDTI implementation:
(i) Target the training of all FLHF staff in CDTI and where possible integrate the CDTI training into that of other programmes;
(ii) Ensure that Mectizan distribution is completed within two months; (iii) Address the issue of CDD incentives and avoid imposing a uniform standard.
This could include working with traditional leaders to mobilize communities, promoting CDDs as first choice for all programmes at community level and selection of CDDs along kinship lines;
(iv) Consult with leaders of the nomadic associations, such as the Fulani Development Association (FULDAN) on approaches for reaching nomadic communities. A possible strategy to explore is the training of mobile CDDs among the nomadic communities;
(v) Advocate with Mr Talban Borgu, the proprietor of Hydro Hotel, who comes from Borgu LGA, for assistance in procurement of an motor boat for reaching isolated communities along the river banks;
(vi) A follow up letter should be written by the NOCP to the Commissioner of Health on the commitment of N7 million for CDTI.
On improving sustainability:
(i) Implement the sustainability plan objectives that are still outstanding; (ii) Continue advocacy for the release of counterpart funds; (iii) The State Onchocerciasis coordinator should prepare a budget ahead of the State
budgeting cycle and submit it to the director of PHC. The budget should be fully costed and include both recurrent and capital expenditure;
(iv) Strengthen the integrated programme supervision which has started and roll it out to the LGA and FLHF levels;
(v) Integrate CDTI and NTD control.
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On advocacy:
(i) NOCP and the SOC should follow up the pledges of the Commissioner of Health and the Acting Permanent Secretary of the Ministry of LGAs and Chieftaincy Affairs;
(ii) The SOC should follow up with the Chairman of Bosso LGA on the commitment to honour the LGA chairmen’s pledge to contribute N300,000 for CDTI.
Task Force on the review of the technical reports (Nigeria). Summary of 7th, 8th and 9th year technical reports: Agenda Item 9 44. The report of 4th meeting of the Technical Review Committee, Nigeria, was presented by Professor Ekanem Braide. During the meeting, which was held in February 2010, 13 Technical Reports were reviewed and accepted with recommendations for improvement of both the report and programme implementation. Eleven operational research proposals were reviewed and recommendations made to the investigators. The Committee also received reports on the extent of implementation of TRC3 recommendations, advocacy campaigns, monitoring of CDTI activities in A Zone, monitoring of CDTI activities, monitoring of Mectizan Inventory by NOCP HQ and NAFDAC as well as observations on geographical coverage survey. A format for assessing performance of mature projects was produced and will be used for assessment during TRC4. 45. The Committee observed that though there has been commendable improvement in quality of reports and programme implementation, the projects need to pay more attention to endorsement of reports, response to past recommendations, executive summary, community involvement, supervision, monitoring and evaluation, sustainability evaluation, implementation of sustainability plans, and operational research. The NOCP was advised to request the Honourable Minister to appoint 2 more members to TRC, ensure that regular LGA/State/zonal review meetings are held, facilitate provision of well-equipped offices for the Zonal/State coordinators, monitor implementation of sustainability plans, investigate the high rate of refusals in some states (Imo, Niger and Zamfara), monitor update of key information on a line listing of all CDTI communities, and mobilise resources for provision of bicycles for CDDs. TCC was informed that TRC5 meeting will be held in Calabar, Nigeria in July 2010. The APOC Director informed TCC that APOC is providing 800 bicycles for CDDs in Nigeria. 46. TCC accepted the report of TRC. Macrofil and Research: Agenda Item 10 47. Dr A. Kuesel of WHO/TDR provided the TCC members with an update on Macrofil and Research with a focus on:
1) Moxidectin development:
48. The Phase 2 study will be unblinded in summer 2010. The Phase 3 study started in DRC in January 2010 after MoH clearance of study conduct in December 2009. Approvals required to finalize study preparation in Ghana are outstanding. The delay in study start relative to time for CDTI implementation may make it impossible to enrol the 1500 ivermectin naive subjects required. A safety focused study which does not require ivermectin naive subjects has been proposed to the EMEA. The delays in Phase 3 capacity building and study start have increased estimated costs for Phase 3 to US $8.5 million (i.e. US $2.5 million higher than the US $6 million grant from Wyeth). Discussions with Pfizer on legal framework and funding of the community effectiveness studies are ongoing. These studies are planned to be initiated in 2011 but it is not certain that all preparatory work (paediatric study, community study site preparation, Ethics Committee and Ministry Approvals) would be completed in time.
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2) DEC patch: 49. Discussions with the manufacturer of the DEC patch on the legal basis for provision of the patches to APOC are continuing. A batch has been ready for shipment since summer 2009 but there are legal issues to be addressed before it can be used. If DEC patch use is approved by the countries in which the community studies will be conducted (currently planned DRC), the DEC patch could add a lot of value to these studies and provide additional data for 'calibration' of DEC patch vs. skin snips for use in “Onchosim”.
3) Ivermectin Response Markers (IRM): 50. The proposal on research to identify molecular markers of response of O. volvulus and budgets by 4 of the 5 collaborating laboratories were submitted in October 2009 by TDR. External review committee feedback was provided to the investigators in November 2009. Submission of the revised proposal is outstanding. The totals budget for years 1, 2 and 3 are US $827,586, US $689,373 and US $780,242, respectively (including draft budget from the MDSC which did not submit a final budget in October). The high costs of the project are due to the fact that beyond research it includes infrastructure and personnel capacity building in Ghana, Cameroun and MDSC for routine evaluation of samples to be collected from APOC surveillance sites. The MACROFIL funds cannot finance both the additional costs for moxidectin Phase 3 and the IRM project. Other funds need to be identified before the project can be initiated.
4) Identification of new drug candidates for onchocerciasis. 51. TDR is continuing the search for new drug candidates through screening of compounds and evaluation of new veterinary drugs for helminths. A draft Target Product Profile (TPP, minimum requirements which a new drug has to fulfil to respond to onchocerciasis control requirements, added value characteristics) was presented and TCC members were asked to consider it for finalisation at TCC 31. The draft TPP will be sent to the TCC members.
5) TCC observations
(i) TCC is concerned about a potential further delay in initiation of the community studies and thus data for a decision on suitability of moxidectin for onchocerciasis control not becoming available until 2015/2016, i.e. after closure of APOC;
(ii) TCC is concerned that the MACROFIL funds are not sufficient to ensure conduct of the Ivermectin Response Marker Project which is as high priority for all onchocerciasis-control partners as is the development of a macrofilaricide (moxidectin) as well as evaluation of potential new drug candidates;
(iii) The long duration of the negotiations on the availability of the DEC patch (in particular the batch already manufactures) to APOC for the elimination feasibility studies/evaluations has resulted in numerous studies having to be conducted without the DEC patch.
6) TCC recommendations on MACROFIL
(i) A letter from the chair of TCC to the Director of TDR regarding the urgency for
finalisation of the legal agreement on the provision of the already available DEC patch batch;
(ii) APOC to continue their effort to find funds for the Ivermectin Response Marker project and moxidectin development.
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Update on nationwide Onchocerciasis mapping in Ghana 52. Dr Grace Fobi and Dr Afework informed the TCC of the rationale for the mapping, based on the patchy information on the current status of onchocerciasis distribution in the country especially in the forest areas; poor transfer of information between programme managers; uncertainties of status in most previously identified and cleaned areas; National Onchocerciasis Review and Planning meeting in 2008 recommended that REMO be done immediately especially in the forest areas to reveal the real picture in the forest areas for treatment. APOC Management supported MOH to carry out Rapid Epidemiological Mapping of Onchocerciasis in 10 Regions in 2009. 53. TCC congratulated the Ghanaian National Team for the initiative and interest shown and made the following recommendations:
(i) TCC appreciates APOC funding to facilitate such an extensive survey but regrets that microfilariae counts were not performed;
(ii) A representative from Ghana should come to TCC 31 and present outcome of the CDTI implementation;
(iii) TCC recommended that the three problematic foci identified by REMO should be followed up closely;
(iv) TCC recommended that APOC management sets up a small group, with expertise from TCC if necessary, to address the epidemiological situation in Ghana especially including monitoring coverage particularly in the area reported on in the publication of Osei et al. (2007) and advise TCC on that regularly and advise management on the necessity to conduct skin-snip surveys;
(v) There should be a workshop on CDTI at the Regional level. Review of operational research: Agenda Item 11 NEW PROPOSALS: Five proposals were received: four from Nigeria and one from DRC. 54. Proposal 1: Community Ownership of onchocerciasis control in DR Congo, Descriptive and quantitative transversal evaluative study. Comments of the Reviewers:
1) No information (CVs etc) was given on the investigators. 2) The proposers gave good background information but the project was considered to be
too ambitious as it was planned to sample villages throughout DRC in a period of 1 month with a budget of around $36,000. The questions in the questionnaire were not always considered to be suitable for the target. Certain of them were very specific and technical and could be difficult to be responded by people from the villages other than health personnel or others directly involved in CDTI.
3) The input of a Social Scientist is required. Conclusions:
1) In summary, it was not clear what results were expected and the questions for this ambitious project were not considered relevant for the target respondents. The methodology (selection of two households per village) was also not suitable.
55. TCC recommended that the proposal is not accepted. 56. Proposal 2: To identify factors responsible for CDDs attrition in Gombe State, Nigeria. The aim of this research proposal was to determine factors that contribute to attrition and how CDD attrition could be minimised to enhance CDTI sustainability.
57. TCC recommended that the research proposal be accepted but that the team revises it to incorporate the following comments.
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1) Expand on literature review under rational and analyse the knowledge gap that the study will contribute to.
2) Add two additional objectives to the study: • To assess the effectiveness of the strategy of targeting elderly persons as CDDs in
reducing CDD attrition. • To find out where CDDs “moved on”
3) A representative sample of CDDs rather than interviewing all, which will also present logistical difficulties, should be okay. The sampling to concentrate in areas where attrition was high and not necessarily be a systematic sample.
4) Include a Plan of Action with a timeframe. 5) Analyse the number of years that the CDDs who dropped out served as CDDs
58. Proposal 3: Participation of communities in Community Directed Treatment with ivermectin in Osun State. The content, methodology, background information and objectives of this proposal did not meet the required standards of TCC. 59. TCC recommended that the proposal should not be accepted. 60. Proposal 4: Gender perception of female participation in the CDTI programme in Oyo State, Nigeria.
1) The researchers provided CVs and background information and it was noted that all researchers were physicians.
2) This introduction was well articulated although the references were dated and needed to be checked for completeness (the reviewers provided more recent references). Information on CDTI in Oyo state (accessible from the NOTF and/or project team) would have enhanced this section.
61. The rationale for the study was well provided but would have benefited from information on what is currently happening in the communities with regard to the participation of women. Information should have been given on the proportion of women CDDs in Oyo State. 62. The team would benefit from a review of CDTI reports for the last five years to assess the trend of women’s participation in CDTI. Recommendations:
1) This research will contribute to understanding the gender dynamics in community work (respond to the JAF request). However, the team will benefit from the inputs of a social scientist/gender expert and it is suggested that they re-think the title. The data collection could be expanded to include a schedule for CDDs and Health Facility Staff/record review. The questionnaire needs to be refined – remove repetition and put in additional questions in response to the objectives. References should be updated (papers and references are suggested).
63. TCC recommended that the proposal is provisionally approved for funding so long as the team makes the suggested revisions. The reviewers are willing to review the revised proposal online. 64. Proposal 5: An assessment of counterpart funding for CDTI activities in Oyo State, Nigeria.
1) An amendment was requested to the title of the proposal, adding “Nigeria” at the end. 2) The rationale of the proposal was good, and the objectives excellent. Generally the
proposal was well written, although the literature review section should have been put before the objectives and there were some minor queries and comments, for example an explanation of why Oyo State was selected for the study and concerning the cost of Ethical improvement.
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65. TCC provisionally accepted this research proposal subject to revision with the following recommendations:
(i) Need to justify why the study is important and is to be conducted in the OYO State; (ii) Write the literature review before the objectives of study; (iii) Have the same period for the interview and the checklist (3 years); (iv) Add in the checklist the amount that Local government will/could commit; (v) Make sure that a sociologist is strongly involved in this study.
66. The rationale did not capture the indicators of sustainability of the onchocerciasis programme as identified in the literature review such as:
(i) Presence of a realistic policy and strategy for long-term programme; (ii) Viable system to support community distribution; (iii) Willingness of federal, state, and local authority to budget for training and
supervision; (iv) Ability of the public sector to order IVM; (v) Issue of providing financial incentives to distributors.
67. Resubmission of Cote d’Ivoire Operational Research proposals
68. Cote d’Ivoire submitted 5 operational research proposals which had been reviewed by TCC29.
69. TCC noted a number of weaknesses and recommended that amendments should be made to three of the proposals before re-submitting them to the reviewers not later than 1 November 2009. The projects concerned were:
1) Adoption of community-directed treatment with ivermectin (CDTI) strategy in post-conflict Côte d’Ivoire.
2) Evaluation of the impact of stopping invermectin distribution on entomological parameters of onchocerciasis transmission.
3) Terms of references of: Study on the acceptability and perception of the efficiency of cabbage palm oil-based cream (Elaers guineensis) on black fly nuisance: a study in four foci in Côte d’Ivoire.
70. After a second reading, of the proposals, the reviewers made the following general observations:
(i) The proposals were similar and it was recommended that one should be dropped and incorporated with the other two;
(ii) The first observations (TCC29) had not been sufficiently taken into account; there was still too much to be done on the three projects;
(iii) The proposals lack a good background on Onchocerciasis, leading to weaknesses and imprecise statements;
(iv) The objectives of the studies were still not very clear; (v) The methodologies of the studies sometimes lacked explanations; (vi) The review of the proposals revealed a lack of coordination between the different
teams in Cote d’Ivoire, resulting in the duplication of some activities and costs. 71. The conclusion was that none of the projects could be financed in this form. 72. TCC members offered their services to help improve the Cote d’Ivoire research proposals. Co-Implementation: Achievements and challenges in CDTI projects in Nigeria: Agenda Item 12
73. The achievements and challenges of co-implementation in Nigeria were presented to TCC members. In his presentation Mr C. Okoronkwo highlighted the co-implementation of several interventions (LF, Schisto, VAS, HMM, etc.) using the CDTI structures, and the involvement of CDTI personnel in other health programs. The co-implementation started in December 2009 with
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APOC support. The impact of co-implementation was assessed by comparing the achievements of 2007, 2008 and 2009. The results showed:
(i) An increase of LF coverage between 2007 and 2009, (ii) An increase of SCH coverage, (iii) A decrease of VAS.
74. In 2010, the co-implementation included additional interventions such as ITN usage, HMM, LLIN delivery. Several challenges were highlighted, including unavailability of commodities (drugs), increased workload for staff, changing intervention strategies, renewed demand of incentives by CDDs, integrated reported process and forms, inadequate funding. Following the presentation, the following observations were made:
(i) TCC members noted that the difference between co-implementation, integration, usage of CDI in other programs, and involvement of CDTI staff in other interventions was not clearly established;
(ii) TCC members encouraged NOTF to address the issues of unavailability of some commodities in delaying the interventions, and the renewed demand for incentives. It was clearly pointed out that the distribution of ivermectin for the control / elimination of onchocerciasis should not be threatened by the unavailability of other drugs or commodities.
TCC commended the work done. Multi-country study on Social Benefits in CDTI: Agenda Item 13 75. Dr Mary Amuyunzu-Nyamongo presented the results of a research study on the assessment of the Social Benefits of CDTI in four countries; Cameroon, DRC, Nigeria and Uganda. The research team, led by Dr Amuyunzu-Nyamongo was comprised of Ms Yolande Flore Longang Tchounkeu (Cameroon), Mr Cele Manianga (DRC), Prof Joseph Okeibunor (Nigeria) and Mr Asaph Turinde Kabali (Uganda). The study underlined the need to assess social benefits that are important in documenting impacts that are often neglected yet important in keeping people motivated to continue implementing CDTI. The study was in response to JAF’s recommendation: “to conduct periodic beneficiary assessments in a sample of projects, which would provide timely information on results”. The study was conducted in consultation with APOC management. The study sites in Cameroon (Western Province, Bangangte Health District), DRC (Kasai CDTI), Nigeria (Imo State), Uganda (Hoima). The selection criterion was based on the length of implementation (over 7 years of implementation); regional representation and the availability of social scientists knowledgeable on onchocerciasis in the participating countries. 76. The study has been completed and the report will be submitted to APOC in due course. 77. TCC comments and recommendations
(i) TCC congratulated Dr Nyamongo for undertaking the study in a very short time and the involvement of children in the study which allowed them to capture the views of all community members;
(ii) TCC recommended continuing the refinement of the analysis and looking for factors that will influence when and how to stop treatment in a framework of elimination;
(iii) TCC also recommended developing proper documentation of the children’s testimonies and drawings for further analysis;
(iv) TCC expressed its eagerness for the final result and the design of Social Benefits Analysis tool.
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Study of blackfly movements: Results and recommendations: Agenda Item 14 78. Several studies enabled the description of migration movements of the blackflies in West Africa. The analysis of the results led to the conclusion that the capacity of the vector to move over long distances, is one of the major obstacles to the elimination of the onchocerciasis in West Africa, be it with vector control or ivermectin, because the movements of blackflies cause dissemination of the parasite. 79. The impact of blackfly movements on the epidemiology of onchocerciasis in the basins under influence has always been a concern for monitoring and control programmes. Indeed, in an area of large-scale blackflies movements, the lack of control over onchocerciasis transmission could lead to a gradual deterioration of the epidemiological situation. 80. An update was presented at the TCC by the MDSC on a study, undertaken by the MDSC and APOC, of seasonal displacements of the females of S. damnosum s.l. in the border area of Benin and Nigeria. This study started in August 2007 with Benin and October 2007 in Nigeria. Results:
(i) The forest flies were the predominant species in Nigeria with few savanna flies; (ii) Few forest flies were infected in some sites in Nigeria; (iii) Most of the flies in Benin were savanna with few forest flies; (iv) Only savanna flies were infected in some sites in Benin; (v) Blackfly population dynamics showed contamination of the Oueme basin by forest
flies from the Ogun and its tributaries in Nigeria; (vi) Hetero-duplex analysis characterized the savanna flies as S. damnosum ss. and the
forest flies as S. soubrense Beffa; (vii) Transmission, measured by pools screening method, showed that in Nigeria the
risk could exist while it is extremely low in Benin. Recommendations:
(i) There is an existing gap in the results since the study was not carried out all year round, TCC recommends that the study should be extended for one year for valid conclusions to be drawn;
(ii) The CDTI activities in Benin are on-going while the situation in Nigeria needs to be documented. TCC recommends conducting an epidemiological evaluation which will have to cover an area larger than that already evaluated.
MANAGEMENT OF THE APOC TRUST FUND Report on the financial management of APOC funded Projects: Agenda Item 15 81. The APOC Finance Unit provided TCC with an update of the budget approved by JAF15. The total approved budget for 2010 is US $29.83 million for the implementation of 117 projects and activities in four ex-OCP countries.
(i) Forecast budget for 117 projects plus 4 ex-OCP countries for 2010 – US $12.59 million;
(ii) As of 5 March 2010, US $5.04 million of the forecast budget of US $12.59 million had been released to projects, which represents 42% of the approved budget.
82. TCC members were also informed that an international workshop on the delivery of essential health services in Africa funded by APOC would take place 7-10 April in Brazzaville, in collaboration with the Office of the WHO Regional Director for Africa. The workshop, a follow up to the one held in October 2009, would be followed by field activities.
83. APOC is processing the release of US $700,000 for drug research by WHO/TDR.
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84. Delays in the release of funds were attributed to the reasons listed below:
(i) Late submission of Annual PAB’s and review of PAB’s for the preparation of the Direct Financial Cooperation (DFC) documents;
(ii) Late return of countersigned DFC’s from countries; (iii) Late Financial returns (sometimes non-submission); (iv) Non-submission of Funding Authorization and Certification of Expenditure
(FACE) and Technical Report of Outcomes Summary report linked to DFC).
85. There was also an issue of the poor quality of some PAB’s submitted (lack of consistency). Report on the Financial Review by APOC management of 1st, 2nd, 3rd, 4th, 5th, 6th, 7th, 8th, 9th, 10th, 11th and 12th year Progress Reports and subsequent year budgets: Agenda Item 16. 86. TCC members were informed that as of 05 March 2010 105 PABs had been received from the expected total of 117. Ninety of the PABs had been treated and DFCs prepared for them. Fifteen PABS were under review and finalization, while 12 PABs had either not been received or were for projects not launched. PABs for DFCs not received were 9 with three PABs for project not launched. 87. A total of 2,172 monthly returns were expected as at 31/12/2009. Of that number, 1,303 were received as of 05 March 2010, leaving an outstanding number of 869 or 40%. Sixty-three Projects have red cards, amounting to 766 outstanding returns. For the year ending 2009, the number of monthly financial returns to be analysed was 1,872, out of which 1,680 or 90% were completed as of March 5th 2010 (10% outstanding for completion). 88. The major issues were:
(i) Submission of financial returns by the Projects not done on a regular basis; (ii) Lack of submission of summary DFC reporting format (GSM requirement); (iii) Retrieval of financial returns and Re-training of project teams on financial
management underway in several countries; (iv) Many discrepancies in “Table No.13” of the Technical report submitted by
Projects (regarding Trust Fund disclosure); (v) Out of 50 reports reviewed 36 (72%) projects reported incorrect Trust Fund
amount approved and released by APOC Management; (vi) 17 (34%) wrongly reported the implementation year of project; (vii) Only 5 (10%) projects correctly reported the data.
89. Following the discussion it was agreed that the PAB format be simplified. 90. The recurrent problem of delay in the submission of financial returns was discussed extensively and it was agreed that a combination of measures was necessary:
(i) Sanctions that will not adversely affect the poor communities being served; (ii) APOC missions to countries to assist project accountants; (iii) Strengthening of APOC finance unit with the recruitment of more finance officers; (iv) An analysis of projects to determine if the age of the project and gradual
withdrawal of funding were affecting the submission of financial returns; (v) Greater involvement of NGDOs to ensure effective management of APOC trust
fund in countries.
91. TCC appreciated the presentation and noted the difficulties in keeping track of financial expenditures and recognised the need to strengthen the Finance unit at APOC management and at country level where needed. 92. TCC reminds all national coordinators of the need to submit reports, especially financial reports, in a timely manner.
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Review of new Project Proposals and 1st, 2nd, 3rd, 4th, 5th, 6th, 7th, 8th, 9th, 10th, 11th and 12th year Annual Technical reports on the implementation of CDTI and Vector elimination Projects. Recommendations on the 2nd, 3rd, 4th, 5th, 6th, 7th, 8th, 9th, 10th and 11th year implementation of projects: Agenda Item 17 93. A total of 8 research proposals were received by APOC management and the number and budget per country are as follows:
DRC (1) US $36,700
Nigeria (4) US $38,698
Côte d’Ivoire (3) US $66,380
Total US $141,778
ANGOLA Moxico I CDTI project (Angola) 3rd year Annual Technical Report 94. This is a project in a post-conflict country with frequent movements of the populations and is in a poor situation with regard to human resources. Taking account of the results obtained the project is encouraged to continue making progress; nevertheless for a project in its 3rd year of distribution with much experience improvements can be made. The report contains sufficient details to evaluate the project. 95. TCC accepted the report with the following recommendations and suggestions for improving reporting and project implementation.
Report related: (i) Submit the report to the partner NGDO for signature; (ii) Complete all sections of the report thoroughly; (iii) Address the previous TCC recommendations in the section designed for this
purpose; (iv) Given that there is a problem of language, request APOC to assure that the project
receives a translation of the recommendations and questions indicating precisely what must be addressed in the section reserved for that purpose;
(v) Fill table 13 (financial contributions), providing information on partners including the NGDO partner;
(vi) Complete table 15 (on co-implementation). Project related:
(i) Include all partners in the editing, including the NGDO; (ii) Establish calendars for work, taking account of activities of the population and
carry out drug distribution in the dry season; (iii) Intensify advocacy to the political and administrative authorities for release of
funds and for their effective participation, and intensify the mobilisation, sensitisation of the population including the use of the media such as radio and others;
(iv) Continue to improve the geographic coverage, which must reach 100% in 2010 and the therapeutic coverage which must reach at least 80%;
(v) Improve the participation of women CDDs and intensify sensitization (vi) Bring the CDDs registers and population census data up to date; (vii) Plan internal monitoring by the NOTF and a mid-term evaluation of sustainability
to be organised by APOC, for 2010.
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BURUNDI Bururi CDTI Project (Burundi) 4th year Annual Technical Report
96. TCC congratulates the project for:
(i) the efforts made in mobilisation and use of various media; (ii) the organisation of a provincial workshop for social mobilisation at the beginning
of the campaign; (iii) the good ratio of CDDs to the population; (iv) the excellent ratio of female to male CDDs; (v) having put in place a ‘mop-up’ system in the Rumonge community where the
population is less willing to participate in CDTI; (vi) having put in place a good system of community supervision, with the
participation of supervisors in training sessions.
97. TCC regrets that: (i) There were interferences in the working calendar that prevented community self-
monitoring from taking place; (ii) The financial support from the Ministry of Public Health was still low and that the
problem of contracting of CDTI has not yet been resolved; (iii) The question of the amount of funds to be given to social science consultants for
the KAP study has become the subject of negotiations. 98. TCC accepted the report with the following recommendations and suggestions for improving reporting and project implementation.
Report related: (i) It would be preferable to put the section which is currently in the “ introduction“
section into the summary; (ii) All the elements included in the section on partnership should be placed in the
specific sections corresponding to each activity of CDTI. There is a lot of duplication at present;
(iii) In the table concerning Mectizan, make a distinction between the columns “remaining from the previous distribution” “received”, “available”… “remaining from the distribution of the year covered by this report.”
Project related:
(i) The project should consider door-to-door distribution to increase coverage.
Cibitoke and Bubanza CDTI Project (Burundi) 5th year Annual Technical Report 99. TCC congratulated the project for:
(i) Efforts made in mobilisation and using various media, (ii) The good ratio of CDDs to the population, (iii) The excellent ratio of female to male CDDs, (iv) For having put in place a good system of community supervision.
100. TCC regrets that there was a conflict in the calendar of activities between the process of filming and the distribution of Mectizan. 101. TCC regrets that the problem of contracting of CDTI has not been resolved. 102. TCC accepted the report with the following recommendations and suggestions for improving reporting and project implementation.
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Report related: (i) The executive summary should be in narrative form; (ii) All sections included in the section on “Partners” should be placed in the specific
sections corresponding to each CDTI activity. Currently there is a lot of duplication;
(iii) In the table concerning Mectizan make a distinction between the columns “remaining from the previous distribution” “received”, “available”… “remaining from the distribution of the year covered by this report.”
Rutana CDTI Project (Burundi) 4th year Annual Technical Report 103. The Rutana CDTI project is situated in the south-east of Burundi, at the border with Tanzania, in a post-conflict country and is in its 4th year of implementation. The project achieved a 100% geographic coverage, a therapeutic coverage of 72.2% and a ratio of 1 CDD to 106 people treated. TCC congratulates them on their performance and encourages them to reach 80% therapeutic coverage. 104. TCC accepted the report with the following recommendations and suggestions for improving reporting and project implementation.
Report related: (i) The editor should carefully read the instructions and recent template for annual
Technical reports (sent by APOC management) and should follow those instructions;
(ii) Provide more details on the 11 communities (“collines”) for which the therapeutic coverage is less than 65%.
Project related:
(i) Reinforce mobilisation/sensitisation of the population so as to reduce the number of refusals and absentees and look for innovative ideas, if necessary, to avoid the same problems coming up each year;
(ii) Estimate the number of CDDs required based on the UTG; (iii) Improve the overall therapeutic coverage to 80% or more, by putting emphasis on
the 11 ‘collines’ of which the therapeutic coverage is < 65%; (iv) Verify the Mectizan inventory in view of the high number of Mectizan tablets
remaining (177,290 or 129,820) and ensure that remaining tablets are used according to the rule of “first in first out” in the following MDA;
(v) Carry out training for CSM. Recommendation to APOC:
(i) Forward a recent copy of the reporting format with instructions to the project. CAMEROON Adamaoua I CDTI Project (Cameroon) 5th year Annual Technical Report
105. TCC accepts this report which is well written. The annexes are well documented. Geographic coverage is 100%; therapeutic coverage was 73.5%. The ratio of population treated to CDDs was too high (1 CDD: 570 persons). The number of refusals was particularly high in the zone of Tibati. The financial contribution of the State and the use of CDTI in other programmes are particularly appreciated by TCC. The project should mention the Mectizan Donation Programme (MDP) in the list of partners. 106. TCC accepted the report with the following recommendations for improving reporting and project implementation.
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Project related: (i) Give explanations for the high number of refusals in the District of Tibati; (ii) Re-do table 9, giving a precise figure for the number of Mectizan tablets ordered.
Is the last column of this table which gives information on motivation of CDDs appropriate? The same applies for the column on secondary effects;
(iii) Give details of plans to improve the ratio of persons treated per CDD; (iv) Give more information on the implementation of the sustainability plan.
East Province CDTI Project (Cameroon) 5th year Annual Technical Report 107. The report is well produced. The project covers 4 health districts, 275 communities and has a population of 108,659 persons in a zone which is co-endemic for Onchocerciasis and loiasis. Geographic coverage is 100%; therapeutic coverage was 80.4% in 2009 (compared to 73% in 2008). Nonetheless it is necessary to draw attention to the worsening ratio of CDDs (1 CDD for 148 persons treated compared with 1: 129 in 2008). Appropriate responses were given to the last recommendations of TCC. TCC appreciated the progress recorded and congratulates all the partners who contributed to this project. 108. TCC accepted the report with the following recommendations and suggestions for improving reporting and project implementation.
Project related: (i) Verify the rate of geographic coverage in 2005 (69%); (ii) Give information on the existence of a written sustainability plan; (iii) Begin to look for ways for implementing recommendations arising from various
evaluations; (iv) Pursue efforts to initiate operational research; (v) Make efforts to reduce the number of Mectizan tablets lost and remaining; (vi) Give accurate information on what is done with remaining tablets; (vii) Implement the results of Independent Participatory Monitoring.
Far North Province CDTI Project (Cameroon) 5th year Annual Technical Report 109. This project, in its 5th year, is situated in the extreme north of Cameroon on the border with Nigeria, and has a geographic coverage of 100% and a therapeutic coverage of 80.75%. The report was well prepared and shows the development of CDTI activities well, including the elements allowing this evaluation. 110. TCC accepted the report with the following recommendations and suggestions for improving reporting and project implementation.
Report related: (i) Re-do table 2 and use 84% for calculating the UTG; (ii) Verify and validate the inventory of Mectizan tablets; (iii) Systematically provide the number of people having benefitted from the activities
of programmes co-implemented with Onchocerciasis control.
Project related: (i) Continue to improve the participation of female CDDs; (ii) Continue to improve participation of communities in CSM; (iii) Put particular emphasis on the Health District of Mokolo in order to increase the
therapeutic coverage to more than 80%.
Recommendation to APOC: (i) Follow-up the order of 1 computer and 1 printer that are awaited.
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Littoral I CDTI Project (Cameroon) 5th year Annual Technical Report 111. TCC accepts the report of this project which is in its 5th year. The responses to queries and comments of TCC 28 were incomplete, notably those relating to financial contributions from APOC and the MoH. The average therapeutic coverage (63%) is too low for a project in its 5th year. Achieving a rapid increase in this therapeutic coverage must be a challenge for the partners of this project. It is equally necessary to check the consistency of some of the figures and provide information under all headings in the reporting format. 112. TCC accepted the report with the following recommendations and suggestions for improving reporting and project implementation.
Report related: (i) Provide the level of the state’s financial contribution in 2008 and if possible of
earlier years (already asked for in 2008). Table 13; (ii) Provide the financial contribution of APOC in 2008 (already asked for in 2008)
Table 13; (iii) Indicate the exact number of Mectizan tablets ordered (Table 10); (iv) Give precise information on the number of deaths following SAEs: 2 deaths (page
18 – paragraph 2.6.1) or 1 death (Table 8); (v) Explain why the numbers of people trained in 2009 are lower to those of 2008; (vi) Explain why the ratio of CDDs per number of people treated increased (1 CDD for
201 persons) rather than decreasing towards the ideal ratio.
Project related: (i) Contact agro-industrial enterprises in the region for funds as requested in the
report of TCC28; (ii) Follow-up efforts made to increase the rate of therapeutic coverage which has
virtually stagnated since the project’s 3rd year; (iii) Implement the recommendations arising from the evaluation of sustainability.
South CDTI Project (Cameroon) 5th year Annual Technical Report 113. The report is well written and presented according to the format approved by TCC (with the exception of the summary). The figures are generally well presented and explained. The percentage of health workers involved in CDTI (table 1): should be 80% instead of 89%. The CDTI project has performed well, shown by a therapeutic coverage which has increased from 60% in 2005 to 72% in 2008 and 74% in 2009. There has been strong financial support from the State, APOC and NGDO and other partners. There has been good adherence of the populations thanks to training and involvement of village chiefs. Increasing the number of CDDs and strengthening the capacities of personnel has contributed to improving the performance of the project.
114. TCC accepted the report with the following recommendations and suggestions for improving reporting and project implementation.
Report related: (i) Present a better analytical summary for the next report (without sections
paragraphs or tables); (ii) Correct the percentage of health workers involved in CDTI (table 1); (iii) Give explanations on the management of the case of SAE; (iv) No explanation was given on the management of the single case of SAE reported.
Recommendation to APOC:
(i) APOC management must help MSP to find a solution for transport equipment (vehicles/motorbikes etc).
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NOTF/HQ (Cameroon) 11th year Annual Technical Report 115. This was a good report. TCC congratulates the NOTF for its efforts, having achieved significant progress towards resolving the problem of delays of payments of incentives for CDDs. TCC encourages the NOTF to suggest that Littoral I project spreads its activities a little more over time. TCC asks the NOTF to encourage Adamaoua and Centre 1, 2 and 3 projects to improve the ratio of CDDs to population. TCC noted with regret that certain elements of the table on training (columns concerning the CDDs) had been copied and pasted from the preceding report. TCC regrets that the table summarising information on SAEs had some gaps (incomplete information concerning clinical symptoms and microfilarial load of Loa loa. 116. TCC accepted the report with the following recommendations and suggestions for improving reporting and project implementation.
In the next report: (i) Use the proper format for reports of NOTF; (ii) Give more information on the results of reflections of the group responsible for
vector control and on methods permitting control with “less costly methods” against blackflies;
(iii) Give information concerning the amounts allocated for incentives of CDDs; (iv) Explain to which extent the project conducted by REFOTDE in the Littoral
project, in 2007, may have had an influence on CDTI in 2009; (v) Distinguish between the CDDs and the community supervisors in the tables,
notably for the projects Nord and Ouest; (vi) Include information coming from the CSM exercises; (vii) Give financial information in US dollars; give details concerning costs of
managing SAEs and for equipment. CONGO Congo CDTI Extension Project (Congo) 6th year Annual Technical Report 117. TCC accepted the report with the following recommendations and suggestions for improving reporting and project implementation.
(i) This is a good report but with too much copying and pasting from the previous report;
(ii) TCC does not understand why the project is not capable of producing a map of the area, which is certainly available at its level;
(iii) In contrast to what was understood in the response to the recommendations of the last TCC meeting, the map of LF should have also been attached. It is not APOC management, which has received it, who should include it in the report of this project;
(iv) Information must be given explaining why the totals of tables 13 (funds allocated) and 14 (funds used) are not the same.
DEMOCRATIC REPUBLIC OF CONGO (DRC) Butembo-Beni CDTI Project (DRC) 3rd year Annual Technical Report 118. The Butembo-Beni focus reached its third year in 2009. Out of 7 districts eligible for CDTI, one is preserved for moxidectin trials, one could not be treated because of attacks by uncontrolled armed troops, another one experienced the same event last year, and finally only 4 districts were treated twice and one only once. 119. The report is complete, well written and informative. Recommendations by the previous TCC have been carefully taken into account, although implementation has been slow.
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120. In 2009 the project lost the financial support of LCIF (Lion’s Club) which was the only NGDO and a main contributor. The MoH has no budgetary line for onchocerciasis control and its contribution is low and far below the stated amounts. However, the planned activities were completed, although financial needs were only covered up to 65% (by APOC essentially); the estimated cost per treatment was $0.116. 121. Less than 10% of health staff members participate in CDTI; no community members acted as CDTI supervisors, there is only one CD for 420 inhabitants and only 6.8% of CDDs are women. 122. However, a significant effort in training was made in 2009: 35/42 health districts staff members were trained, as were 131/157 health staff members in health centres and posts and 1,750/2,360 CDDs. In spite of this effort human resources for CDTI are still very insufficient. 123. Out of the 1.429 million people eligible, 1 million were treated in 1,060 of the 1,473 communities; geographical coverage was 100%, but therapeutic coverage only 52%, which is low, but nonetheless shows progress compared to a geographic coverage of 20.4% in the first year and a therapeutic coverage of only 9.4%; refusals and abstentions represented 10.8%, apparently related to a fear of new drugs and rumours of side-effects. 124. There are weaknesses at the level of communities because of the absence of incentives for CDDs; the communication of health zones staff towards CDDs is often poor as well as the management of Mectizan at HZ level and reluctance of staff at this level to participate in monitoring and supervision of CDTI. 125. Despites these drawbacks, given the variety of significant adverse conditions, the recent inception of the project which is still in a learning phase, and the efforts made in work implementation and reporting, as well as low but significant progress, it was decided to accept the report, considering that in the absence of other significant financial contribution, halting APOC support would mean stopping implementation efforts which should give results in the long-term. 126. The coordinator should intensify efforts in training, accompanying and monitoring CDDs, and sensitizing the communities (taking advantages of regression of pruritis and de-parasitism induced by Mectizan), together with reinforcement of staff motivation in health centres and zones. 127. APOC should investigate whether there is some hope for LCIF to resume some contribution to the project in forthcoming years, and if this is not the case, APOC management should urge the health authorities to search for new sponsors of CDTI. 128. TCC accepted the report. Ituri CDTI Project (DRC) 3rd year Annual Technical Report 129. The report has been written simply and is easy to read. TCC congratulates the project for its good performance. The population is willingly adhering to the CDTI programme. Geographic coverage is 100%; therapeutic coverage was 80.4%. However, there are several gaps in the document, especially in completing tables 2, 3, 5 and 13. 130. TCC accepted the report with the following recommendations.
Report related: (i) Take note in the next report of the gaps indicated in this report, (ii) Complete as much as possible of tables 2, 3, 5 and 13, (iii) Provide information on the number of meso and hyper-endemic communities, (iv) Provide reasons for the delay in the arrival of APOC funds.
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Project related:
(i) Follow-up advocacy in order to increase the number of health workers involved in CDTI;
(ii) Train more CDDs so as to reduce their workload; (iii) Reinforce mobilisation and sensitisation of the population so as to reduce the
number of refusals and absentees; (iv) Plan and carry out CSM and SHM ; (v) Plan an external sustainability evaluation for 2010 with the purpose of using its
report to develop a sustainability plan for the project. Kasongo CDTI Project (DRC) 4th year Annual Technical Report 131. TCC accepted the report with the following recommendations and suggestions for improving reporting and project implementation.
Report related: (i) All partners must sign and endorse the report; (ii) Make a more concise summary, avoiding long paragraphs and repetition of the
concepts and reasoning; (iii) Explain why only 1384 CDDs were trained and retrained whilst the writer of the
report also alluded to a figure of 5014; (iv) Explain the reasons for the delay in release of APOC funds and delivery of
Mectizan rather than simply stating that the necessary procedures had been followed.
Project related:
(i) Find ways and means of avoiding delays in accessing budgeted funds; (ii) Aim at and reach 100% geographic coverage and at least 80% therapeutic
coverage in 2010; (iii) Put in place the ratio of 1 CDD per 100 persons so as to be able to reduce the
workload of CDDs; (iv) Continue to advocate for CDTI funds budgeted from the PMA of SSP; (v) Advocate alongside APOC partners for appropriate logistic support, given that the
project is in its 4th year
Recommendation to APOC: (i) To consider the replacement, if possible of the project vehicle.
Lubutu CDTI Project (DRC) 3rd year Annual Technical Report 132. The report is better edited than in 2008. The analytical summary is more concise and more understandable and there are few inconsistencies. The performance of the project was improved by the inclusion of new zones and an improvement of the CDD to population ratio. TCC accepted the report with the following recommendations for improving reporting and project implementation.
Report related: (i) Improve table 14 on the trends in rates of coverage; (ii) Provide more information on the importance of CDD attrition; (iii) Explain the curious absence of SAEs even though 19 cases had been recorded in
2008.
Project related: (i) Improve the low involvement of women in CDTI activities, (ii) Start training for CSM.
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Masisi-Walikale CDTI Project (DRC) 1st year Annual Technical Report (re-submission) 133. The report is well written compared to the first submission. The summary has been improved taking account of the observations of TCC29. The project conducted activities on sensitisation, training of CDDs and supervision but no distribution of ivermectin took place. 134. TCC recommends that the report is accepted in view of the efforts compared to the first submission, whilst making the following recommendation:
(i) Project staff should distribute ivermectin to communities as soon as possible. Masisi-Walikale CDTI Project (DRC) 2nd year Annual Technical Report (re-submission) 135. The executive summary is acceptable and there have been improvements in the presentation of the report by providing some figures (the population size, the number of ivermectin tablets, number of workers trained, the number of communities covered). No activity was carried out in the field for security reasons. 136. TCC accepted the report in view of the efforts compared to the first submission with the following recommendation for improving project implementation:
(i) Project staff should conduct treatment activities in the field as quickly as possible.
Masisi-Walikale CDTI Project (DRC) 3rd year Annual Technical Report
137. The CDTI project did not give satisfactory responses to the recommendations of TCC29. There are a number of gaps in the report. Much information is not provided; notably several tables are incomplete or contain errors. Activities started late in the year being reported. Efforts must be made to improve this in future. In reading the reports of years 1, 2 and 3, it was noted that there are contradictions in the data and the information given. 138. The TCC considered the report and returned it for re-submission to APOC based on the following suggestions and recommendations.
(i) Five out of ten cases of SAEs have not been followed-up or managed. It is therefore recommended that the project should rigorously follow-up all reported cases of SAEs;
(ii) The management of orders and of stocks of medicine must be improved upon. In the next report the project should provide detailed information on the drug inventory.
Katanga-Nord CDTI Project (DRC) 4th year Annual Technical Report
(i) The report is of only average quality for a project of five years; (ii) The project showed a good performance, there were good rates of therapeutic and
geographic coverage. There was increased involvement of women in CDTI; and a good ratio of CDDs to the population.
139. TCC accepted the report with the following recommendations and suggestions for improving reporting and project implementation.
Report related: (i) Re-do table 2 giving the correct figures for the UTG; (ii) Re-do table 14 giving the figures for the condition of equipment; (iii) Provide more precise information on CSM, evaluation and monitoring.
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Project related: (i) Improve the financial contribution of the Government to CDTI; (ii) Improve the rate of release of allocated budgets; (iii) Conduct CSM; (iv) Explain the high rate of absenteeism; (v) Initiate operational research projects, particularly on absenteeism.
Rutshuru-Ngoma CDTI Project (DRC) 4th year Annual Technical Report. 140. The report is too concise and it would have been better for the project to have given more information on certain points. For example, no information was provided on the participation of communities in the health district of Rutshuru and no explanation was given for this lack of data (Table 4). On the whole, the geographic and therapeutic coverage are not satisfactory, 75% for geographic coverage and 57% for therapeutic coverage. In particular, the coverages at Rutshuru were very low: 38% for geographic coverage and 29% for therapeutic coverage. No explanation was given. No treatment was carried in 2008 for reasons of finance: the funds were blocked by WHO. The project must take all measures to avoid this sort of situation in the future. The project is in its fourth year, and no monitoring has been carried out. 141. TCC accepted the report with the following recommendations
(i) Provide an explanation for the very low coverage at Rutshuru, (ii) Conduct monitoring/evaluation, (iii) Make efforts to improve geographic and therapeutic coverage.
Tshopo CDTI Project (DRC) 6th year Annual Technical Report 142. In this report satisfactory replies have been given to the recommendations of TCC 28. The document is well edited and the information is generally precise and detailed. The project is situated in an area co-endemic for onchocerciasis and loiasis with high risks of occurrence of SAEs. This explains the exclusion from treatment of 4 of the 19 health zones sited in the project area. The project started in 2003 but underwent an interruption for two consecutive years (2004 and 2005) following a high mortality of people showing SAEs. Although a progressive increase in geographic coverage (from 28% in 2003 to 69% in 2009) and in therapeutic coverage (from 13% in 2003 to 56% in 2009), these rates remain low. The participation of women in CDTI activities has improved and this effort must be followed-up. The reduction in the number of cases of SAEs from 44 in 2007 to 5 in 2008 and 1 in 2009 is encouraging; as well as that of cases of deaths (from 3 in 2007 in 2007 to 1 in 2008 and 0 in 2009). 143. The TCC considered the report and requesting that it should be re-submitted to APOC after taking account of the following observations and recommendations.
(i) Complete Table 1; (ii) Provide precise explanations on the use of stocks of remaining tablets; (iii) Check and correct data for the previous treatment coverage reported in Table 9,
particularly for the years 2006 and 2008; (iv) Complete the data provided by adding the missing results for each of the 6 health
areas; (v) Pursue efforts to improve geographic and therapeutic coverage which remain
unsatisfactory on the whole; (vi) Follow-up efforts to increase the participation of women in CDTI activities.
Sankuru CDTI Project (DRC) 6th year Annual Technical Report 144. The recommendations of TCC were taken into account. The report is complete and the text well written and easy to read. The report however, does not always follow the recommended standard format and sometimes contains unnecessary information (tables and figures giving the same
29
information). TCC particularly appreciated the efforts made to provide a report for the 30th session of TCC. TCC congratulates the project for the good ratio of CDDs to the population and for the good coverages obtained. 145. TCC accepted the report with the following recommendations.
Report related:
(i) Take note in the next report of the gaps indicated in this report; (ii) Use an up to date copy of the reporting format; (iii) Summarise the problems raised from supervision as well as the strengths and
weaknesses of the project.
Project Related: (i) Take actions to avoid a large number of expired Mectizan tablets; (ii) Plan and carry out CMS and SHM; (iii) Identify topics for operational research.
COTE D'IVOIRE Côte d’Ivoire CDTI Project 2nd year Annual Technical Report 146. The Côte d’Ivoire project is a former OCP project which was more or less interrupted from 2002-2007 because of civil unrest. Re-launching onchocerciasis control through CDTI alone appeared to be necessary to maintain or restore the good protection obtained through vector and parasite control up until OCP’s closure and to protect neighbouring oncho-freed countries from reinvasion and re-infection. 147. 2009 was the second year of re-launching, with new staff who are less familiar with CDTI and APOC procedures. 148. The report is a quite complete and very informative one, showing clear understanding and analysis of strengths and weaknesses and illustrating a remarkable effort over a short period of time by the coordinator and team of the National Programme for Onchocerciasis and Blindness Control (PNLOCé). 149. Unfortunately the Project reports on results from about only one half of the districts and populations targeted for CDTI, as clearly stated by the national coordinator. This is because of an over-ambitious coverage plan, inspired by previous TTC recommendations (moving from 24 districts to be treated in 2008 to 50 in 2009) which could not be implemented in time despite intensification of training and which resulted in spreading CDTI activities throughout the year; supervision in several districts being performed at the end of 2009 - too late for their results to be incorporated in the report. 150. Although coverages are still low (GC 37%, TC 73%), as are the numbers of CDDs and their proportions relative to the communities, this cannot be extrapolated to the whole country. There has been progress, especially in training of health staff members and CDDs, as well in advocacy, sensitization and monitoring. However, the available human resources are still far below the minimum required. 151. TCC accepted the report despite it being incomplete in order not to delay the restoration of an urgently needed control system in the country, but insisted that a complete report, be submitted to TCC as soon as possible. 152. TCC accepted the report with the following recommendations.
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Project related: (i) Reorganize the annual plan for Mectizan delivery in order to treat people before
the maximum peak of transmission and in time to allow collection of data in all treated districts in due time;
(ii) Follow the endorsed plan of action and incorporate all measures identified to compensate for insufficiencies identified in 2009;
(iii) Intensify training and improve commitment of all CDTI actors at all levels. ETHIOPIA East Wollega CDTI Project (Ethiopia) 5th year Annual Technical Report 153. The Project seems to be running well. The report was endorsed by partners. Activities were in a logical sequence. The geographic and therapeutic coverage were high at 100% and 81% respectively. Training manuals have been translated into the local language. Capacity building targeted to needs has improved. A sustainability evaluation was carried out in this cycle and the sustainability plans have been written and submitted. However, information was not provided in this report on partner equipment and condition during this cycle; or on the MOH contribution from inception. 154. TCC accepted the report with the following recommendations and suggestions for improving reporting and project implementation.
Report related: (i) Separate the total of 142,946 persons not treated, giving figures for absentees and
refusals in table 7; (ii) Explain how two districts, Boneya Boshe and Sibu Sire, had 86% and 91%
therapeutic coverages respectively as these figures are too high for the eligible population;
(iii) Reconcile the statement on CSM with data given in table 11; (iv) Complete table 13 giving the financial input of all partners; (v) Explain why a partner contribution was not received this year.
Project related:
(i) Continue efforts to increase the number of female CDDs; (ii) Upscale stakeholders meetings to all communities; (iii) Improve on training of health workers and CDDs to overcome listed weaknesses.
Gambella CDTI Project (Ethiopia) 5th year Annual Technical Report 155. The quality of the report is only moderate for a 5 years project. The performance of the project is good as a 100% geographic coverage and over 70% therapeutic coverage were maintained over the last three years. There are several issues that need to be addressed. 156. TCC accepted the report with the following recommendations and suggestions for improving reporting and project implementation.
Report related: (i) Provide information on the financial contribution of the MOH and the
communities; (ii) Provide information on the outcome of the sensitization, mobilization and
supervision; (iii) Provide more information on the implementation of the sustainability plan.
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Project related: (i) Address the problem of CDDs attrition with the communities; (ii) Address the health staff shortage with the MOH; (iii) The CDD: population ratio should be increased as a means of improving
performance; (iv) Address TCC 29 recommendations more vigorously; (v) Invest in CSM; (vi) Address the high refusals and absentees in Goderie; (vii) Ensure that all communities have supervisors; (viii) Identify questions for operational research.
Illubabor CDTI Project (Ethiopia) 6th year Annual Technical Report 157. This is a good well running project. The report was endorsed by partners. Activities were in a logical sequence. The geographic and therapeutic coverages were high at 100% and 81% respectively. Information was provided on partner equipment and condition during this cycle. 158. TCC accepted the report with the following recommendations and suggestions for improving reporting and project implementation.
Report related: (i) Provide the cost per treatment.
Project related: (i) Ensure proper coordination of co-implemented campaigns (polio, Vitamin A,
Deworming, VCT etc) to avoid delay in CDTI activities; (ii) Select more female CDDs; (iii) Use mass media for health education, mobilization and sensitization; (iv) Intensify advocacy for support from central Government; (v) Train all health staff on CDTI to avoid adverse effects of a high turnover of health
staff; (vi) Retrain all CDDs and others involved in documentation on record keeping; (vii) Address conclusively the problem of delay of APOC funding.
Jimma CDTI Project (Ethiopia) 6th year Annual Technical Report 159. The project is well integrated into the government health system and is achieving good geographic and therapeutic coverage. Most FLHF workers are trained in CDTI and the project has achieved a good CDD:population ratio. Costing of community contributions introduced a comparatively high cost to the overall total. Although operational research has previously been advised, the project has not yet developed any operational research proposal. 160. TCC accepted the report with the following recommendations and suggestions for improving reporting and project implementation.
Report related: (i) Sub-headings should not be included in the Executive Summary, (ii) Provide information on the outcome of advocacy.
Project related:
(i) Use media and diversify channels for mobilization and sensitization; (ii) Conduct more targeted advocacy; clear identification of advocacy issues and
appropriate targeting of decision makers; (iii) Train more female CDDs and upscale SHM; (iv) Ensure use of checklist for supervision at community level; (v) Implement recommendations of the sustainability evaluation.
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Recommendation to APOC: (i) APOC management should advise on costing of community contribution and its
use in calculating cost per treatment. Metekel CDTI Project (Ethiopia) 5th year Annual Technical Report 161. The Project is doing well, particularly with respect to integration and in-country funding. However, there is need to work harder at improving therapeutic coverage particularly in Dangur District. 162. TCC accepted the report with the following recommendations and suggestions for improving reporting and project implementation.
Report related: (i) Address past TCC recommendations exhaustively; (ii) Improve on the executive summary, including all key information; (iii) Calculate the cost per treatment, the CDD population ratio and the male: female
CDD ratio; (iv) Use the new reporting format; (v) Provide information on:
o Community response to sensitization and mobilization and suggestions for improvement
o Number and percentage of communities with female CDDs o The reason for, and outcome of advocacy o ATrO achieved for District staff trained o Actual percentage of staff trained o Numbers of absentees and refusals o Funding for 2 years before the year of reporting o Opportunities o Reason for the regular increase in the number of villages o Reason for non-treatment in 2005
Project related:
(i) Train all health staff, (ii) Retrain all those involved in CDTI on record keeping, (iii) Upscale CSM and SHM, (iv) Devise a strategy for treating mobile populations, (v) Replace non-functional equipment, (vi) Produce reports of supervisory visits.
Recommendation to APOC:
(i) APOC should share the sustainability evaluation report with country policy-makers and the project.
West Wollega CDTI project (Ethiopia) 5th year Annual Technical Report 163. There are many positive achievements of the project; communities are well sensitised and mobilised with excellent community involvement and increasing participation of women. Capacity building, Mectizan procurement, integration and supervision are functioning well. In spite of being a good programme, the project management has once again not provided the requested information as per the template. The project management should ensure that all information required in the template is provided. 164. TCC accepted the report with the following recommendations and suggestions to provide a revised version with the missing information to APOC
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Report related: (i) All requested information as per template must be fully provided. If information
is not available, please state that this is so rather than leave it blank; o complete tables 12 (equipment) and 13 (funding) (repeated), o Reverse alterations on table 7.
(ii) UTG to be calculated at 84% of total population.
Project related: (i) The NOTF should support project staff to acquire capacity in advocacy, CSM and
SHMs; (ii) Address operational issues of high refusals, high absenteeism, and high drug
wastage; (iii) Internal monitoring by NOTF is to be undertaken at least once a year.
GHANA Ghana 1st Year Annual Technical Report
165. This is the first year report of the Ghana project. The previous TCC recommendations were addressed. Several pieces of information were missing from the report, which does not allow the project's achievements to be properly assessed. Several cases of SAEs (26) were reported, however, no information was provided on their management. Also, no information was provided on drug management or for the inventory. Many tables were not completed. 166. The TCC considered the report as an interim report and requested the project to re-submit a final report to APOC, after addressing the following observations and recommendations.
Report related: (i) Include an Executive Summary; (ii) Provide information on community involvement in CDTI activities; (iii) Clarify the reported cases of SAEs and provide relevant information on their
management; (iv) Provide detailed information on the ordering, storage, delivery and inventory of
drugs; (v) Provide information on Section 4.1, 4.2, 4.3 and 4.4.
Project related:
(i) Address the attrition problem. Train more CDDs, (ii) Document community contributions, (iii) Initiate Supervision.
LIBERIA South-East CDTI Project (Liberia) 4th year Annual Technical Report. 167. The TCC considered the report as an interim report and recommended resubmission to APOC management and a full report to be submitted in time for review by TCC 31. South-Western CDTI Project (Liberia) 4th year Annual Technical Report 168. The TCC considered the report as an interim report and recommended resubmission to APOC management and a full report to be submitted in time for review by TCC 31.
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NIGERIA Akwa Ibom State CDTI Project (Nigeria) 2nd year Annual Technical Report (re-submission) 169. The TCC considered the report and accepted it in view of the fact that there were improvements and many issues had been overtaken by events.
Report related: (i) Ensure that the Annual Technical Report is endorsed; (ii) The current TCC concerns should be addressed; most issues in year 2 have been
overtaken by events; (iii) The issue of $33,550 amount spent by HKI on behalf of APOC- should be
resolved; (iv) Provide details on financial support provided by the NGDO partner; (v) Conduct CSM and SHM to improve community involvement and supervision.
Project related:
(i) Increase and sustain therapeutic coverage to a level of at least 80%; (ii) Reduce the CDD:Community member ratio; (iii) Intensify community mobilization and sensitization; (iv) Initiate CSM and SHM.
Akwa Ibom State CDTI Project (Nigeria) 6th year Annual Technical Report. 170. TCC noted that NOTF had carried out a site visit to the project as recommended by TCC 29, and pointed out the poor project performance to policy makers who promised to address the matter. 171. TCC did not review the report because it was not endorsed by one of the partners. The report was referred back to NOTF for the partnership and leadership issues to be resolved locally. SIERRA LEONE Sierra Leone 4th Year Annual Technical Report 172. Although the project is in its fifth year (it was originally under SIZ), this is the first report to TCC/APOC. The collaboration between Guinea, Liberia and Sierra Leone is commendable and should be supported. The Coordinator has not used the current reporting form, however and the report was not endorsed and contained too much budgetary information. It is critical for the team to be sent the current form for use when compiling the next report. It was indicated that treatment was not conducted in one health district but the reason was not given. Limited information is provided on advocacy, sensitization, supervision and health education. The integration of CDTI with NTD co-implementation does not seem to have improved coverage. 173. TCC accepted the report with the following recommendations
Report related: (i) There is too much background detail – which is important but not necessary in
such a report. It is important to provide geographic and social/cultural/economic information in the background section that will help in the implementation of the programme.
Project related:
(i) Conduct a close follow-up of the trained staff to ensure that the programme is appropriately implemented;
(ii) Strengthen record keeping – the reported 0 absentees does not seem realistic; (iii) Address the issue of refusals in Bonthem, Kambia, Bombali and Tonkolili; (iv) Conduct training in CSM and SHM and implement these activities.
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Recommendation to APOC: (i) If appropriate, conduct epidemiological, entomological and community-based
surveys in areas that have been surveyed in the past and/or in some of the project sites;
(ii) This is an NTD project – which is good in terms of co-implementation. However, the team must understand the need to ensure that onchocerciasis activities do not get adversely affected by being put in second place;
(iii) The project team should be encouraged and supported to document the implementation processes and provide this information to APOC for drawing lessons in co-implementation.
TANZANIA Morogoro Focus CDTI Project (Tanzania) 5th year Annual Technical Report 174. The report is good. Progress has been made by the project particularly in training, community involvement in supervision, integration, mobilization of funds from Government, and CDD gender balance. 175. TCC accepted the report with the following recommendations
Report related: (i) Address past TCC recommendations exhaustively, (ii) Calculate the cost per treatment, CDD population ratio and male:female CDD ratio, (iii) Use the new reporting format, (iv) Provide information on:
o Sustainability evaluation, o Community support, o Reason for, and outcome of advocacy, o Incentives, o Attrition, o Outcome of supervision.
Project related:
(i) Initiate in-country inter-sectoral collaboration to enhance resource mobilisation, integration and sustainability;
(ii) Train all health staff on CDTI; (iii) Train more CDDs; (iv) Retrain all involved in CDTI on record keeping.
SUMMARY OF 7TH, 8TH, 9TH and 10TH year ANNUAL YEAR TECHNICAL REPORTS CENTRAL AFRICAN REPUBLIC (CAR) CAR 8th year Annual Technical Report 176. The report writing is of average quality. The analytical summary is very poor. It gives the number of endemic prefectures and the number of health workers trained in CDTI and in community self-monitoring. For the rest, the delay in transfer of funds is given as the cause of the delayed start of activities in October 2009. The authors say that activities started in May 2009 because of a delay in transfer of funds and that the results in the report represent those from less than 15% of communities treated. They consider that it is difficult in these circumstances to make an objective analysis of results and that a definitive report will be sent in the next few weeks. 177. The TCC considered the report and returned it because it is only partially completed. A final complete report must be submitted to TCC.
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Report related: (i) Check and correct inconsistencies in the figures given in table 5 on community
participation in CDTI, notably the numbers of CDDs, which is ten times lower than the numbers of CDDs in 2008.
Project related:
(i) Six out of seven recommendations of TCC 29 are still valid: o Improve the rates of therapeutic and geographic coverage, o Improve the involvement of women in CDTI, o Improve the ratio of CDDs to population, o Plan a greater integration of CDTI activities, o To develop further, the concept of CDTI in endemic zones, o To intensify advocacy, IEC, sensitisation and mobilisation.
CHAD Chad 10th year Annual Technical Report 178. The report is very well written and presented according to the general format of TCC. The figures are also well presented and commented on. In 2008 and 2009 the Project achieved a very good and stable CDTI performance with 81% therapeutic coverage. CSM was functioning in 69.5% of all communities; that is a praiseworthy activity. 179. TCC accepted the report with the following recommendations and suggestions to provide revised version with missing information to APOC
Project related: (i) Continue to work to maintain a very good performance of the project; (ii) Improve the ratio of CDDs to population by increasing the number of CDDs; (iii) Seek strong support from the State as this is needed in implementing the
operational sustainability plans. CONGO Congo CDTI 9th year Annual Technical Report 180. This is a Project in its 9th year, strongly supported by APOC, MDP and the NGDO: OPC. Responses have been given to the recommendations of TCC26. The report is well edited. The essential information is presented in the analytical summary. A total of 755,124 people living in 748 communities are covered by this project. The UTG was 634,304 and 611,399 person were treated in 2009. The geographic coverage was 100% whilst the average therapeutic coverage ranged from 74% to 81%, which is very positive. The ratio of CDDs/population treated remained too high (1 CDD/775 persons in an urban zone!). Activities of social mobilisation have been developed in favour of local NGDOs, particularly those in rural zones. However, the rate of CDD attrition is high (24% on average), especially in the urban zone (up to 54% at MFilou). 181. TCC expressed its concern over threats to the sustainability of this project, which is about to enter its 10th year: this is particularly in relation to the rate of attrition of CDDs and the weak financial participation of the State (only $5,715 released in 2009. 182. TCC accepted the report with the following recommendations and suggestions:
Report related: (i) Give details of the area covered by the project; (ii) Give details of solutions foreseen to reduce the high rate of CDD attrition; (iii) Give the results of SHM; (iv) Give better, more precise information on actions taken for the replacement of
materials and means of transport.
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Project related: (i) Encourage communities to undertake CSM; (ii) Improve the numbers of health workers trained or retrained; (iii) Initiate operational research proposals, taking account of the numbers of
competent people available locally; (iv) Follow up efforts to carry out sensitisation of political decision-makers.
DEMOCRATIC REPUBLIC OF CONGO (DRC) Ueles CDTI Project (DRC) 7th year Annual Technical Report 183. The report is written simply and is easy to read. The information given is generally precise and detailed. The inclusion of a map and photographs illustrate the document well. There is a disagreement between the amount released in 2009 (table 19: $139,775.6) and the amount of only $33,974.6 indicated in table 20, provided for activities during the reporting period. The ratio of CDDs/population is 1 CDD: 200 persons, which means a high workload. Geographic coverage was 82% in 2009. The therapeutic coverage varied from 72% to 83% in treated communities, but overall coverage of the zone was only 68%, apparently because of health zones that were not treated? There were no cases of SAEs. 184. TCC accepted the report with the following recommendations:
Report related:
(i) Use narrative only for the summary; (ii) Give information on the results of a survey conducted between 12 and 22
December on “the impact of CDDs in the detection and transfer of blind people”; (iii) Complete the report by providing information on the distribution of Vitamin A and
Mebendazole.
Project related: (i) Carry out training to reduce the ratio of CDDs/population; (ii) Renew CDTI activities at Dungu, Faradje and Makoro as soon as possible.
EQUATORIAL GUINEA Bioko CDTI Project (Equatorial Guinea) 8th year Annual Technical Report 185. The report was generally well written and easy to read. The figure for the total population fluctuates from one year to the other (2007: 70,207; 2008: 54,276). Table 12 is incomplete. Geographic and therapeutic coverage remain low. No plan of sustainability has been developed and there has been no CSM or SHM conducted in the reporting period. 186. TCC accepted the report with the following recommendations.
Report related: (i) Fill all the sections of table 12, (ii) Check the figures for the total population of the Project area.
Project related:
(i) Plan and carry out CSM or SHM; (ii) Put in place a ratio of 1 CDD per 100 persons so as to reduce the workload of
CDDs; (iii) Intensify sensitisation to maintain or improve geographic and therapeutic coverage
from one year to the next; (iv) Develop a plan of sustainability and transfer to national ownership in preparation
for the exit of APOC in 2015; (v) Identify and implement innovative approaches to eliminate the disease.
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ETHIOPIA Kaffa Shekka CDTI Project (Ethiopia) 8th year Annual Technical Report 187. This is a good report of a project that has made commendable progress over the years. Good coverage, consistent support by MOH (District and Zone) and high level of integration are indications that sustainability will be easily achieved. 188. TCC accepted the report with the following recommendations and suggestions to provide revised version with missing information to APOC
Report related: (i) Address all past TCC recommendations, (ii) Improve on the executive summary by making it more comprehensive, (iii) Calculate the cost per treatment, CDD pop ratio and male female CDD ratio, (iv) Use the new reporting format, (v) Complete tables 14 and 15, (vi) Clarify the indication in 2 that distribution is going on in urban areas.
Project related
(i) Train more CDDs, (ii) Retrain all involved in CDTI on record keeping, (iii) Explain how CSM was done without training, (iv) Conduct training on CSM and SHM in all communities, (v) Conduct Operational Research on challenges, (vi) Reduce the number of wasted and expired drugs.
Bench-Maji CDTI Project (Ethiopia) 7th year Annual Technical Report 189. This was a well written report of a well run project. Previous TCC recommendations have been addressed. All activities were in a logical sequence but distribution was still partly in the rainy season resulting in a high number of absentees especially in Mizan Anan district. The refusals have reduced in number. The CDD population ratio at 1:119 is better but in spite of the projects efforts, the female to male CDD ratio 1:5 is still low. 190. TCC accepted the report with the following recommendations and suggestions to provide revised version with missing information to APOC
Report related: (i) Indicate the role of each partner in the project, (ii) There should be no sub-titles in the summary.
Project related:
(i) Continue effort to reduce absentees; (ii) Train more CDDs to achieve at least 1: 100 minimum set by APOC; (iii) Continue efforts to increase the number of female CDDs; (iv) Improve on forecasting and Mectizan dosage, Ensure usage of residual tablets
before expiry; (v) Institute SHM in communities especially as training is already done; (vi) Core CDTI activities like training, supervision, advocacy should now be
supported by government funding; (vii) Vehicle, motorcycles and photocopier need to be repaired/replaced by APOC – in
this 7th year project.
Recommendation to APOC: (i) Confirm that an evaluation has been done and a sustainability plan written.
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North Gondar CDTI Project (Ethiopia) 7th year Annual Technical Report 191. The project is well integrated into the government health system and is achieving good geographic and therapeutic coverage. However, the therapeutic coverage has never reached 80%, the new APOC target. The CDD to population ratio has exceeded the target. Other strong areas of the project are sensitisation and mobilisation of the communities, supervision and human resource capacity building. Challenges include; delays in release of funds, high refusal rates, absenteeism and drug wastage. 192. The recommendations of TCC 28 were not fully addressed.
193. TCC accepted the report with the following recommendations and suggestions to provide a revised version with missing information to APOC.
Report related: (i) Provide missing information on integration, (ii) Complete tables 2 and 4, (iii) Include reasons for and outcome of advocacy, (iv) Comment on progress of implementation of the Sustainability Plan.
Project related:
(i) Complete implementation of TCC 28 recommendations; (ii) Improve the female CDD ratio; (iii) Aim for a therapeutic coverage of > 80%; (iv) Attend to operational issues of high refusals, absenteeism and high drug wastage
(NOTF to investigate high drug wastage which is common in several projects); (v) Explore with the Regional Health Bureau and NGDO ways of improving
disbursement of funds to the projects. LIBERIA Lofa, Bong, Nimba and Montserrado counties 8th year Annual Technical Report 194. The following innovative efforts are commendable:
(i) Efforts to attract more international and local partners support for CDTI, (ii) Inter-sectoral partnership in community mobilization, (iii) Inclusion of CDTI into POA of all the 15 counties.
195. However, the project is unable to ensure early disbursement of funds to the counties and still have a prolonged timeline for the implementation of activities. 196. TCC accepted the report with the following recommendations.
Report related:
(i) The Project should seek clarification on their project year from APOC and reflect it accordingly;
(ii) The Report needs to be endorsed by all partners; (iii) Finalize the report and submit.
Project related:
(i) Stabilize and sustain high coverages; (ii) Implement special country initiatives aimed at increasing no of Health workers
and CDDs available for CDTI; (iii) Sustain the innovative initiatives regarding advocacy and mobilization.
Recommendation to APOC:
(i) APOC to consider replacing their old motorcycles.
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MALAWI Malawi Extension CDTI Project 10th year Annual Technical Report 197. This report is well written. The team should be commended for sending in a good report. It summarizes the activities in a concrete manner. The monitoring and evaluation results and the observations of TCC members have been put into use. 198. TCC accepted the report with the following recommendations and suggestions to provide revised version with missing information to APOC.
Project related: (i) Find mechanisms for building on the current collaboration with the Tea
Associations to bring on board other private sector organizations; (ii) Conduct the planned training of CDDs and others on record keeping, which has
implications on the ordering of drugs and monitoring programme performance; (iii) The team should implement CSM and SHM; (iv) The team should be encouraged to document its experiences of co-implementation
because there are currently four diseases being addressed by the CDDs – onchocerciasis, lymphatic filariasis, schistosomiasis and trachoma.
Thyolo and Mwanza CDTI Project (Malawi) 10th year Annual Technical Report 199. This was a well written report of a Project integrated into the Government Health system. MDA has equally been added using the CDTI structure. 200. TCC accepted the report with the following recommendations and suggestions to provide revised version with missing information to APOC.
Report related:
(i) Provide information on the number of communities with community supervisors, (ii) Provide information on the in-kind incentives provided by the community.
Project related:
(iii) Implement Community Self Monitoring; (i) Review guidelines on steps to take in MDA to avoid delays in ivermectin
distribution. TANZANIA Ruvuma CDTI Project (Tanzania) 8th year Annual Technical Report. 201. This report was incomplete. The reviewers were unable to assess many aspects of the project due to lack of information especially for Namtumbo, Ludewa and Songea Districts. 202. The TCC considered the report and returned it because it is only partially completed. A final complete report must be submitted to TCC31.
Report related:
(i) Complete the report with data from all the sites, (ii) Provide a comprehensive response to the last TCC comments, (iii) Ensure there is consistency in all sections of the report.
On programme implementation:
(i) Train more health staff to be involved in CDTI; (ii) Improve geographic and therapeutic coverage (the low level reporting could
however be due to incomplete information); (iii) Train communities and implement CSM & SHM.
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Tanga CDTI Project (Tanzania) 8th year Annual Technical Report 203. This was a well written report. The Project does not have an NGDO partner but is making progress with sustainability and has undertaken co-implementation of other NTD control.
204. TCC accepted the report with the following recommendations.
Project related:
(i) Increase HWs involvement in CDTI, (ii) Improve advocacy, (iii) Ensure that NTD co-implementation does not jeopardize CDTI.
Mahenge CDTI Project (Tanzania) 10th year Annual Technical Report,
205. The report was not endorsed by all partners. Treatment during the year took place in only one of the two districts, Kilombero. No treatment took place in Ulanga district because an epidemiological survey was taking place. Was this lack of treatment on the advice of the epidemiologists? This should not have been the case and further information should be obtained.
(i) Good project performance in advocacy, innovative methods for sensitisation and an exemplary 1:1 Male : Female CDD ratio has been attained. Supervision and integration is also going on fairly well. NOCP however did not carry out an internal monitoring visit during the year;
(ii) The health staff involvement is low which could constrain the developing area of co-implementation. A large number of SAEs reported were supposed to be due to praziquantel co-implementation but no details are provided.
206. TCC accepted the report with the following recommendations and suggestions to provide revised version with missing information to APOC.
Report related:
(i) Correct the percentage of health workers trained to 47% and not 38.1%; (ii) Include the outcomes of advocacy; (iii) Complete the table on SAEs; (iv) $7,000 was approved for purchase of a motorcycle. This requires follow-up action
of who authorized the purchase.
Project related: (i) All FLHF staff should be trained in CDTI, (ii) An alternative NGDO partner should be identified, (iii) Provide a motorcycle to address the transport constraints of the project, (iv) NOCP should carry out internal monitoring at least once a year, (v) More sensitisation is required, especially on co-implementation.
Kilosa CDTI project (Tanzania) 7th year Annual Technical Report, 207. This is a concise and well written report, which shows the commitment of project implementers especially in supervision, innovative community sensitization and success with NTD implementation using CDTI structure. 208. TCC accepted the report with the following recommendations.
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Report related: (i) Ensure that the information in the executive summary is consistent with the rest of
the report; (ii) Report on, and account for the balance of about 400,000 drugs that are not
accounted for;
Project related:
(vi) The team should conduct M&E; (i) Train and implement CSM and explore the collaboration with the Health assistants; (ii) Utilise the Mectizan day for mobilisation; (iii) The team should develop realistic budgets – the current budget is 30% of what was
projected; (iv) Increase the proportion of health workers engaged in CDTI from 33%.
209. Some general recommendations were made by TCC concerning Annual Technical Reports as follows:
(i) APOC management should review Interim Reports internally and any report submitted to TCC will be reviewed as a complete Annual Report;
(ii) Former SIZ countries should be grouped together separately in the Agenda and should continue using their own reporting format except for Sierra Leone.
ANY OTHER BUSINESS: Agenda Item 18 210. TCC country visits:
(i) The APOC Director, requested that during any TCC visit, TCC members should run a CDTI workshop in order to strengthen and reinforce the Programme;
(ii) During 2010, visits are provisionally planned for Equatorial Guinea, Congo Brazzaville, DRC, CAR and Cameroon;
(iii) Equatorial Guinea: This country should prepare their integrated plan for NTD control before a country visit is made. One of the objectives of a visit would be to evaluate how this integrated plan will impact on CDTI;
(iv) A country visit will take place to Congo Brazzaville by Dr Ogoussan and Dr Yebakima – details of other country visits will be determined later;
(v) Dr Boussinesq will assist APOC to follow up on visits to be made to communities that have received doxycyclin in Cameroon in the coming year;
(vi) TCC should visit the 4 sites vector control projects to validate data on elimination of transmission;
(vii) TCC should visit sites where there have been epidemiological evaluations and validate the findings.
211. Annual Technical Report Format
(i) TCC recommended that an amendment be made to the Annual Technical Report format. This will come in the section on SAEs and will be the addition of a “check box” to be ticked if the reporting project has sent a report on SAEs to MDP, and if “Yes” a second check box should be completed to indicate whether they have also sent a clinical report. The format is to be amended by Dr Ogoussan.
Date and Place of the next TCC meetings: Agenda Item 19 212. The 31st session of TCC will take place in Ouagadougou from 13-18 September 2010 and the 32nd TCC meeting will take place from 7-12 March 2011.
(iii) Ensure that the report is endorsed by the relevant partners; (iv) Provide information on the reason for consistent under-utilisation of APOC
approved funds and recommendations for improvement; (v) Confirm the total population figure.
43
Closure of the Meeting: Agenda Item 20 Message from the Director of APOC 213. In her closing remarks, Dr Amazigo, reminded the meeting that, ‘a man or a woman who pays respect to the great paves the way for their own greatness’. She expressed her respect to Professor Adenike Abiose, whom she was fortunate to have had as Chair of TCC throughout her tenure as APOC Director. Dr Amazigo also extended her appreciation to Drs Philippon and Boussinesq, who have served the onchocerciasis control programmes for many years, and thanked the Government of Burkina Faso, the WHO Representative to Burkina Faso, Dr Djamila Cabral, and the WHO Regional Director for Africa, Dr L. Gomes Sambo who have been instrumental in all that APOC has achieved. The Director acknowledged the contributions and advice of Drs Dadzie, Sékétéli, Boatin, Professor Homeida and Dr Antoine Kabore. She expressed her thanks to the Finance staff, Mr Agblewonu, Mrs Keita and the entire APOC staff for their commitment to APOC. 214. Noting that during the past 4 years and 3 months spent as Director, the support of TCC members had resulted in many achievements by the Programme. Examples included the Yaoundé Declaration in 2006, the placing of onchocerciasis on the 2007 agenda of the Regional Committee for Africa and the approval, in 2007, of the extension of APOC to 2015. The huge financial support and re-commitment of donors including donations from Merck and AfDB were all achieved with TCC guidance. Thanks to their support, the APOC PAB for the period up to 2015 was approved, in addition to which, JAF asked APOC for a supplementary addendum, which is currently being finalised. APOC is fortunate in having a solid group within the World Bank, providing high-level support and a committed CSA. The mandate for a second term of office for the WHO/AFRO Regional Director was highlighted in addition to the continuous support from the NGDO coalition and groups. Dr Amazigo hoped to meet each participant again in the September TCC meeting, and wished all a successful push towards “shrinking the map of onchocerciasis in Africa”. Message from the Chair TCC 215. In her final remarks, Prof. Abiose thanked the Director of APOC and TCC members for their continuous commitment. She announced the end of her tenure as TCC Chair and the possibility of this being her last TCC session. She was pleased to note that she had met many people since she ventured into APOC and TCC nearly 15 years ago, and she explicitly appreciated the hard work that had been put in to have CDTI accepted in Africa as a strategy for onchocerciasis control and to help strengthen health systems. Prof. Abiose also acknowledged the hard work and leadership qualities of the APOC Director, who has worked harmoniously with TCC and expressed her appreciation and indebtedness to Drs Yameogo, Noma and other APOC staff for their dedication. Prof Abiose has observed over the last 4 years how network development has led to fantastic support from donors, who are happy with the results obtained by the Programme and with the APOC leadership. Prof. Abiose concluded by stating that she has enjoyed working with TCC members and wished them all the best for the future.
44
ANNEX 1: LIST OF PARTICIPANTS TCC MEMBERS 1. Prof. Adenike Abiose, Sightcare International, P.O. Box 29771, Secretariat Main Office, Ibadan,
Oyo State, Nigeria, Tel. 234- 2-7517329, Fax 1-509-5628212 - Mobile 234-8037865702, Emails: [email protected] and [email protected]
2. Prof. Mamadou Souncalo Traoré, Département de Recherche en Santé publique, FMPOS, BP :
E810, Bamako, Mali, Mobile: (223) 66 75 9051, Tel. Home : (223) 20 20 6868 – Fax (223) 20 22 96 58 – Email: [email protected]
3. Dr Kisito Ogoussan, Associate Director, Onchocerciasis, Mectizan Donation Program, 325
Swanton Way, Decatur GA, 300 30, USA - Tel: 1 404 687 5633, Fax: 1 404 371 1138, Email: [email protected]
4. Prof. Soungalo Traoré, 01 BP 2938, Ouagadougou 01, Burkina Faso, Tél: (226) 50 37 46 37, Cel:
(226) 78 85 24 56, Fax: (226) 50 34 28 75, Email: [email protected] 5. Prof. Louis-Albert Tchuem Tchuenté, Coordinator, National Control Programme of
Schistosomiasis and STH, Director, Centre for Schistosomiasis and Parasitology, P.O. Box 7244, Yaounde, Cameroon, Tel: (237) 2221 01 83 (office); (237) 9991 18 09 (Mobile) Fax: (237) 2221 50 77; Email: [email protected]
6. Dr Michel Boussinesq, Institut de Recherche pour le Développement (IRD), UMR-145, 911
avenue Agropolis, BP 64501, 34394 Montpellier Cedex 5, France, Tél: (33) 4 67416162, Email: [email protected]
7. Dr Mamadou Mariko, INRSP, BP 1771, Bamako, Mali, Tel (223) 75 02 59 81, Email:
[email protected] 8. Dr Mary Amuyunzu Nyamongo, African Institute for Health and Development, P.O. Box 45259,
Nairobi 00100, Kenya, Tel/Fax: (254) 20 3873385; Cell: (254) 722 850 401; Emails: [email protected] and [email protected]
9. Dr André Yébakima, Entomologiste médical, Centre de Démoustication, BP 679 - 97200 Fort-de-
France, Martinique; Tel.: (00 596) 596 59 85 44 - Fax: (00 596) 596 70 26 46 - Email: [email protected] and [email protected]
10. Dr Johnson Ngorok, Deputy Regional Director; Sight Savers International (SSI), P O Box 34690,
00100 GPO, Nairobi, Kenya – Tel: +254 20 60 69 70 – Mobile: +254 722 56 78 97 - Email: [email protected]
11. Mrs Francisca Onyekachi Olamiju, Executive Director, MITOSATH, 605 Hospital Place,
Opposite Greenvalley Suites, GRA P.O. Box 205, Postcode 930001, Jos, Plateau State, Nigeria, Mobile: (234) 80333 18085 - Fax : (234) 73 46 47 92, Email : [email protected]; [email protected]
12. Dr Bernard Philippon, Chargé de mission OPC, 17 Villa d’Alésia, 75014 Paris, France - Tel/Fax :
(00331) 40 44 94 04/ (00331) 44 12 41 90 - Email: [email protected]; [email protected] WHO/GENEVA
13. Dr T. Ukety, Responsible Officer, NGDO Coordination for Onchocerciasis Control, World Health
Organization (WHO), 20 Avenue Appia, 1211 Geneva 27, Switzerland - Tel: +41-22-791-1450 – Fax: +41-22-791-4772 - Email: [email protected]
45
14. Dr Annette Christiane KUESEL, Scientist, TDR, World Health Organization, 20 Avenue Appia,
1211 Geneva 27, Switzerland, Tel: +41-22 791-1541 - Fax: +41-22 791-4774 - Mobile: + 4179 596 5718 – Email: [email protected]
15. Ms Juliet Ochienghs, APOC Focal Point, WHO/HQ, 20 Avenue Appia, 1211 Geneva 27,
Switzerland, Tel: +41-22-791-1450, Fax: +41-22-791-4772, Email: [email protected] WAHO
16. Dr Doulaye Sacko, Coordonnateur de Vision 2020, Organisation Ouest Africaine de la Santé, 01
B.P. 153, Bobo-Dioulasso, Burkina Faso - Tel : (226) 20 97 57 75 – Fax : (226) 20 97 57 72 Email : [email protected]; [email protected]
WORLD BANK
17. Dr Andy C. Tembon, Regional Coordinator for School Health, Nutrition and HIV/AIDS, West
and Central Africa AFTHE, The World Bank Group, MSN J10-1004, 1818 H Street., N.W. Room J10-142, Washington, D.C. 20433, USA - Tel: 202-458-4879 - Fax: 202-4738216 - Email: [email protected]
INVITED
18. Prof. Ekanem Braide, Chairperson of the Nigeria Technical Review Committee, 10 B Ediba Road,
P.O. Box 3679, Calabar, Nigeria - Tel.: 234 80 41 68 42 - Email: [email protected] 19. Fatu Yumkella, MSc, MPhil, Managing Director, Dalan Development Consultants (DDC), 4 Maze
Area, Off Marcus Jones, King Street, Wilberforce, P.O. Box 491, Freetown, Republic of Sierra Leone – Tel: 232-33-851405, 232-76-627878, 232 77 641736 - Email: [email protected]; [email protected] – Website: www.dalanconsult.com
20. Mr. Chukwu OKORONKWO, Programme Officer, National Onchocerciasis Control Programme
(NOCP), New Federal Secretariat Complex, Shehu Shagari Way, P.O. Box 083, Garki, Maitama-Abuja, Nigeria – Tel: (+234) 80336198945 – Email: [email protected]
TCC SPECIAL MEETING PARTICIPANTS 21. Dr Hans-Peter Duerr, Universitaet Tuebingen, Institut fuer Medizinische Biometrie
Westbahnhofstr. 55, 72070 Tuebingen, Germany - Phone: ++49 (0)7071 29 78259 – Email : [email protected]
22. Dr Thomas R. Unnasch, Global Infectious Diseases Research Program, Department of Global
Health, College of Public Health, University of South Florida, 3720 Spectrum Blvd., Suite 304, Tampa, FL 33612, Florida, USA- Phone: 813-974-0507 - Fax: 813-974-0992 – Email: [email protected]
23. Prof. Mamoun Homeida, President, University of Medical Sciences & Technology (UMST), P O
Box 12810, Khartoum, Sudan - Fax: (249 183)224799 - Tel: (249 183)227599 - Email: [email protected]
24. Dr. Michele Murdoch, Consultant Dermatologist, Watford General Hospital,
Vicarage Road, Watford, Hertfordshire, WD18 0HB, United Kingdom - Tel. +44 1923 208036 - Fax +44 1923 217945 – Email: [email protected]; [email protected]
25. Prof. Peter J. Diggle, CHICAS, School of Health and Medicine, Lancaster University, Lancaster
LA1 4YB, United Kingdom – Tel. (01524) 593957 – Fax (01524) 592681 - Email: [email protected]
46
26. Dr Kenneth Nnamdi Opara, Faculty of Sciences, Department of Zoology, University of Uyo, P.M.B. 1017, Uyo, Akwa Ibom State, Nigeria – Mobile Phone N° 08067085205 – Email: [email protected]
27. Prof. Daniel A. Boakye, Head, Parasitology Department, Noguchi Memorial Institute for Medical
Research, University of Ghana, P.O. BoxLG581, Legon, Accra, Ghana - Tel: +23321501178 - Mob: +233244545147 - Fax: +23321502182 – Email: [email protected]
28. Dr Boakye A. Boatin, N° 12 Obodai Close, East Legon, P.O. Box CT 1380, Accra, Ghana – Tel.
233 21 507116 – Email: [email protected] 29. Dr Azodoga Sékétéli, Ingénieur Agronome, Entomologiste médical, 224, Rue des Morelles,
Tokoin Wuiti, Lomé, Togo - Tel. : (228) 226 83 85 / 228 900 94 05, Email: [email protected] 30. Dr Antoine Kaboré, Ouagadougou, Burkina Faso – Mobile : (226) 70 20 53 80, Tel./Fax : (226)
50 43 00 67, Email : [email protected] 31. Dr Kwablah Awadzi, Onchocerciasis Chemotherapy Research Centre, Hohoe Hospital, P.O. Box
144, Hohoe, Ghana – Tel. 233 21 668871 (Hohoe) (0)93522132 (Accra) – Email: [email protected]
32. Dr Hans Remme, 120 Rue des Campanules, 01210, Ornex, France - Tel: 336 4545 7404 – Email:
[email protected] 33. Dr Jesse Bump, Harvard School of Public Health, 677 Huntington Ave, I-1210, Boston, MA
02115 USA, Tel. +1 617 3863196 – Email: [email protected]
WHO/OUAGADOUGOU 34. Dr Djamila K. Cabral, WHO Representative, 1487 Avenue d’Oubritenga, 03 B.P. 7019,
Ouagadougou, Burkina Faso, Tel : (226) 50 30 65 65, Email: [email protected]
WHO/IST/OUAGADOUGOU 35. Dr Bokar Touré, IST Coordinator, 1487 Avenue d’Oubritenga, 03 B.P. 7019, Ouagadougou,
Burkina Faso, Tel: (226) 50 30 65 09, Email: [email protected]
WHO/MDSC 36. Dr. Laurent Toé, Responsible Officer, Molecular Biology Laboratory, MDSC, P.O. Box 549,
Ouagadougou, Burkina Faso, Tel: (226) 50 34 29 53, Fax: (226) 50 34 28 75, Email: [email protected]
37. Dr. Yiriba Bissan, Entomologist, MDSC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226)
50 34 29 53, Fax: (226) 50 34 28 75, Email: [email protected] 38. Dr. Aimé G. Adjami, Molecular Biology Laboratory, MDSC, P.O. Box 549, Ouagadougou,
Burkina Faso, Tel: (226) 50 34 29 53, Fax: (226) 50 34 28 75, Email: [email protected]
WHO/APOC 39. Dr Uche Amazigo, Director, APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34
29 53, Fax: (226) 50 34 28 75, Email: [email protected] 40. Dr Laurent Yaméogo, COORD/APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50
34 29 53, Fax: (226) 50 34 28 75, Email: [email protected]
47
41. Dr Mounkaïla Noma, Chief, Epidemiology and Vector Elimination Unit (CEV/APOC), P.O. Box
549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29 53, Fax: (226) 50 34 28 75, Email: [email protected]
42. Mr Honorat Zouré, BIM/APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29
53, Fax: (226) 50 34 28 75, Email: [email protected] 43. Dr Hailemariam Tekle Afework, EPI/APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel:
(226) 50 34 29 53, Fax: (226) 50 34 28 75, Email: [email protected] 44. Dr Grace Fobi, COP/APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29 53,
Fax: (226) 50 34 28 75, Email: [email protected] 45. Mrs Zainab Akiwumi, ACO/APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34
29 53, Fax: (226) 50 34 28 75, Email: [email protected] 46. Mr K. Bénoît Agblewonu, BFO/APOC,P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50
34 29 53, Fax: (226) 50 34 28 75, Email: [email protected] 47. Ms Néné Keïta, FO/APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29 53,
Fax: (226) 50 34 28 75, Email: [email protected] 48. Mr Saïdou N’Gadjaga, ITH/APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34
29 53, Fax: (226) 50 34 28 75, Email: [email protected] 49. Mr Tendainashe Siwombe, ITO/APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50
34 29 53, Fax: (226) 50 34 28 75, Email: [email protected] 50. Mr Issaka Niandou Yacouba, ISO/APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226)
50 34 29 53, Fax: (226) 50 34 28 75, Email: [email protected] 51. Mr Yaovi Aholou, AO/APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29
53, Fax: (226) 50 34 28 75, Email: [email protected] 52. Mr Samuel Odame Bamfo, TRAD/APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226)
50 34 29 53, Fax: (226) 50 34 28 75, Email: [email protected] 53. Dr Stephen Leak, Technical Officer/APOC, Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50
34 29 53, Fax: (226) 50 34 28 75, Email: [email protected] 54. Mr Paul Ejime, Communication Officer/APOC, Box 549, Ouagadougou, Burkina Faso, Tel:
(226) 50 34 29 53, Fax: (226) 50 34 28 75, Email: [email protected] 55. Mr Assi Aké, Technical Officer/APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50
34 29 53, Fax: (226) 50 34 28 75, Email: [email protected] 56. Mrs B. Savadogo, AHR/APOC, Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29 53,
Fax: (226) 50 34 28 75, Email: [email protected] 57. Mr Edward Lloyd-Evans, FO/APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50
34 29 53, Fax: (226) 50 34 28 75, Email: [email protected]
48
INTERPRETERS 58. Mrs Safiétou Barry, 09 BP 526 Ouagadougou 09, Burkina Faso, Tel: (226) 70 21 41 14, Email:
[email protected] 59. Mr André Nikiéma, 01 BP 922, Ouagadougou 01, Burkina Faso, Tel: (226) 50 33 03 12, Mobile:
78 80 90 53, Email: [email protected]; [email protected] 60. Mr Djerma Sita, 01 BP 1771, Ouagadougou 01, Tel 50 34 23 10 / 50 34 43 26, Mobile: 70 20 00
58, Email: [email protected] 61. Mr Nagabila Oumarou, 03 BP 7038, Ouagadougou 03, Burkina Faso, Tel: 70 26 33 32, Email:
AA/Mtg-12.03.2010
49
ANNEX 2 PROVISIONAL ANNOTATED AGENDA
AFRICAN REGION
African Programme for Onchocerciasis Control (APOC) 01 B.P. 549, Ouagadougou 01, Burkina Faso Tel: (226) 50 34 29 53; 50 34 29 59; 50 34 29 60; 50 34 36 45/46 Fax: (226) 50 34 28 75; 50 34 36 47
TECHNICAL CONSULTATIVE COMMITTEE Thirtieth Session
Ouagadougou, 08 to 13 March 2010
PROVISIONAL ANNOTATED AGENDA
DAY I – Monday 8 March 2010
08:30-09:00
1. Opening 2. Adoption of the agenda
08H30-09H00
09H00-09H05
Special Session on Elimination of Transmission
Section 1: Informal Consultation on Elimination of Onchocerciasis Transmission with Ivermectin Treatment and conceptual framework of elimination
09H05-11H15
Tea Break 10H25 - 10H40
Session 2: Results of the First-Round of Epidemiological Evaluations of Progress towards elimination endpoints and implications for APOC strategy
11h15-18H00
Lunch Break 13H00- 15H00
09:00-18:00
Tea Break 16H00 - 16H15
DAY II – Tuesday 9 March 2010
Special Session on Elimination of Transmission (Cont’d)
Session 3: Transmission zones where ivermectin treatment is required to achieve local elimination
09H00-11H00 09:00-11:00 Tea Break 10H25 - 10H40
11:00-13:00
Section 4: Distribution of Loiasis, Review of APOC’s Plan for further RAPLOA surveys and comprehensive analysis of Loiasis data
11H00-13H00
Lunch Break 13H00-15H00
Session 5: Other Issues of Importance for Elimination 15H00-18H00 15:00-18:00
Tea Break 16H00- 16H15
REV.2
50
DAY III – Wednesday 10 March 2010
INFORMATION 3. CSA: Matters arising from the 126th and 127th sessions (Dr Amazigo) 08:00-08:20
4. JAF: Matters arising fro the 15th session: Decisions (Dr Amazigo) 08:20-08:40
5. NGDO: Matters arising from the 35th session (Dr Ukety) 08:40-09:00 08:00-09:20
6. TCC: follow-up of the key recommendations of the twenty ninth session (Dr Yaméogo)
09:00-09:20
Other Strategic and technical issues 8. Country visit by TCC members 09:20-10:00
Tea Break 10:00-10:15 10. Macrofil and Research:
(i) Update on Moxidectin and Target Product profile for drug for Onchocerciasis control via mass treatment
(ii) Update on the DEC patch test and Lohmann
(iii) Update on nation-wide Oncho mapping in Ghana
10:15-11:00
11:00-11:15
11:15-11:45 09:20-12:40
12. Co-Implementation: Achievements and challenges in CDTI projects in Nigeria
13. Multi-country study on social benefit of CDTI
14. Study of blackfly movements: Results and recommendations
11:45-12:05
12:05-12:25
12:25-12:55
Lunch Break 12:55-14:45
Management of APOC Trust Fund 15:00-15:30 15. Report on the financial management of APOC funded Projects 15:00-15:15 Reviews 16. Report on the review by the APOC management of 1st, 2nd, 3rd, 4th, 5th, 6th, 7th 8th, 9th, 10th, 11th and 12th year progress reports and subsequent year budgets (Mr Agblewonu)
15:15-15:30
17. Review of new Project Proposals and 1st, 2nd, 3rd, 4th, 5th, 6th, 7th, 8th, 9th, 10th, 11th and 12th year Annual Technical reports on the implementation of CDTI and Vector elimination Projects. Recommendations on the 2nd, 3rd, 4th, 5th, 6th, 7th, 8th, 9th , 10th and 11th year implementation of the projects
Introduction to the review exercise: Summary budget of submitted proposals (Mr Agblewonu) 17.1 Moxico CDTI Project (Angola) 3rd year annual technical report
17.2 Bururi CDTI Project (Burundi) 4th year technical report
15:30-15:45
15:45-16:05
16:05-16:25
Tea Break 16:25 -16:40
15:30-18:35
17.3 Cibitoke-Bubanza CDTI Project (Burundi) 5th year annual Technical
report
17.4 Rutana CDTI Project (Burundi) 4th year technical report
17.5 Metekel Project (Ethiopia) 5th year technical report
17.6 East Wollega CDTI Project (Ethiopia) 5th year technical report
17.8 West Wollega CDTI Project (Ethiopia) 5th year technical report
16:40-17:00
17:00-17:20
17:20-17:40
17:40-18:00
18:00-18:20
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DAY IV – Thursday 11 March 2010
17.9 Gambella CDTI Project (Ethiopia) 5th year technical report
17.10 Illubabor CDTI Project (Ethiopia) 5th year technical report
17.11 Jimma CDTI Project (Ethiopia) 5th year technical report
17.12 Masisi-Walikale CDTI Project (DRC) 1st year technical report (re-
submission)
17.14 Masisi-Walikale CDTI Project (DRC) 2nd year technical report (re-
submission)
17.15 Masisi-Walikale CDTI Project (DRC) 3rd year technical report
08:00-08:20
08:20-08:40
08:40-09:00
09:00-09:20
09:20-09:40
09:40-10:00
Tea Break 10:00-10:15
17.16 Katanga-Nord CDTI Project (DRC) 5th year technical report
17.17 Butembo-Beni CDTI Project (DRC) 3rd year technical report
17.18 Ituri CDTI Project (DRC) 3rd year technical report
17.19 Lubutu CDTI Project (DRC) 3rd year technical report
17.20 Kasongo CDTI Project (DRC) 4th year technical report
17.21 Rutshuru-Goma CDTI Project (DRC) 4th year technical report
17.22 Tshopo CDTI Project (DRC) 6th year technical report
10:15-10:35
10:35-10:55
10:55-11:15
11:15-11:35
11:35-11:55
11:55-12:15
12:15-12:35
Lunch Break 12:35- 14:45
17.23 Sankuru CDTI Project (DRC) 6th year technical report
17.24 Akwa Ibom State CDTI Project (Nigeria) 2nd year tech. report (re-submission) 17.24 Akwa Ibom State CDTI Project (Nigeria) 6th year technical report
17.25 Congo Extension CDTI Project (Congo) 6th year technical report
17.26 Côte d’Ivoire CDTI Project 2nd year technical report
15:00-15:20
15:20-15:40
15:40-16:00
16:00-16:20
16:20-16:40
Tea Break 16:40-16:55
08:00-18:35
17.27 Ghana CDTI CDTI Project 1st year technical report
17.28 South-Eastern CDTI Project (Liberia) 4th year technical report
17.29 South-Western CDTI Project (Liberia) 4th year technical report
17.30 Sierra Leone CDTI Project 4th year technical report
17.31 Morogoro Focus CDTI Project (Tanzania) 5th year technical report
16:55-17:15
17:15-17:35
17:35-17:55
17:55-18:15
18:15-18:35
52
DAY VI – Saturday 13 March 2010
Adoption of the report (conclusions and recommendations) of TCC30
21. Closure of the session
08:00-10:00
10:00-10:30
08:00-10:45
Tea Break 10:30-10:45
Reports reviewed by TCC member on line - Summaries presented by Dr Fobi on Friday 12 March 2010
1. CAR CDTI Project 8th year technical report 3. Chad CDTI Project 10th year technical report 4. Congo CDTI Project 9th year technical report 5. Ueles CDTI Project (DRC) 7th year technical report 6. Bioko CDTI Project (Equatorial Guinea) 8th year technical report 7. Kaffa Shekka CDTI Project (Ethiopia) 8th year technical report 8. Bench-Maji CDTI Project (Ethiopia) 7th year technical report 9. North Gondar CDTI Project (Ethiopia) 7th year technical report 10. Lofa, Bong, Nimba & Montserrado counties CDTI Project (Liberia) 8th year technical report 11. Thyolo & Mwanza CDTI Project (Malawi) 13th year technical report 12. Extension Districts CDTI Project (Malawi) 10th year technical report 13. Kilosa CDTI Project (Tanzania) 8th year technical report 14. Mahenge Focus CDTI Project (Tanzania) 11th year technical report 15. Ruvuma Focus CDTI Project (Tanzania) 10th year technical report 16. Tanga Focus CDTI Project (Tanzania) 8th year technical report
Rapporteurs: Dr Stephen Leak Ms Julie Ochienghs Dr Tony Ukety
DIR/COORD/APOC: 05/03/2010
DAY V – Friday 12 March 2010
17.32 Adamaoua I CDTI Project (Cameroon) 5th year technical report
17.33 East Province CDTI Project (Cameroon) 5th year technical report
17.34 Far North Province CDTI Project (Cameroon) 5th year technical report
17.35 Littoral I Province CDTI Project (Cameroon) 5th year technical report
17.36 South Province CDTI Project (Cameroon) 5th year technical report
17.37 NOTF/HQ (Cameroon) 11th year technical report
08:00-08:20
08:20-08:40
08:40-09:00
09:00-09:20
09:20-09:40
09:40-10:00
Tea Break 10:00-10H15
9. Task Force on the review of technical reports (Nigeria)
Summary of 7th, 8th, 9th, and 10th year technical reports
11. Review of operations research proposals
10:15-11:10
11:10-12:05
12:05-13:00
Lunch Break : 13:00-14:45
18. Other matters
19. Date and place of the thirty-first session of the TCC
15:00-16:15
16:15-16:30
Tea Break 16:30-16:45
08:00-18:30
20. Report (Conclusions and Recommendations of TCC30)
Preparation of the report (conclusions and recommendations)
(Rapporteur & Co-rapporteurs)
16:45-18:30
53
ANNEX 3: CONCEPTUAL FRAMEWORK FOR ELIMINATION OF TRANSMISSION OF ONCHOCERCIASIS INFECTION
0
20
40
60
80
100
% of baseline
Phase 1 Phase 2 Phase 3
Transmission: Transmission declining towards negligible levelsIrreversibly approaching zero due to insufficient or absentadult worms
Zero
Intervention:Active intervention, aimed at reducing wormburden or transmission (mass treatment and/or vector control) None None
Surveillance: Monitoring & evaluation of progresssActive surveillance to proof elimination
Surveillance for timely detection of a possible
reintroduction of infection
Transmission
Adult worm population
Adult worm population reduced to such low
levels that it is irreversibly moving to its demise / extinction
Confirmed elimination of transmission
Time
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ANNEX 4: IMPLEMENTATION OF TCC29 KEY RECOMMENDATIONS AND
SUGGESTIONS
Recommendations of TCC 29 on Strategic and technical issues
Subject/Topic
Action to be taken
Status of implementation
Curriculum and training module on the CDI strategy for faculties of medicine and nursing schools
TCC encouraged training of trainers on CDTI and writing a book on CDI (para. 16b)
- ToT was done at IRSP/Benin by former Director and other APOC facilitators
- Synopsis prepared and authors are being identified
Country visit to Malawi
APOC to release capital equipment and support in data management at all levels (para. 19)
- Is being taken care within 2010 budget - Support in data management to be
carried in May 2010 Country visit to Tanzania
Country to rally other donors to support co-implementation Support documentation of the co-implementation process and effectiveness of integration Invest in data collection and improvement of data quality (para.24 & 25)
- Stakeholders’ meeting conducted - Advocacy conducted by APOC
Director, and Dr Leak - Data collection was funded US$
61,000
Country visit to Ethiopia
APOC should fund training of health workers at lower levels (para.28.i) Annual technical reports addressing by TCC 27 (East Wollega) and TCC 28 (West Wollega) to be submitted (para. 28 ii) APOC to fund REA, geographical coverage and village identification (para. 28 iv)
- - Communications on course to get a proposal from the country
- Resubmitted reports accepted by
TCC29 - Budget was approved for REA and it is
under review for geographical coverage
Country visit to Burundi
Sustainability plans to be developed for 2 projects (para.30)
- Advocacy visit of APOC Management planned for May 2010
- Sustainability plans (Rutana & Bururi) developed and received
Country visit to Congo
APOC Management to assist the NOTF to finalize and implement APOC’s devolution and exit plans (para.35)
- Devolution and exit plan developed and submitted.
Country visit to Côte d’Ivoire
APOC to reinforce technical and financial support to PNLCé in Epidemiological and entomological evaluations, training of technicians entomologists, epidemiologists, in CDTI, logistic/equipment (computer, laboratory) (para.42)
- Training in entomology and CDTI implemented
- Training in epidemiological evaluation implemented
- provision made for logistic in 2010 DFC
3. Task force review committee (TRC) Nigeria Uganda Tanzania
TRC/Nigeria will present to TCC 30 format and results of comparative assessment of CDTI projects aged ≥7 years (para.48) APOC to speed up setting up of TRC in Tanzania and Uganda (para.53b)
- Nigeria TRC chair will answer - Uganda TRC set up and funded – 1st meeting planned in April - Letter sent requesting establishment of the TRC
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Feasibility of elimination of onchocerciasis transmission in Africa
- To conduct extensive analysis of REMO data and determine transmission zones in Africa
& - to preserve mf samples from subjects for
future genetic analysis – development of molecular markers for ivermectin resistance (para.56b).
- Analysis done and presentation made to TCC 30
- has been integrated in the protocol of
future epidemiological evaluations
Vector migration, vector/ parasite complexes, human migration
- There is a need to have better knowledge of the distribution of species of Simulium
- improvement of knowledge and investigation on the identity, distribution, abundance and movements in the context of shrinking the map and surveillance of transmission free areas are needed (para.65a & b)
- Available historical data compiled and sampling to complete mapping will start in April 2010
- Plan elaborated in collaboration with MDSC and the team in charge of the epidemiological evaluation to strength the entomological aspects of evaluation and surveillance
Macrofil and research
APOC to provide funds to fill the gap of funding needed for ivermectin maker and moxidectin projects (para.68b)
- The process is on going to get estimate of funds needed by WHO/TDR
RAPLOA
Any epidemiological survey on LF to be coupled with RAPLOA (para.70a) Loa loa high risk map to be submitted to TCC 30 (para.70c) RAPLOA surveys to be completed in the entire programme area (para.70d)
- RAPLOA mapping is being carried out in risk areas in APOC countries
- Map presented during TCC 30 - Activity on going
Operational research proposals
TCC requested re submission of the 5 revised operational proposals from Côte d’Ivoire to reviewers no later that 1st November 2009 (para.81)
- Implemented and reviewers will report to TCC 30
Recommendations of TCC 29 on CDTI projects – Technical reports Congo Extension
to provide information on progress with mapping of LF(para.123iii)
- Mapping completed
Liberia to inform APOC and MDP on the staff change (South West project) (para.126vii) to improve capacity for utilization of approved budget (South East) (para.128ix)
- Recommendations forwarded to NOTF/Liberia
Nigeria - NOTF to put in place a national drug distribution system and storage facility (para.132iv)
- NOTF to conduct a comprehensive
appraisal of implementation of CDTI in Akwa Ibom and feed back to TCC through APOC by October 20th, 2009 – APOC to suspend funding the project until reply received (para.136)
- Discussions are ongoing - Implemented
South Sudan
West Equatoria to conduct a census (para.149) APOC to resolve problems faced by projects in receiving Trust fund (para.150)
- Recommendation forwarded to the project and SSOTF
- Implemented
DR Congo Bandundu project to provide data for Vit A supplementation and mass distribution of Albendazole (para.152) Lubutu to carry blood test systematically in case of SAEs (para.156)
- Recommendations forwarded to the project; No supplementation of Vit. A
- Recommendation forwarded to the project
and SAE management unit
56
Masisi Walikale to rewrite year 1 technical report and include activities and expenditure in year 2 report for review by TCC 30 (para.159a) NOTF to appoint a responsible for SAEs in Kinshasa (SAEs unit 1) (para.170) A TCC/APOC team to conduct a mission to look at management of SAEs in DRC projects (para.170.iv)
- All concerned projects will be trained and equipped
- Implemented - Implemented - Country visit to be organized with TCC
members
Recommendations of TCC 29: Other matters Revised format of annual technical reports
Format to be sent to countries for pre testing and results to be presented to TCC 30 (para.227
- Format presented to the last NOTF meeting and forwarded to all countries for pre testing
Co-implementation
Studies to be conducted to evaluate the economic benefits of co-implementation control activities taking into account various epidemiological situations (para.230) APOC to implement rapid epidemiological surveys (ICT test, questionnaire) for NTDs to be co-implemented (para.231)
- Not yet implemented - Not yet implemented, but APOC will put
emphasis on diseases that will be co-implemented
