The Public Health Value of Public-Private
Partnership (PPP) in Africa:
A personal perspective
Prof. Francois-Xavier Mbopi-Keou,
Member, UNAIDS Scientific and Technical Advisory CommitteeCouncil Member, International Society for Infectious Diseases
University of Yaounde I & Cameroon Ministry of Health
UNESCO-Merck Africa Research Summit , Geneva, 19-20 October 2015
Outline (1)
1. Background
2. The Understanding of Public Health value of Public-
Private Partnership
3. HIV-related Public-Private Partnership and Health
System Strengthening in Africa:
• Contributing to a better understanding and the
Management of STDs interactions : The case of GSK in
the clinical and Biological studies of HIV and HSV
interactions in Africa
• Contributing in strengthening Research & Public Health
labs : The role of PEPFAR, ASLM, WHO, FIND, CDC,
The IDA in this historic change in Cameroon
Outline (2)
• Contributing to equitable access to essential Medical
products and Technologies : The case of Merck Millipore
in the development and Validation of the Muse® Auto
CD4/CD4% Assay in Cameroon
• Contributing to effective access to Health care delivery :
The case of the Mobile Health Units in Cameroon
sponsored by the Cotco Pipeline Chad/Cameroon Project
4. Lessons learned
5. Acknowledgements
1. Background
• Infectious diseases, do compound an already heavy public
health burden and threaten the health and survival of
millions in Africa
• PPP between governments and companies (in cooperation
with additional partners such as donors, technical agencies
and nongovernmental organizations) gain new importance
in extending health services
• This presentation will focus on selected cases of
HIV/AIDS related PPP and health sector strengthening in
Africa
2. The Understanding of Public Health value of Public-
Private Partnerships (PPP)
• PPP refers to :
a) global health initiatives of impressive magnitude (Buse &
Harmer, Soc Science and Med, 2007)
b) Partnership of private companies and development
agencies (Beckman et al, ILO, Geneva, 2005)
c) Business relation of the private sector with public
organizations (United Nations, A frame work for
collaboration, 2008)
d) The privatization of public services and the public-private
mix of health care provision (Evans D, Bull World Heath
Organization, 2006; Seikh et al, Trans R Soc Trop Med
& Hyg, 2005)
3. HIV-related Public-Private Partnership and
Health System Strengthening in Africa
Mbopi-Keou et al. J Infect Dis 1999
Mbopi-Keou & De Mowbray, Lancet Infect Dis 2003
Mbopi-Keou et al. Lancet Infect Dis, 2002
Belec & Mbopi-keou, Lancet, 2012
Contributing to a better understanding and the
Management of STDs interactions : The case
of GSK in the clinical and Biological studies
of HIV and HSV interactions in Africa
* Genital herpes and HIV: deadly synergy
- clinical reactivation of HSV-2 with HIV
- increased shedding of HIV in patients
with symptomatic and asymptomatic genital herpes
* Genital herpes increases the per-contact transmission
of HIV-1
[Gray et al, Lancet 2001]
Journal of Infectious Diseases 2000; 182:1090-6
HSV-2 antibody prevalence and HSV-2 shedding by
HIV-1 status
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
HIV negative (N=221) HIV positive (N=79)
Serum IgG to HSV-2
Genital HSV2 in HSV-2 sero+ve
20%
43%
P<0.0001
(35)
(174)
(73)
(31)
Neutralizing antibodies to HSV
Mbopi-Keou F.X., L.
Belec, Dalessio, J., Gresenguet, G., Mayaud, P.,
Weiss, H.A., Brown, D.W.G., Ashley-Morrow
RL. Neutralizing antibodies to Herpes simplex
virus type-2 (HSV-2) in cervicovaginal
secretions of African women.
Clin Diagn Lab Immunol 2003, 3: 388-393.
•Biological interactions between HSV and HIV
Mbopi-Keou and colleagues, Clinical Microbiology and
Infection 2003, 3: 388-393.
The public Health value of the GSK
HIV/Herpes project
* Assess the burden of clinical disease due to
HSV-2 in different settings
* Evaluate the potential of anti-herpetic therapy to
reduce HIV transmission:
- Effect of suppressive therapy on HIV shedding
among dually infected
- Effect of therapeutic treatment for GUD on HIV
* Develop and test preventive interventions
(youth interventions, safe & effective vaccine)
.
Contributing in strengthening Research &
Public Health labs : The role of PEPFAR,
ASLM, UNAIDS, WHO, FIND, CDC &The
IDA in this historic change in Cameroon
• A National Public Health Lab is under construction
• 600 laboratories within the central, regional and district
levels that are enrolled in and actively implementing basic
quality assurance systems
• 595 laboratories enrolled and actively participating in the
national Proficiency Testing program for HIV testing.
• 9 labs have gone through external audit by SLIPTA
certified auditors for accreditation
• Cameroon has 7 trained ASLM certified SLIPTA Auditors
who provide support to other countries across the continent
Contributing to equitable access to essential
Medical products and Technologies : The case
of Merck Millipore in the development and
Validation of the Muse® Auto CD4/CD4%
Assay in Cameroon
Background
The 2010 WHO revised guidelines for scaling up ART in resource limited countries emphasized the need of immunological assessment based on CD4 enumerationand HIV viral load
Belec L, Mbopi-Keou FX, Gershi-Damet GM, Mboup S. Lancet Infect Dis, 2012
Background
Previous studies evaluated other platforms for CD4
enumeration in ressource limited settings:
Mbopi-Keou FX, Sagnia B, Ngogang J, Angwafo
FF, Colizzi V, Montagnier L, Bélec L. J Transl
Med, 2012;
Mbopi-Keou et al, Clin Vaccine Immunol, 2012
Objective
To evaluate the simplified, robust, single-platform
Muse® Auto CD4/CD4% Assay (EDM Millipore, Merck
KGaA, Darmstadt, Germany) for CD4 T cell numeration
in absolute count and in percentage, compared against
the reference CE IVD-qualified Guava auto CD4/CD4
percent system® (EDM Millipore) flow cytometry
method
Methods
Muse AutoCD4/CD4 Assay
Results with pediatric samplesComparative device
Muse
Comparative deviceMuse
Result from adult sample
Comparative deviceMuse
CD4 T cell count (Comparative Device)
CD
4 T
cel
l co
unt
(Muse
Auto
CD
4/C
D4%
)
CD4% (Comparative Device)
CD
4%
(M
use
Auto
CD
4/C
D4%
)
CD4 T cell Count Analysis
32
CD4 T cell Count Data y = 0.95 x + 25.22 R2= 0.99
y = 0.92 x+ 1.01, R2= 0.97
CD4% Data
Total Lymphocyte count (Comparative Device)
To
tal L
ym
ph
ocy
te c
ount
(Mu
se A
uto
CD
4/C
D4%
)
Total Lymphocyte Counts
Total Lymphocyte Count Data
Y= 0.99 x + 113.7 R2= 0.98
Example Staining patterns from Study
P3 Muse
CD4 Count
(Cells/uL) 543.4
CD4% 25.8
TLC
(cells/uL) 2102.7
A7 Muse
CD4 Count
(Cells/uL) 632.4
CD4% 39.1
TLC
(cells/uL) 1616
P3 Muse
CD4 Count
(Cells/uL) 2918.6
CD4% 38.5
TLC
(cells/uL) 7588.3
P3 Muse
CD4 Count
(Cells/uL)
143.1
CD4% 17.4
TLC
(cells/uL)
822.5
Adult Pediatric Pediatric Low Count
Control
Example Low CD4 Count Screenshots from Study
MA9
CD4 (cells/µL) 51.8
CD4% 5.7
TLC (cells/µL) 913.8
CD4 (cells/µL) 72.2
CD4% 4.5
TLC (cells/µL) 1591.7
MA3
CD4 (cells/µL) 216.9
CD4% 12.8
TLC (cells/µL) 1692.4
MA12
CD4 (cells/µL) 186.4
CD4% 47.0
TLC (cells/µL) 396.7
MA16
Muse® AutoCD4/CD4% Assay: CE/IVD
Assay for CD4 Monitoring
Features Benefits
Assay provides CD4 T cell count, CD4% & Total
Lymph Count Results in blood
One Method for Adult & Pediatric Samples
30 min Sample Prep Time; No wash Rapid Results; Simple sample prep
Automated Acquisition & Gating Software Easy to use; Usable by less skilled operators
Low Biohazardous waste (based on microcapillary
cytometry)
Less Disposal Issues
CD4 Counts & CD4% Results
Acquire on Muse ® Cell Analyzer
15
Acquire on Muse® Cell Analyzer
The public Health value of the Merck
Millipore Muse® Auto CD4/CD4% project
• The Muse® Auto CD4/CD4% Assay analyzer is a reliable
alternative flow cytometer for CD4 T lymphocyte
enumeration to be used in routine for immunological
monitoring according to the WHO recommendations in
HIV-infected adults as well as children living in resource-
constrained settings
Mbopi-Keou et al, ICAAC, Washington DC, USA,
September 5-9, 2014, Abstract no D-1511;
Mbopi-Keou et al., ICASA 2015, to be held in Zimbabwe 29
November - 4 December 2015 Abstract no TUPDB001
Contributing to effective access to Health care
delivery : The case of the Mobile Health Units
in Cameroon sponsored by the Cotco Pipeline
Chad/Cameroon Project
Taking the health care closer to the millions in our villages
Mbopi-Keou et al, AIDS 2007;
Mbopi-Keou et al, Plos Negl Trop Dis, 2014
4. Lessons learned
• PPP works well if they reconcile philantropy with business
strategy for the private partner and systemic surplus for the
public partner
• PPP needs a clear policy & priority fields
• PPP requires mutual understandings
• Time-limited PPP can have a meaningful contribution
• Succesful PPP can help define future Public health
interventions and research arenas
5. Acknowledgements
The University of Yaoundé I & Ministry of Health Cameroon
(H Gonsu Kamga, J Amougou, GCM Kalla, W. Mbacham, C
Ebana Mvogo, J-E Pondi, MA Sosso)
The Institute for the Development of Africa
Université des Montagnes (F Mimo Tanghu et al.)
The Chantal Biya International Research Center on
HIV/AIDS Yaounde (MS Sosso, B Sagnia, A Ndjolo, V Colizzi)
Hôpital de la Cité Verte (P Omgba Bassega, J Mindimi )
Université of Paris (L Bélec)
LSHTM & HPA London (P Mayaud, R Peeling, D Mabey ,
DW Brown, P Piot et al)
CDC Atlanta (CG Teo, J Nkengasong et al.)
Nat Ref Center for HIV & STDs in Senegal (S Mboup)
Merck Millipore (Jim, John, Philippe, Kamala, Julie et al.)
.
Jeune Afrique
Economie 2002; 346: 87
Conclusion
“...I was taught from a young age to place all my cares in the hands of the Lord.”
Melanie Schurr, 1998
Thank you
