December 2011 Trip Report to the DRC from Dr. Shungu, Part 1

Greetings from Kinshasa! Yes, I'm now in Kinshasa, flying in safely yesterday from Nairobi. With all the post-elections publicized tensions and even dozens of tragic incidence throughout the country, I was pleasantly surprised to find Kinshasa in almost a business as usual mode. However, as long as Tshisekedi, the leader of the opposition party who lost to Kabila, the incumbent president, has not yet conceded, the situation can rapidly take a turn for the worse.

The primary goals for this trip are 1) attend the annual Joint Action Forum (JAF) meeting in Kuwait City, 2) make initial visits of 2 newly acquired CDTI projects acquired as a result of a creative partnership agreement recently established between UFAR and Sightsavers International (SSI), 3) refurbish our new office in Kinshasa and 4) identify and hire a country representative.

The JAF is the governing board of African Program for Onchocerciasis Control (APOC) that meets once a year to decide on the objectives, policies and strategies, discuss and approve plan of action and budget, and review APOC's progress. The 17th session of the Joint Action Forum (JAF 17) of the APOC sponsored and hosted by the Kuwait Fund for Arab Economic Development was held from 12-14 December 2011 at the Sheraton Kuwait Hotel and Towers in Kuwait City, Kuwait. The meeting was attended by 149 delegates, including the Honorable Ministers of Health from onchocerciasis-endemic countries, Directors and Coordinators of National Onchocerciasis Control Programs, representatives of donors countries, NGDOs, WHO, the World Bank, Merck & Co, Inc and Research Institutions. I arrived a day late and missed mostly the introduction ceremonies on the first day. Summaries of major agenda topics relevant to UFAR are provided.

Future of APOC

The original mandate of APOC was due to expire in 2015. At last year's JAF 16 meeting in Nigeria, the Committee for Sponsoring Agencies (CSA) for APOC was charged with the task of providing advice on the future of APOC during this year's JAF meeting. CSA's recommendation to JAF based on an extensive evaluation was to extend APOC's mandate to 2025 and to transform this organization into a neglected tropical disease (NTD) hub. The recommendation was based on the following:

  1. New scientific findings showing that onchocerciasis can not only be controlled but can definitely be eliminated as a major public health problem. However, none of the 31 endemic African countries would be capable of eliminating oncho by 2015.
  2. Increased interest and emphasis on co-implementation of preventive chemotherapy for NTD using the CDTI powerful platform.
  3. Need to strengthen basic national health systems

Importance of safeguarding the huge investments by the all the partners over more than the past 35 years.
JAF 17 thanked CSA for their recommendation and requested that in collaboration with APOC management, they submit a detailed new plan of action with costs reflecting this new direction for consideration by JAF 18.

WHO/APOC Progress Report

The report highlighted APOC's key activities in 2010-2011 which included the refinement of onchocerciasis mapping in several critical and challenging countries including DRC, delineation of high risk areas co-endemic for oncho-loiasis, improvement of Mectizan treatment coverage in post-conflict countries, continued epidemiological assessment and entomological evaluation where Mectizan treatment has been stopped, co-implementation of other health interventions with CDTI activities and progress toward strengthening national health systems. Cross-border issues were also discussed.

JAF encouraged APOC to scale-up the use of other approaches to achieve control and elimination of onchocerciasis, including consideration for trice a year treatments in problematic areas.

NGDO Report

The NGDO report presented jointly by Tony Ukety, the NGDO Group Coordinator and Franca Olamuji, the current NGDO chair focused on the achievements and challenges faced in 2010-2011. The challenges included the withdraw of support to 8 CDTI projects by 3 NGDOs due to financial constraints, management of SAEs in several countries with high oncho-loiasis co-endemicity and delays in the delivery of drug supply and implementation of integrated intervention. The recent Sightsavers and UFAR partnership in DRC and CBM's reinforcement of CDTI activities in Angola and DRC were cited as excellent examples of efforts to mitigate some of the challenges. The Group expressed its strong and full commitment based on accumulated years of experience towards onchocerciasis elimination throughout all endemic areas.

Integrated Mapping

An update was provided on integrated mapping of onchocerciasis, loiasis and five other NTDs using the well established rapid epidemiological mapping of onchocerciasis (REMO) and rapid assessment procedure for loiasis (RAPLOA) methods in 11 countries. APOC was encouraged to publish the results ASAP in scientific journals.

Research Activities with TDR and APOC Collaboration: Update on Moxidectin

Moxidectin is an ivermectin-like drug that has been under development by Pfizer as a potential macrofilaricidal drug (capable of killing adult worms of Onchocerca volvulus). Limited data from small phase 2 clinical studies presented to the JAF suggested that moxidectin could result in a 6-month period of skin amacrofilaria, and also that a single dose of the drug does not kill all adult worms or sterilize them in 18 months. However, Pfizer made a corporate decision to stop co-sponsoring further development of moxidectin as of July 2011. Subsequently, the WHO's tropical disease research (TDR) branch has agreed to assume the responsibility for managing all further clinical trials activities for moxidectin.

JAF 18's recommendation was that further decisions on moxidectin development should await the review of the results from Phase 3 studies expected in 3Q 2012.

To Be Continued