Richard Hayes London School of Hygiene amp Tropical Medicine Outline of Presentation Brief overview of control efforts and targets Malaria Leprosy HIV Learning from these infectious disease control efforts that could be relevant for TB ID: 746143
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Slide1
Accountability and targets: lessons learned from control programmes for other infectious diseases
Richard HayesLondon School of Hygiene & Tropical MedicineSlide2
Outline of Presentation
Brief overview of control efforts and targets: Malaria
Leprosy
HIV
Learning from these infectious disease control efforts that could be relevant for TBSlide3Slide4
Ballooning targets!Slide5
Malaria
Summary of Goals and Targets
1955-1969
– Global Malaria Eradication Programme (total coverage)
1995-2000
– Action Plan for Malaria Control
Aimed to reduce malaria mortality by at least 20% compared to 1995 levels in at least 75% of affected countries
2000
– Abuja Declaration: at least 60% of those at risk for malaria benefit from protective measures by 2005
2000s/2010s
– World Health Assembly goals to reduce malaria cases and malaria-related deaths by 75% between 2000 and 2015
2000s/2010s
– MDG 6 “combat malaria” and SDG 3.3 “end the epidemic of… malaria”
2015
– Rollback Malaria Partnership targets: by 2030, reduce malaria incidence and mortality globally by 90% or more (
compared with 2015
)Slide6
Malaria Goal for 2030
To reduce incidence and mortality rates globally as compared to 2015 by 90% or greater
Elimination
of malaria from at least 35 countries (8 of which are in Africa)
Prevent re-establishment of malaria in all countries that are malaria freeSlide7
Malaria: key lessons
MEP galvanised support but was unrealisticAfrica was excluded from decision-makingFailure of MEP led to reduced funding, deskilling, resurgence of malaria and increase in resistance
Current strategy combines elimination in target countries with continuing control efforts in highly endemic areas of Africa
Importance of sustained commitment and combination of horizontal and vertical componentsSlide8
Leprosy
Summary of Goals and Targets
1991
-
World Health Assembly resolution to “eliminate leprosy as a public health problem by 2000”
Elimination = prevalence of less than 1 in 10,000 globally
2000
– Target of
global
leprosy prevalence of < 1/10,000 achieved
At country level, all but 6 countries reported reaching this target by 2005
Transmission was not interrupted – continuing high incidence at sub-national level in countries like India and Brazil
2007
: Elimination target officially abandoned
2011-2015
strategy and
2016-2020
strategies have moved towards a focus on reducing grade-2 disabilities, cases in children and discriminationSlide9
Leprosy
From elimination to reducing the burdenSlide10
Leprosy: key lessons
Elimination target galvanised support and appeared to be effective at global levelBut this ignored ongoing transmission and prevalence of disabling sequelae at local levelDifficult to sustain funding, technical skills and research in face of “elimination”
Changing case definitions can skew interpretation of trends
Perverse incentives in case reportingSlide11
HIV/AIDS
Summary of Goals and Targets
2000
– Millennium Development Goal 6 to “Combat HIV/AIDS, malaria and other diseases”
2001
– Political Declaration of Commitment on HIV/AIDS
First clear quantitative targets (e.g. reduce number of infants infected with HIV by 20% by 2006)
2000s
– ‘3 by 5’ initiative, to enrol 3 million on ART by 2005. Followed by ‘15 by 15’ initiative, achieved in 2015 with 15m accessing ART
2011
– UNAIDS ‘getting to zero’ vision: zero new infections, zero AIDS-related deaths, zero discrimination
2014
– Launch of 90-90-90 targets by 2020, and ‘fast-track’ strategy
2015
– SDG Goal 3, target 3: “End the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases…”Slide12
ART scale-up
(‘Process’ target)
New infections
(‘Outcome’ target)
HIV
Source:
UNAIDS 2017.
Ending AIDSSlide13
HIV: key lessons
Danger of complacency when some targets metTension between inspirational targets and what can be achievedOverlapping and inconsistent targets and reporting overload
Global advance may mask local failure
90-90-90: The last 10% are the hardest
Additional tools will be neededSustaining funding as mortality declinesSlide14
End TB Strategy
Source:
World Health Organization. The End TB Strategy. Global strategy and targets for tuberculosis prevention, care and control after 2015. Geneva: WHO; 2015Slide15
TB Elimination Challenges
Finding the unknown casesInadequate HIV treatment
Drug resistance
Achieving SDGs
UHC, addressing structural factors
Reduction in diabetes, smoking and air pollution
Concentration in vulnerable groups
Latent TBSlide16
What did we learn?
Global targets but local programmes
Global targets galvanise support, but are not always relevant locally or in specific subgroups
Involve wide range of stakeholders
Ensure equity
Consider outcomes as well as process measures
Consider all key outcomes
Avoid confusion with numerous overlapping and inconsistent targetsSlide17
What else did we learn from malaria, leprosy and HIV control efforts?
Eradication or elimination campaigns must not be at cost of control in high burden settingsVertical/horizontal: balance central technical expertise with integration into general health services
Targeting reservoirs of infection critical, but may be stigmatising
Need measurable targets and investment in data collection
Need to sustain funding when incidence declining
Continued investment in research is essential
Science + Service delivery + social/economic progress Slide18
Acknowledgements
Tazeem Bhatia, Jamie Enoch, Mishal Khan, Sophie Mathewson, David Heymann, Osman Dar
UNAIDS for funding work on background paper for meeting on HIV targets in
Glion
, October 2017