Report of the thirty-third session of the Technical Consultative Committee (TCC): Ouagadougou, 12- 16 September 2011

AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) REPORT OF THE THIRTY-THIRD SESSION OF THE TECHNICAL CONSULTATIVE COMMITTEE (TCC) Ouagadougou, 12-16 September 2011 DIR/COORD/APOC/REP/TCC33 06/03/2012 i TABLE OF CONTENTS Acronyms .......................................................................................................................................................................v Opening: Agenda item 1..............................................................................................................................................1 Adoption of the Agenda: Agenda item 2...................................................................................................................2 INFORMATION ..........................................................................................................................................................2 CSA – matters arising from the 132nd and 133rd sessions: Agenda item 3 .......................................................2 Update on activities of the NGDO Group: Agenda item 4 ....................................................................................2 Follow-up of the key recommendations of the thirty-second session of TCC: Agenda item 5.........................3 Consultation on Community Self-Monitoring: Agenda item 6.............................................................................4 Feasibility of elimination of onchocerciasis infection and interruption of transmission in Africa: Agenda item 7 ..............................................................................................................................................................................5 Macrofil and Research: Agenda item 8 ..................................................................................................................10 Report on the 45th Mectizan expert Committee meeting: Agenda Item 9........................................................13 APOC/MDP mission on SAEs management in the Democratic Republic of Congo: Agenda Item 10.........13 Review of Operational Research Proposals: Agenda Item 11.............................................................................14 i). Assessing low female participation and opportunities for increasing their involvement in community-directed treatment with ivermectin in Zamfara State, Nigeria .......................................14 ii). Migratory patterns of the nomadic Fulani herdsmen and their default and uptake of ivermectin in Ardo Kola LGA, Taraba State, Nigeria............................................................................15 iii). Female participation in the CDTI Programme in Oyo State, Nigeria ..........................................16 iv). Increasing community participation in community-directed treatment with ivermectin in communities in Benue State ........................................................................................................................18 v). To identify factors responsible for CDDs attrition in Gombe state, Nigeria .................................19 vi). An assessment of counterpart funding for CDTI activities in Oyo State, Nigeria ......................19 Training of NOTFs in management and analysis of data: Agenda item 12......................................................22 Main findings of the CSA advisory groups: Agenda Item 13..............................................................................22 MANAGEMENT OF THE APOC TRUST FUND...............................................................................................25 Report on the financial management of APOC funded Projects: Agenda item 14..........................................25 ii Report on the review by the APOC Management of 1st, 2nd, 3rd, 4th, 5th, 6th, 7th, 8th, 9th, 10th and 11th year progress reports and subsequent year’s budgets: Agenda Item 15...........................................................26 Review of new Project Proposals and of 1st, 2nd, 3rd, 4th, 5th, 6th, 7th, 8th, 9th, 10th and 11th 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, 11th and 12th year implementation of the projects: Agenda item 16 ....................................................................................................................................27 DEMOCRATIC REPUBLIC OF CONGO............................................................................................................27 Ituri South (DRC) CDTI Project proposal....................................................................................................27 Review of Annual Technical reports .......................................................................................................................28 ANGOLA.....................................................................................................................................................................28 Bengo CDTI Project (Angola) 2nd year Annual Technical Report 2010 ...................................................28 Kuando Kubango CDTI Project (Angola) 4th year Annual Technical Report...........................................29 Huila CDTI project (Angola) 4th year Annual Technical Report ...............................................................30 Moxico CDTI Project (Angola) 4th year Annual Technical Report............................................................30 CAMEROON..............................................................................................................................................................31 Littoral 1 Province (Cameroon) 6th year Annual Technical Report...........................................................31 NOTF/HQ (Cameroon) 12th Year Annual Technical Report ......................................................................32 COTE D'IVOIRE.......................................................................................................................................................32 Cote d'Ivoire CDTI Project (Comoé, Bandama, Sassandra, Cavally and their affluents) 3rd year Annual Technical Report 2010 ...................................................................................................................................32 DEMOCRATIC REPUBLIC OF CONGO............................................................................................................33 Masisi Walikale CDTI Project (DRC) 3rd year Annual Technical Report, 2009 Re-submission.............33 Masisi Walikale CDTI Project (DRC) 4th year Annual Technical Report, 2010.......................................33 Butembo-Beni CDTI Project (DRC) 3rd year, 2010, Annual Technical Report ........................................34 Lubutu CDTI Project (DRC) 4th year Annual Technical Report ................................................................35 Mongala CDTI Project (DRC) 6th year Annual Technical Report............................................................35 Equateur Kiri CDTI Project (DRC) 6th year Annual Technical Report.....................................................36 Tshuapa CDTI Project (DRC) 6th year Annual Technical Report..............................................................37 Bas-Congo CDTI Project (DRC) 6th year Annual Technical Report 2010................................................37 Lualaba CDTI project (DRC) 6 or 5th year Annual Technical Report 2010 .............................................38 Ubangi Nord CDTI 5th year 2010 Annual Technical Report (DRC).........................................................39 Ubangi Sud CDTI Project (DRC) 6th year 2010 Annual Technical Report..............................................39 DRC NOTF/HQ 11th Year Annual Technical Report ..................................................................................40 SOUTH SUDAN .........................................................................................................................................................41 East Bahr El Ghazal CDTI Project (South Sudan) 4th year Annual Technical Report, 2010 ..................41 East Equatoria CDTI Project (South Sudan) 5th year Annual Technical Report 2010.............................41 Upper Nile CDTI Project (South Sudan) 5th year Annual Technical Report 2010 ...................................42 West Bahr El Ghazal CDTI Project (South Sudan) 5th year Annual Technical Report 2010...................42 West Equatoria CDTI Project (South Sudan) 6th year Annual Technical Report, 2010...........................43 SSOTF CDTI Project (South Sudan) 5th year Annual Technical Report, 2010.........................................43 iii SUDAN.........................................................................................................................................................................44 Sudan CDTI Project 10th year Annual Technical Report............................................................................44 TANZANIA.................................................................................................................................................................46 Tunduru CDTI Project (Tanzania) 6th year Annual Technical Report ......................................................46 NOTF/HQ Project (Tanzania) 12th year Annual Technical Report ...........................................................46 Review of the 7th, 8th, 9th, 10th, 11th, and 12th year Annual Technical Reports ..........................................47 ANGOLA.....................................................................................................................................................................47 Lunda Norte Project (Angola) 7th year Annual Technical Report..............................................................47 Lunda Sul Project (Angola) 7th year Annual Technical Report..................................................................47 DEMOCRATIC REPUBLIC OF CONGO (DRC)...............................................................................................48 Bandundu CDTI Project (DRC) 7th year Annual Technical Report...........................................................48 Bandundu CDTI Project (DRC) 8th year Annual Technical Report...........................................................48 Tshopo CDTI project (DRC) 7th year Annual Technical Report ................................................................49 Sankuru CDTI Project (DRC) 8th year Annual Technical Report..............................................................50 Kasai CDTI Project (DRC) 10th year Annual Technical Report ................................................................51 CENTRAL AFRICAN REPUBLIC (CAR) ...........................................................................................................52 CAR 9th year CDTI project Annual Technical Report 2010 .......................................................................52 LIBERIA......................................................................................................................................................................52 Northwest CDTI Project (Liberia) 9th year 2010 Annual Technical Report .............................................52 TANZANIA.................................................................................................................................................................53 Mahenge CDTI Project (Tanzania) 12th year Annual Technical Report ...................................................53 Kilosa CDTI Project 9th year Annual Technical Report (Tanzania)..........................................................53 Ruvuma CDTI Project (Tanzania) 12th year Annual Technical Report .....................................................54 Tukuyu CDTI Project (Tanzania) 10th year Annual Technical Report ......................................................55 Reports of TRC Review Committees: Agenda Item 17........................................................................................56 Report on the 5th Session of the Technical Review Committee of Cameroon ............................................56 Report on the 2nd meeting of the Uganda Technical Review Committee (TRC) .......................................57 Report of the 7th Technical Review Committee, Nigeria ..............................................................................59 Other matters: Agenda item 18................................................................................................................................62 a) Presentation of CDTI implementation in Burundi .............................................................................62 b) Issue of rejecting or accepting reports..................................................................................................62 c) Evaluations of sustainability in South Sudan.......................................................................................62 d) Discrepancy between reported and actual coverage – Littoral 2 and Centre 1..........................65 iv e) Issue of changing the age for mature Projects to be reviewed separately from 7 to 5 years and changing the review format to present just critical issues .....................................................................65 f) NTD co-implementation issues ...............................................................................................................66 g) LF and Onchocerciasis collaboration....................................................................................................66 h) Issue of internships for APOC ...............................................................................................................66 i) Country visits .............................................................................................................................................66 Date and place of thirty-fourth and thirty-fifth sessions of the TCC: Agenda item 19 ..................................67 Closure of the session: Agenda item 20...................................................................................................................67 Annexes ........................................................................................................................................................................68 v 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 Medicale et Veterinaire 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 Sensitisation Advocacy Mobilisation 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 Organisation 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 vi PHC Primary Health Care RAPLOA Rapid assessment procedure of Loa loa REA Rapid Epidemiological Assessment RPRG Regional Programme Reporting Group SAE Severe Adverse Events SCI Special Country Initiative SHM Stake Holder 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 WHO Regional Office for Africa WHO/NTD Neglected Tropical Diseases – Department within WHO cluster of communicable diseases (WHO/NTD) WV World Vision 1 Opening: Agenda item 1 1. The Director of APOC, Dr Paul-Samson Lusamba-Dikassa warmly welcomed all the participants of TCC33 to Ouagadougou and acknowledged the presence of the CSA Advisory Group members, Dr Hodgkin, Dr Ilunga, Dr Ndyomugyenyi, Dr Ali Mzige, and representatives from Burundi, Mme Ciza, Dr Nahishakiye and the APOC Technical Adviser, Dr Baza. Dr Lusamba informed the meeting that APOC has two new staff members, Mme Gissou, Finance officer and Dr F. Sobela, a Health Systems specialist. Two new TCC members, Dr Essomba from Cameroon, and Dr Michael Thiede, have been appointed by the WHO Director General. Dr Lusamba was pleased to announce that on 9 September 2011, APOC received the Champalimaud Foundation award of €1 million, presented to APOC by the President of Portugal in the presence of the Prime minister of Portugal and representatives of the Foundation among others. Noting that there were many items on the TCC meeting agenda, ranging from strategic and technical issues, financial matters to the outcome of CSA advisory group meetings, Dr Lusamba thanked the participants for coming and handed over to the Chair, Professor Mamoun Homeida. 2. Professor Homeida, Chair of TCC allowed the UN security coordinator to give a briefing on the security situation before formally opening the session. 3. Professor Homeida warmly welcomed the new Director of APOC, Dr Lusamba-Dikassa, expressing his confidence that Dr Lusamba’s wisdom would help the Programme in its move towards elimination. He gave a special welcome to the group from Burundi – Dr Ciza, the Governor of Rutana Province and President of the Rutana NOTF. Dr Nahishakiye, Medical Director of the Burundi CDTI Project and the APOC Technical Adviser to Burundi, Dr Baza and Dr Yebakima were still to arrive. 4. Before starting with the first item on the agenda, Professor Homeida noted that as a result of the change of paradigm to elimination, TCC has had to rethink APOC’s work – this requires TCC to spend more time considering technical and strategic issues. There were 48 Annual Technical reports to review, of which 14 were reviewed by email and the rest to be reviewed in plenary. Prof Homeida noted the importance of reviewing reports whilst observing that the Programme has matured and TCC should rethink how best to review them. One method is through the Technical review Committees (TRCs). These should be expanded into other countries in addition to Nigeria, Cameroon and Uganda so as to reduce the workload. When Technical Report reviews are presented to TCC this should be done briefly, just to bring issues of concern to TCC’s attention rather than to give all the details. The presentations should be 30 minutes maximum with 10 minutes of discussion. The Chair also suggested that Southern Sudan and Uganda could be linked together. Dr Fobi would be presenting summaries of the older projects submitted by email. The Chair suggested decreasing the age of accepting mature projects from 7 to 5 years so that more could be reviewed by email, thus reducing the TCC session by half a day for these reviews. With the shift from control to elimination, everything should focus on this aspect and TCC should therefore rethink how to present Projects/proposals. 5. Finally, the Chair noted that one person has contributed so much on science of interventions, socio- economic aspects, and RAPLOA, culminating in the RAPLOA map of loiasis distribution, providing their thinking regarding modelling and providing great support for the APOC Programme, and previously OCP. The Chair asked TCC to applaud Hans Remme for all this work noting that he is one of three significant people who have contributed to onchocerciasis control, including Brian Duke and Dr Awadzi. 6. All participants of TCC introduced themselves. 7. The full list of participants is appended as Annex 1. 2 Adoption of the Agenda: Agenda item 2 8. The agenda was adopted without changes. 9. The final agenda is appended as Annex 2. INFORMATION CSA – matters arising from the 132nd and 133rd sessions: Agenda item 3 10. Dr Lusamba-Dikassa reported on the 132nd CSA meeting held in Paris from 15-16 March 2011 and the 133rd meeting held from 19-21 July 2011 also in Paris. The main points arising from discussions of CSA 132 were as follows: (i) Regarding the Criteria and Guidelines for the certification of elimination of onchocerciasis, CSA recommended that WHO Legal could look into the process involved in the internal WHO approval of the criteria so that CSA can follow the same process; (ii) In relation to the search for a macrofilaricide, CSA agreed that Pfizer should continue with trials on moxidectin and encouraged TDR to ask Pfizer to do so. CSA further recognised that moxidectin has the potential to be an alternative drug to ivermectin and therefore supported the continuation of this trial; (iii) On TCC membership, CSA approved a request from APOC Management to consider Dr Michael Thiede from Germany as Health Economist in the TCC. 11. The meeting of CSA 133 revisited the issue of criteria and guidelines for the certification of onchocerciasis and agreed upon the following: (i) APOC Management should consult with OEPA to send a request to WHO-DG for setting up a Group of Experts; (ii) Search for a macrofilaricide: in view of the fact that Pfizer had pulled out of the Phase 3 trials, CSA recommended that a team should be set up to look into the available data and come up with a clear analysis to see if it is worth continuing; (iii) In relation to stopping ivermectin treatment for onchocerciasis control, there is a need for better coordination with the LF programme and getting all partners to meet and work out a common plan. 12. TCC thanked APOC management for the update. Update on activities of the NGDO Group: Agenda item 4 13. Dr Ukety presented an update on the NGDO group. The next (38th) meeting will take place in September 2011, after TCC33. The NGDO group has 15 members including 6 out of the 8 original founding members, plus three Associate members. Key activities in 2011 included involvement and financial and technical support of the group to APOC CDTI Projects. The group has contributed to the almost half billion ivermectin treatments given over the last 20 years. Regarding cross-border collaboration between Uganda and DRC, Dr Ukety emphasised the support given by the group contributing to the progress being made towards onchocerciasis elimination in Uganda. This support has involved the training 3 of technicians in entomology and strengthening cross-border collaboration between Uganda and DRC. Meetings were held to develop contacts between the authorities of Uganda and DRC and with the assistance of the WHO representative to Uganda official communications have been facilitated to the Minister of Health in DRC. 14. The NGDO group recommended: (i) Strong involvement of the APOC Director to facilitate a high-level cross-border meeting; (ii) That a side meeting be organised/facilitated by the APOC Director between the Ministers of Health of Uganda and DRC, or their representatives, at the forthcoming JAF meeting in Kuwait. 15. Generally, challenges faced by the NGDO group are finding partners for projects that do not have them; for example, 6 out of 20 projects in DRC lack partners. This challenge is being addressed in various ways, for example, SightSavers is being supported by UFAR and cbm is reinforcing staff within DRC and in Angola with APOC support. There is also concern over Lions Club support – they are not participating in meetings but still give grants to projects. Lions Club Foundation has agreed to partially fund the new Phase V Kitgum and Pader CDTI project in Uganda. The Malaria consortium is also providing support to NTD control in South Sudan. IMA will attend the forthcoming meeting in Nairobi, whereas Light for the World withdrew from the Group at the end of August due to limited resources. They will, however, continue to support the projects they have been involved with in Ethiopia for two years. 16. Additional funds and continued advocacy and involvement of high level officials are needed to support cross-border activities. In discussion it was noted that Lions Club in Cameroon and other NGDOS have decided to focus more on their key mandates of blindness control, especially in savanna zones where onchocerciasis causes more blindness. Generally, the financial crisis is leading NGOs to review their priorities and if CDTI Projects are not in line with these then they may lose NGDO support in some cases. 17. TCC recommended that the NGDO group could include Burundi in future cross-border meetings with DRC and Uganda. 18. It was noted that in Tanzania, the partners in NTD control are required to deposit funds in a common basket and this can lead to a lack of acknowledgement of NGDO support, especially at lower (District) levels. Governments should be encouraged to acknowledge all support that is given including that which goes to ‘basket’ funding. 19. TCC thanked Dr Ukety for the concise presentation and acknowledged the role of NGDOs in the partnership and they should be an integral part in the fight against onchocerciasis. Follow-up of the key recommendations of the thirty-second session of TCC: Agenda item 5 20. Dr Yameogo presented a summary of the status of implementation of recommendations of TCC32. This summary is given in full in Annex 3. Key actions that have either been initiated or completed by APOC Management as a follow-up to recommendations of TCC32 are outlined below: (i) Strategic and technical issues: a) From JAF16 on Vina valley Cameroon: it is suggested that follow-up to JAF16’s decision is done through a restricted group at TCC33; b) Arab countries to be invited and a film to be produced to seek additional funding from Arab countries in JAF17. 4 (ii) CDTI projects and technical issues: a) No treatment should take place in hypo-endemic zones co-endemic for onchocerciasis if prevalence of loiasis is above 40%, even in transmission zones. (iii) Others matters: a) Consultation on CSM and SHM (reported below); b) CSM as an integrated activity – APOC is looking at ways to do this; c) TRC reporting format; d) Filling the posts for TAs in DRC – being implemented; e) Closantel issue: efficacy of ivermectin – not implemented but a related publication by Cupp et al., (2011) was published recently; f) CDI curriculum manual – the first draft is available following a workshop on this topic; g) Training of entomological technicians; h) PATH collaboration and OV16 – update from Dr Domingo given below; i) TCC supported development of Moxidectin with Pfizer – Dr Kuesel will present on these issues; j) Ubangui Project Pilot mobile and bicycle donation for reporting SAEs TCC to advise on costing and partners. 21. Discussion points: Studies on Loa loa will be useful to determine the likelihood of SAEs occurring – information could be easily obtained if epidemiological studies of onchocerciasis carried out are coupled with a Loa loa study. There is a need for increased collaboration between the two programmes nationally and internationally. More guidelines for stopping ivermectin distribution in areas of LF endemicity are needed. There is a need to determine the impact of stopping onchocerciasis treatment where LF treatment is ongoing It was noted that strong collaboration between TCC and the board of AFRO, which is working on LF is needed, so as to advise partners and countries. The final decision of when to stop treating should be made by a national body, using the guidelines of APOC/MDP etc. 22. TCC thanked APOC management for the actions taken and made the following suggestions: (i) Conduct joint epidemiological evaluations alongside onchocerciasis evaluations to get a better idea of the distribution and impact of ivermectin on Loa loa; (ii) It is important to establish the impact and current situation regarding loiasis and it would be useful to publish the baseline data that exists; (iii) It was decided that the TCC sub-committee meeting suggested by TCC32 on the Vina Valley situation should not be pursued as it has been overtaken by events. 23. The full presentation on the implementation of the recommendations of TCC32 is attached as Annex 3. Consultation on Community Self-Monitoring: Agenda item 6 24. Dr Fobi described the process and purpose of CSM and presented an update on in-country consultations in Burundi and DRC and on a consultation on community-self-monitoring held in APOC in May 2011. 25. TCC considered it necessary to determine what impact CSM has had on the performance of CDTI, especially in terms of coverage and sustainability. Increased involvement of community members as supervisors of the activity would help the level of implementation of CSM. Questions of incentives are similar to those affecting all CDTI activities. The funding required for CSM is clearly not sustainable but should be provided for initiating the process, which should then be continued by communities 5 autonomously. With increasing co-implementation of other NTD control activities, integration of CSM with other Programmes is essential and will be more cost-effective. To this end, the CSM facilitators guide should be reviewed. APOC will hold a workshop in October 2011 to review training materials and encourage implementation of CSM using a standardised format. 26. Conclusion: There is some weak evidence that CSM may facilitate distribution of ivermectin but TCC would like more scientific evidence for this. 27. A sub-committee was formed to look into guidelines for CSM and establish if there is a need for revision. The sub-committee was also charged to form an impression of the impact of CSM on CDTI and to suggest research that is needed to look into the impact in more detail and finally to discuss the issue of funding for CSM. The sub-committee, reporting back to TCC at the end of the session would highlight if it is done properly and has value in terms of coverage and sustainability. 28. TCC thanked Dr Fobi for the clear presentation and the report of the committee will address the issues raised: (i) APOC management should obtain evidence on the value of CSM for improving its implementation; (ii) Review of CSM from technical reports and visit these communities in the field to collect the evidence. Recommendations of the sub-committee on CSM Presented by Dr Yumkella 29. Dr Fatu Yumkella presented the recommendations of the sub-committee formed by TCC to address the issues raised concerning implementation of CSM and the apparent lack of understanding of the purpose and value of this activity. The sub-committee considered that there is a need for a multi-country study, able to look at different situations and examine all aspects of CSM. As this would have a cost implication for APOC management the suggested 6-month timeline for the study would depend upon the possibility of finding the necessary funds. As TCC has members conversant with CSM such as Dr Yumkella, they should be asked to submit an outline for the study including field preparations and financial implications. TCC asked Dr Yumkella, with other TCC members to develop a protocol or terms of reference and recommended that countries should apply to be a part of the study. There should be one person to coordinate the study and partners would be selected from the participating countries. The TCC sub- committee was asked to put together a semi-final ToR and budget to be submitted to APOC management. Feasibility of elimination of onchocerciasis infection and interruption of transmission in Africa: Agenda item 7 a) Elimination of Onchocerciasis with ivermectin treatment Senegal and Mali study: 30. Dr Remme presented the final epidemiological and entomological results of evaluations of the multi-site study in Mali and Senegal designed in 2005 to see if elimination is possible. The first phase of the study consisted of an evaluation of the fall in infection during treatment. In the second phase, treatment was stopped in test areas. In the third phase, treatment was stopped in the whole project area and evaluation of the impact of previous treatments took place for at least two years. Yearly entomological evaluations took place and epidemiological evaluations were conducted in the first year to provide a baseline, followed by subsequent periodic evaluations. The criteria for stopping treatment were: an mf prevalence of less than 1% in 90% of villages and low vector infectivity of less than 0.5 per 1000 pool-screened flies. The foci of Bakoye, Gambia and Faleme were selected for detailed study. The initial results showed that there was still 6 a low prevalence of 0.84% infection in Faleme, which did not therefore meet the criteria for stopping treatment. Entomological data were very good everywhere: all below an infection rate of 0.5 per 1000 in the flies. In Phase 2, treatment was stopped in selected areas. In Bakoye, no fly infection was detected at all, whilst in the Gambia focus, results were the same, with zero infection for flies and epidemiological data showing 0% prevalence. In Phase 3, treatment stopped everywhere in 2008. Evaluation results for Phase 3 showed that in both the Bakoye and the Gambia foci, infection rates were zero and entomological results showed zero infection rates for all the flies. Follow-up results showed no recrudescence of infection – onchocerciasis is eliminated. 31. Collaboration with LF programmes was discussed in view of the problems that could occur with evaluation if combined ivermectin and albendazole treatments for LF were to continue. The LF programme started after onchocerciasis elimination – after such a long period of ivermectin treatment for onchocerciasis it is unlikely that any further treatment for LF would have been needed as this disease is also likely to have been eliminated. One argument for continued treatment for LF is that the LF Programme treats by District rather than in a defined focus, but in practice, most APOC treatment is also done by District. 32. The conclusion of the study was that evaluation levels were lower than the thresholds given in the guidelines and lower than the Onchosim model predicted. The risk of recrudescence of infection is practically zero, so ivermectin treatment alone has eliminated infection. 33. Conclusions: (i) TCC concluded that collaboration between onchocerciasis and LF programmes is vital at the National and International levels as APOC moves towards elimination of onchocerciasis infection and as ivermectin treatment will stop in some areas. There is a need to identify practical steps to initiate the collaboration between onchocerciasis and LF Programmes and TCC recommended that the Regional Programme Reporting Group (RPRG) and TCC should meet to set guidelines for this collaboration; (ii) TCC thanked Dr Remme for his presentation and congratulated him and the teams involved in the field work for having achieved such good results, including in the Faleme focus ; (iii) TCC recognises a need for further research to be done on using albendazole to treat LF after many years of ivermectin treatment. b) Progress towards onchocerciasis elimination in APOC countries 34. Dr Afework described epidemiological evaluations that have taken place between 2009 and 2011 in relation to the predictive Onchosim model for elimination of onchocerciasis infection and interruption of transmission as described in previous TCC meetings. In some foci e.g. in Tanzania, progress is faster than predicted. In Cameroon, however, Centre 1 and Littoral 2 projects still show a higher prevalence than expected. The latter project areas have a high prevalence of loiasis and this may have contributed to the high prevalence observed. In Centre 1 CDTI Project, in Cameroon, the mf prevalence and the rate of blindness can be very high. The expected prevalence of onchocerciasis ranged from 5-10% but observed data showed that it ranged from 30-70% after several years of treatment. During the evaluation exercise, data to verify actual therapeutic coverage was collected through interviews of people with respect to the 2010 MDA and going back 5 years. Among the 20-plus age group 37-82% had taken treatment and the average therapeutic coverage for many villages was only 40-45%. The supply of drugs to the villages had been a problem and people were not treated because of unavailability of drugs. Treatment registers were also lacking. Treatment data were fragmented with loose pieces of paper and notebooks being used to record it. There were also conflicts between District officials and within communities. Supervision was 7 inadequate but the NGO, HKI, had been working for 20 years in Cameroon. It was suggested that perhaps the project was more focussed on issues related to co-implementation rather than the core target of APOC. This survey in Centre 1 Project could signal how far the Programme can go with co-implementation without affecting onchocerciasis control. The problems detected in these projects need to be addressed quickly. They have theoretically received thirteen years of repeated treatment but the results correspond to what would be expected from only 5 years of treatment. The first case of SAEs in Littoral CDTI Project in Cameroon, occurred in August and onchocerciasis doesn’t have a big impact; the population may be more ready to receive treatment but the occurrence of SAEs has had an impact on people’s participation. 35. A second group of projects had a prevalence of between 30 and 10 CFML. Most of these projects show good results, however, Edo/Ondo Projects in Nigeria still have a high prevalence, despite reporting good treatment coverage. When visited, an assessment showed that the treatment coverage was poorer than recorded in the Annual Technical Reports. 36. The last group of Projects had a prevalence of between 3 and 10 CFML e.g. North Gondar, in Ethiopia, which has had only 8 years of treatment and Tanga in Tanzania. Most of these projects have results below the predicted level. In Malawi, the two CDTI Projects have zero prevalence, however, it was confirmed that in Mozambique, there are communities affected by onchocerciasis just across the border from the Malawi Projects. It was considered important to determine if treating in the main transmission zone would affect prevalence outside this zone, but in practice these areas had received treatment from the LF group so it was not possible to assess this. The results of evaluations carried out in APOC projects are summarised in the table below: Conclusion of evaluation Number of sites Elimination probably already achieved 11 Close to elimination 6 On track, but still some way to go 6 Total with satisfactory progress: 23 Unsatisfactory Progress 4 Total evaluated: 27 Discussion points: 37. The poor results and situation in Centre 1 Project in Cameroon were discussed at length although it was noted that the Project has had problems for some time. Supervision at the District level is poor and this information has been submitted to higher authorities in Cameroon by the NOTF but with no effect. 38. It was, however, observed on an optimistic note, that there has been progress in reducing the disease as a public health problem. Taraba is doing better than Onchosim prediction. Re-launching of CDTI is only taking place in communities where access was a problem – it is not general for all of the Taraba CDTI Project area. It was noted that the same problems may arise with Centre 3 Project, which is an area co-endemic for loiasis if coverage is low due to fears of SAEs among the population. 39. TCC observed that coverage rates given in Annual Technical Reports do not always reflect reality. 40. TCC recommended that independent treatment coverage surveys are important to verify coverage rather than relying on reports from Projects. 8 41. Although country led, the Programme should be proactive and TCC should write and share the available figures with the MoH so that a joint solution can be discussed and agreed upon; alternatively, TCC should arrange a country visit to see the project and discuss it with the authorities. It was suggested that a first step would be to carry out an overall review of the programme, prepare a report and prepare suggestions for improvements. It was therefore decided that APOC management should review the previous 4/5 years reports. If it appears that there is managerial weakness, such evidence would provide the rationale for the Minister to be contacted. c) Delineation of transmission zones – examples of Malawi 42. TCC 29 emphasised the importance of determining the extent of transmission zones; this involves investigating entomological aspects such as distance travelled by flies, availability of breeding sites, migrations, infectivity and influences of ecological factors such as deforestation. There is a need to understand species distribution, the impact of wind on distribution, physical features and breeding site characteristics. Cytospecies identification is necessary to determine whether populations are distinct or the same; this will also help to identify non-vector species. Prof Boakye described the background regarding genetic variation among Simulium spp. and the significance of identifying these variants in relation to transmission zones and the possibility of using chromosome analysis for determining risk. Distribution of cyto-species is less well known for APOC countries, as is their distribution and possibility of migration. There is a need for distribution data, so as to assess the possibility of re-population etc. The example of Malawi was given; Malawi requires increased capacity to conduct long-term studies, therefore training has been given in cyto-taxonomy, species identification and species distribution. Investigation of species distribution was conducted in two areas; this should have been done in both the dry and rainy seasons. Simulium thyolense appeared to be confined to the east side of the country. The situation in one area, close to the Mozambique border, is unclear. (i) Discussion point: The main points of discussion were the need to develop timelines for entomological assessments and the possibility of migration of vector species. Additional priority countries include Nigeria, in which people are currently being trained and DRC and Chad, for which training is planned. Cameroon also has migratory species and should be considered, especially in relation to cross-border regions with Nigeria; (ii) TCC thanked Dr Boakye for the update. d) Entomological studies for assessing transmission levels 43. Dr Yameogo presented an update on entomological studies for assessing transmission and highlighted the following: (i) The overall objective of the study: to assess the feasibility of interruption of transmission of O. volvulus in areas under ivermectin treatment alone or associated with focal vector elimination activities; (ii) Specific objectives include: putting in place technical structure and procedures to facilitate the implementation of the study; set appropriate catching points for the assessment of the level of infestation of S. damnosum spp. and S. neavei by O. volvulus; (iii) Activities carried out included the review and approval of the protocol finalised by the entomology working group; situation analysis; advocacy and sensitisation; training of technicians (training already conducted in Chad and Nigeria and Uganda is in the preparatory phase); supervision of activities; data analysis and decision-making; 9 (iv) Entomological assessments in Nigeria: preliminary data were collected in Cross River, Ebonyi, Kaduna Lere and Kaduna Birnin Gwari; (v) Preliminary observation from Chad: prospection for site selection undertaken in Bebedja and Danamadji in August found that potential breeding sites were few and not productive as the rivers were not flowing much. It is recommended that further prospection should be done in September before implementation of the assessment protocol; (vi) Recommendations include: accelerate launching of activities in Tanzania; assist Chad to identify suitable catching points; assist Nigeria to decide on number of catching points per evaluation site, recording and analysis; send an entomologist to Uganda to assist in reviewing the situation in order to accelerate assessment activities. 44. TCC comments: (i) TCC commended the researchers for the good and encouraging work although the results are still preliminary; (ii) There is a need to have sufficient numbers of flies to analyse; the staff doing this work must be adequately trained and appropriate sites must be selected and since transmission cases are found in streams during the rainy season it is better to do this exercise at that time; (iii) Countries must be informed that this is just a protocol, which must be adapted in accordance with the terrain; (iv) MDSC should be better prepared and ready to analyse the flies captured using the pool- screening technique when they receive them. 45. The following clarification was given by APOC management: (i) It is hoped to have a report to be presented to the forthcoming JAF though the final results will not yet be available as entomological evaluation will continue on some sites; (ii) Out of the 14 persons trained in Chad only 4 were good enough to carry out entomological evaluation; (iii) APOC can develop a proposal and come up with a budget to include financing in the protocol; (iv) The technique of pool-screening will have to be improved but generally, the idea is to develop this technique in areas where the studies are carried out and install laboratories in these countries. 46. TCC thanked Dr Yameogo and looks forward to the results. e) Elimination of Onchocerca volvulus infection: New diagnostics of PATH: 47. Dr Domingo thanked APOC for the opportunity to provide an update on the PATH project to develop a rapid Ov-16 test. The test detects antibody response (IgG4) in people to the Onchocerca volvulus antigen Ov-16, as such does not distinguish between past and current infections. Data were presented to show progress in the product development. A request was made by Dr Domingo to engage with APOC at this point for the development of the Ov-16 rapid test. Separately, PATH would like to start discussing with APOC the field study design for evaluation of the test due to start in October 2012. Dr Domingo updated TCC on discussions with APOC and MDSC staff specifically (i) to collaborate with Dr Afework on collecting temperature and humidity exposure profiles on surveillance trips, and participate at an upcoming surveillance trip as observer, (ii) early discussions with Hans Remme regarding developing demand projections for a test for post-elimination surveillance, and (iii) early discussions with MDSC for performing components of the field evaluations in Burkina Faso. PATH will continue to provide APOC with updates on all its activities. 10 48. Discussion: Dr Domingo clarified that PATH is a Non-profit organisation, it doesn’t commercialise anything. The project to develop a diagnostic antibody test based on the Ov16 antigen is funded by BMGF and is not an active infection test. Tests on people who have cleared the disease could still give a positive signal. The test is the same as that being used in Uganda and in the OEPA region. The company selling the LF test is no longer making it available. The test will give some false negatives – there are people who don’t develop antibodies – but so far no false positives have been detected in tests. As PATH doesn’t manufacture the test it will be necessary to transfer the technology to a company in order to make the test available. The target for the test is to use it in foci where elimination is going to be certified and this will require many people to be tested for a number of years. An antigen detection test, detecting a present infection, would be very useful but has not, so far been developed. 49. TCC thanked Dr Domingo for his presentation on the development of the OV16 diagnostic test for onchocerciasis by PATH and the process that would be involved in its eventual commercialisation. Macrofil and Research: Agenda item 8 50. Dr A. Kuesel (WHO-TDR) presented an update on Moxidectin development, Ivermectin Response Markers and the DEC Patch test. a) TCC supported development of Moxidectin with Pfizer: 51. Development of moxidectin was conducted in collaboration between WHO and Wyeth. In 2009, Pfizer acquired Wyeth. As of July 4th 2011, Pfizer is no longer a co-sponsor of the moxidectin development program. WHO/TDR will assume responsibility for managing all related clinical trial authorization activities for moxidectin. Consequently, all communications regarding moxidectin clinical trials should be directed to WHO/TDR. WHO and Pfizer remain valued partners in health care and will continue to collaborate in other important program areas like eliminating blinding trachoma by 2020. A TDR and APOC convened External Advisory Committee (EAC) met on 10 September 2011 to review the data available on moxidectin to-date in view of the need to identify a new license holder, manufacturer and donor for moxidectin, the new knowledge about the effect of CDTI on transmission and the status of implementation of CDTI in APOC countries. The EAC was asked to advise WHO on whether and how to proceed with moxidectin development. The EACs principal recommendations were: (i) If the Phase 3 study data confirm that moxidectin is a more potent microfilaricide than ivermectin which results in a prolonged period of very low microfilaremia/ amicrofilaremia, moxidectin will be an important tool for APOC / national onchocerciasis control programmes to interrupt parasite transmission faster than possible with ivermectin:  Transmission after a dose of moxidectin would be reduced relative to transmission after a dose of ivermectin or even stopped for around 6 months. This would result in a lower rate of new infections. A lower rate of re-infection will reduce the number of years of treatment needed for permanent interruption of transmission irrespective of whether moxidectin has a macrofilaricidal or permanently sterilising effect;  The long period of amicrofilaremia after moxidectin treatment would ensure a significant impact on transmission even when treatment occurs outside the time window optimal for reducing transmission, i.e. just before the start of rainy season. This is important since timing of mass treatment is community directed (and/or subject to logistical factors);  6-monthly treatment with moxidectin treatments could result in very low or no transmission throughout the year;  Moxidectin would accelerate reduction/permanent interruption of transmission and be of value particularly in post-conflict countries where CDTI was initiated much later than in other APOC countries. 11 (ii) The histopathology data do not allow conclusions about the mechanism that leads to the differences in skin microfilaria levels after moxidectin and ivermectin treatment and provide no definitive evidence on macrofilaricidal or sterilizing activity of moxidectin. This is not surprising given that all indicators of viability or reproductive activity are qualitative or semi-quantitative, the timing of the nodulectomies (18 months) and the sample size. The histopathology data should not discourage continuation of moxidectin development. (iii) The incidence of Mazzotti reactions which occurred in a statistically significantly higher proportion of subjects treated with moxidectin than ivermectin (pruritus, rash, itching, severe asymptomatic postural hypotension) is not an impediment to mass treatment. Severe Symptomatic Postural Hypotension (SSPH) occurred in a higher proportion of moxidectin than ivermectin treated subjects, but the difference was not statistically significant. Depending on the results of the Phase 3 study, more emphasis than for CDTI may have to be given during moxidectin mass treatment implementation on appropriate information and education. (iv) WHO should continue development of moxidectin in the most time efficient manner all the way to completion of the community study, provided that the Phase 3 data and the paediatric study data confirm current data on efficacy and safety of moxidectin. (v) TDR should ensure that the paediatric study is initiated as soon as possible and can be conducted with the drug manufactured for the Phase 3 study to avoid delays and additional costs due to identification and qualification of a new manufacturing site and conduct of a bioequivalence study. (vi) WHO should negotiate with Pfizer to obtain all rights for use of moxidectin for NTDs and all related data, technology, and knowledge, including the methods and costs for manufacturing of the human formulation developed by Wyeth at the scale required for use by control programmes. This will avoid further delays in moxidectin development and WHO having to spend money for redoing work already done by Wyeth or Pfizer. It will furthermore facilitate finding a license holder and donor, in particular once all data as per development plan are available. (vii) Evaluation of the safety of moxidectin in Loa loa co-infected subjects should be initiated with testing of moxidectin in animals experimentally infected with Loa loa (not included in current cost estimates). Decisions on further evaluations will be guided by the outcome of this study. (viii) TDR should develop a plan to assess the efficacy and safety of moxidectin in LF. (ix) TDR and APOC should jointly initiate the search for a license holder and donor immediately. Lack of a license holder and donor should, however, not delay studies and other work required for obtaining a recommendation on control programme use. b) Ivermectin response markers: 52. This project aims to assess whether long term use of ivermectin results in selection of O. volvulus with a reduced sensitivity to the embryostatic effect of ivermectin by identifying genetic differences between O. volvulus from previously untreated subjects and previously treated subjects with different extent of repopulation of the skin after ivermectin treatment. If such differences are identified and subsequently validated, the project aims to develop a diagnostic tool for surveillance by onchocerciasis control programmes and build the capacity at MDSC, in Ghana and Cameroon to support use of the tools 12 by control programmes and data analysis. The work was initiated in 1-2Q2011 in collaboration between researchers in Australia, Cameroun, Canada, France, Ghana and at the MDSC. As a first step, the whole genome of O. volvulus was sequenced and is now available to all investigators at an FTP site. Bioinformatic analysis of 800 differences in genome sequences between parasites from untreated, 'good responders' and 'poor responders' from Ghana and Cameroon is ongoing. MDSC has verified that archived parasite samples from areas with different levels of endemicity, forest/savannah, different vectors and different ivermectin treatment history can be used for genetic analysis. Thus, these samples, as well as microfilaria samples collected during ongoing APOC epidemiological evaluation since 2009 will be available for validation of genetic differences resulting from the bioinformatic analysis. 53. TCC thanked Dr Kuesel for the update and made the following observations: (i) The Advisory committee has recommended that the Moxidectin and IVM response marker studies continue but the funding requirements must be assessed. APOC has invested US $700,000 each year and TCC now has to decide whether moxidectin is a drug worth pursuing, and if so, where can we find a license holder? TCC accepted that the project should be completed provided that sufficient funds are available. TCC noted the strong support for continued development by TCC32. The drug would be of value for recently started CDTI projects especially as the programme currently depends upon a single drug. A drug that brings mf prevalence down to zero for several months will be very useful; should resistance to ivermectin be confirmed, moxidectin could be given in such cases. Moxidectin could also be useful in countries co-endemic for Loa loa if it is found to be safer than ivermectin. In that case it would be a breakthrough for LF control Programmes, especially in Central Africa where there is Loa loa. (ii) Regarding feasibility of funding continuation of the project, US $2.4 million would be needed over a period of four years to provide all data required for a recommendation on whether or not moxidectin should be included in onchocerciasis control programmes, i.e. completion of the Phase 3 study, conduct of the paediatric study (the last study required for registration and also a prerequisite for conduct of the community studies as currently planned) and conduct of a 1-year community study. This estimate does not include assessment of safety in Loa loa co-infection and assumes that no drug-related work conducted by Wyeth and Pfizer needs to be repeated and that the study drug will be manufactured exactly as for the Phase 3 study. (iii) In addition there would be the cost of developing an ivermectin response marker, which would require an additional $6-700,000 per year. 54. TCC endorsed the EAC recommendations which are consistent with TCC 32 recommendations. TDR and APOC need to mobilise the funds required, taking into account the financial requirements for continuation of the Ivermectin Response Marker project. 55. TCC endorsed continuation of the moxidectin project with APOC and TDR support. 56. TCC noted that testing the safety of moxidectin in Loa loa-infected Baboons could provide very useful information. c) Update on the availability of the DEC patch test: 57. TCC was informed that progress has been made with negotiations on manufacturing of the DEC patch test for APOC but that some technical issues are still being negotiated. 58. TCC stressed again that the availability of the DEC patch is urgent and becoming more urgent every month. 13 Report on the 45th Mectizan expert Committee meeting: Agenda Item 9 59. Dr Ogoussan described the Mectizan Donation Programme, which was established in 1987 and the process for drug procurement. Estimates of the numbers of tablets to be shipped to countries are based on population censuses, numbers of people treated previously and usage of previous supplies of tablets. The number of tablets approved for treatment is based on a calculation using 2.8 tablets per treatment. 60. Albendazole is shipped by boat to countries and ivermectin by air, which is why both drugs may not always be shipped to the country simultaneously. It is necessary to order 6 months ahead in order to avoid delays. 61. Guidelines are provided for any sort of drug procurement – the procurer must know the process. APOC/MDP mission on SAEs management in the Democratic Republic of Congo: Agenda Item 10 62. The objectives of this mission were to: (i) Convey MEC /AC 45th and TCC 32 recommendations regarding projects in co-endemic Oncho and loiasis regions in DRC; (ii) Assure that provision is made to apply the guidelines; (iii) Preparation for a workshop on CDTI and appropriate management of Severe Adverse Events (SAEs); (iv) Participation in the DRC Neglected Tropical Diseases strategic plan validation. 63. Participants were representatives of 18 out of the 20 projects in DRC, the NOCP and National Onchocerciasis working group; Representatives of some divisions of the MoH: Pharmacy & Primary health care, NGDO partners: CBM, IMA, Lions Club International, APOC: NTD advisor and MDP. 64. Each coordinator presented the project activities followed by discussion. In summary: (i) Geographical coverage ranged from 45% (Ubangi Sud) to 100%; 8 projects had not attained 100% GC; – Therapeutic coverage ranged from 42% (Ubangi Sud) to 82%; – 4 projects attained the recommended 80% coverage: Bandundu, Ituri Nord, Katanga Nord and Sankuru. (ii) Justification: slow extension to the co-endemic areas; (iii) The time available was insufficient to properly review weaknesses and opportunities for projects which had not attained coverage goals; (iv) In the 2010 MDA, 33 SAEs occurred in Ubangi Nord and Sud projects and with better outcome: no deaths; (v) Four co-endemic projects planned to extend MDA to new districts or health zones in 2011: these are Tshopo, Ubangi Nord, Ubangi Sud, and Kasongo; (vi) Uele project is scheduled to extend MDA to new areas in 2012; – The meeting carried out a Budget Gap analysis, Training, surveillance/supervision; – SAEs management. 14 (vii) There is a funding gap of $100,318 (APOC 70% & MDP); – US $21,642 :for Ubangi Nord project; – US $18,811 for Ubangi Sud project; – US $10,452 for Kasongo project; – US $23,498 for Tshopo project; – US $8,225 for the focal points of the SAE Unit; – US $17,690 for DRC National programme activities at the central level. 65. Main priorities were to reinforce ownership by government, improve coverage and extend access; reinforce the monitoring and evaluation and promote operational research. 66. The total provisional budget for the 5 years was: US $115,819,338. Review of Operational Research Proposals: Agenda Item 11 a) Introduction 67. Operational research proposals were introduced with a brief statement of the status of accepted proposals that are in progress. 68. TCC asked APOC to provide a summary of operational research projects and funds given from 1996 to the present, at the next meeting of TCC. b) Reviews i). Assessing low female participation and opportunities for increasing their involvement in community-directed treatment with ivermectin in Zamfara State, Nigeria. Investigators: Enwezor, F.N.C. et al. Reviewer’s comments and conclusions: 69. The study aims to investigate factors determining the low participation of women in Zamfara with the potential of informing processes to increase their engagement in CDTI. The Introduction is appropriate and situates the topic of study in the broader context of controlling onchocerciasis. The Background and Rationale are also written. The team makes reference to the project coverage and the limited engagement of women in CDTI activities. Treatment coverage is 81% so perhaps the key question to ask is: how has lack of women’s participation affected coverage? The team notes that: ‘to measure reliable coverage, compliance and sustenance of the CDTI programme, there is a need to increase significantly the level of women’s participation’ – the cited data does not support this assertion. Research questions: 70. All these are satisfactory. The team should consider asking the question: What would be the value added of increased female participation? General and specific objectives: 71. These are satisfactory but the use of the qualifier “if any” is not necessary. Methodology: 72. The sample size calculation generates an N of 142,985 but it is not clear how this is reduced to 1,700. 15 Study site: 73. This is well defined. Data collection and management plan: 74. Well defined with a clear indication of which questions would be addressed through the different tools. Budget: 75. This is unrealistic given the various study instruments: 10 days are budgeted for data collection with 3 researchers: (i) 1,700 household questionnaires, (ii) 74 in-depth interviews, (iii) 8 focus group discussions. Study tools: 76. The household questionnaire could be expanded to include questions on factors that influence women’s participation in CDTI. Assessment: 77. Although the participation of women is a key concern for CDTI projects, the current project has high treatment coverage at 81%. It is not clear how increased female participation would contribute to the project coverage. The budget as provided will not be adequate for the proposed activities. Recommendation: 78. Although gender is an important issue for CDTI, the rationale provided does not justify the study. The team could be encouraged to compare this project site with another Islamic site with low treatment coverage to understand the factors determining coverage including gender. 79. TCC rejected the Proposal. ii). Migratory patterns of the nomadic Fulani herdsmen and their default and uptake of ivermectin in Ardo Kola LGA, Taraba State, Nigeria. Investigators: Alamveabee, E., Idyorough, H. M., Olamiju, F. & Apake, E. Reviewer’s comments and conclusions: Observations 80. This study aims to establish the social organisation of a nomadic tribe (Fulani) and its pattern of movements, the behaviour, attitudes, acceptability towards ivermectin distribution and willingness to participate in and uptake of ivermectin. 81. The locality selected is an LGA within Taraba, which is hyper-endemic with onchocerciasis. The LGA is selected because of the low therapeutic coverage. 16 82. The authors’ description of nomadism in general is good but lacks information about the particular clan being targeted for the study. 83. The research questions are about why ivermectin coverage is low in this area even in comparison to similar nomadic tribe in the neighbouring LGA. 84. So the title of the study being about nomadic Fulani herdsmen and their default is misleading. The authors themselves admit (P.5) that the absenteeism in this LGA may not be explained by migratory nature of Nomadic Fulani since there is an LGA with Nomadic Fulani performing reasonably well and another of a similar nature performing poorly. An appropriate methodical approach could, therefore, be to set up a comparative study between these two LGAs. 85. The study is now set into 4 phases with field testing of instruments, baseline data collection, intervention phase and final study phase. While the instruments are outlined and research design and baseline of data collection has been pre-determined “i.e. introduction of the kinship system” thus assuming that the nomadism is the cause of the low coverage. The intervention itself is not well described. 86. The questionnaires try to capture too many variables and in this way become less focused and much of the same questions are used for the individuals/CDDs and leaders. It is also not clear who will respond to the questionnaires at the household level. The team plans to review records but it is not clear what period this review will cover. Assessment: (i) The research question should be narrowed to find out why this specific LGA with nomads is not achieving the same level of treatment coverage similar to LGAs with people of similar social structure; (ii) The best approach is, therefore, a comparative study; (iii) The comparative study could be then approved in two phases:  The baseline phase -with the development of instruments appropriate to answer the question regarding the factors that determine low treatment coverage then analysed to inform interventions;  Intervention phase - in the light of the results design, implement and evaluate an intervention. Recommendation: 87. TCC rejected the Proposal in this format and advises the team to resubmit in light of the above comments. iii). Female participation in the CDTI Programme in Oyo State, Nigeria. Investigators: Uchendu O.C, et al. Reviewer’s comments and conclusions: 88. Response to TCC 32 Reviewers comments: (i) Meaningful responses were provided to comments of the reviewers provided at TCC32; (ii) Effort were made to address the gaps identified (for example, schedules have now been developed to assess the CDDs own perspective and for the review of relevant health facility records). 89. The context and rational for the study have been adequately addressed in the Introduction and the Objectives are clear, however, the proposers are advised to expand Objective 1 to read – “To assess 17 community knowledge about CDTI and perceptions of female participation in CDTI activities in selected LGAs in Oyo State.” The Methods are clear and the study Design is responsive to the objectives, however, there is a need for the project statistician to review the calculation of sample size. As it is, the sample size is based on the percentage of WOMEN participating in the selection, based on Uganda’s experience. For this study the respondents are ADULTS in selected households. The statistician should re-assess whether the calculation of sample size is valid. The sample size is 730 respondents - approximately an equal number (370) in each LGA? Study population: (i) There is a need to take steps to make sure that the number of respondents is not skewed in favour of one gender. For example, what if 80% of consenting respondents are males? (ii) Attempt to be more strategic to obtain gender balance, for example by selecting one adult male in one HH and a female in the next. (iii) It might also be useful to keep track of number of respondents who declined to take part in the study by gender and by reason. 90. The content of instruments described for data collection responds to the objectives. However, for the HH survey, there should also be collection of some qualitative data in order to get a better idea of the reasons behind perspectives bearing in mind that these results will be used to develop strategies to improve female participation. The qualitative data will be particularly helpful to re-design IEC messages so as to attract more female CDDs. 91. Suggestions for consideration to improve on tool content were provided in the body of the text using track changes. (To be sent to Proposers). Proposed methods are standard and appropriate. (i) Suggestions provided to address anticipated challenges; (ii) Dissemination plans are acceptable. However, the suggested time frame - within one month - seems too short - within three months – would be more practical, subject to timely analysis and documentation of findings. 92. The work schedule for Data collection implies that data collection will last for 8 weeks (60 days) assuming data collection takes place over the weekend. This is not consistent with the similar line item in the budget, which indicates 30 days. Whichever is correct, the time allocated for data collection is rather long. Therefore it is advised to reduce the number of days allocated to data collection and increase the number of days allocated to data management, to account for the increased level of effort that will be required to manage additional qualitative data. Adjust the budget accordingly but for the same budget total. 93. The number of days allocated for data collection needs to be re-checked as this has budget implications. Recommendation: 94. TCC accepted the Proposal incorporating the changes suggested above. (it was provisionally accepted by TCC30). 18 iv). Increasing community participation in community-directed treatment with ivermectin in communities in Benue State. Investigators: Professor Mrs. E. U. Amuta et al. Reviewer’s comments and conclusions: 95. The rationale for the study is justifiable and will help address operational issues in this CDTI project. 96. Although the proposal does not mention ethical clearance the NOTF would need to confirm that this research has obtained the required ethical clearance for the study. The objectives are clear and will address the research questions. The study area is defined and comprises three study sites selected from the three senatorial zones in Benue State, Nigeria. These sites will be 9 Communities that are already benefiting from CDTI intervention. More information is however required on the sampling method and sample size. (i) The study design is suitable but more information is required on the analysis tools that will be employed; (ii) The research in its current form only involves collecting information at the community and Health facility levels; however, administering tools like H-form on the LGA and even to State officials will provide a more holistic view of the issues and avoid a skewed view of community perceptions; (iii) Data collection tools are clearly defined and appropriate for the study; (iv) Adequate Information is not provided regarding report writing and dissemination of findings; (v) The work schedule is provided and input has been made using track changes; (vi) A budget adjustment will be made in line with the work plan adjustment. 97. The reviewer’s recommendations are as follows: (i) That this research proposal be accepted with minor changes; (ii) That the research proposal be approved for funding when the corrections highlighted above have been effected; (iii) Disbursement of funds should be made in two instalments. The first one when the corrections have been effected and the second one when the first phase of the report has been received and reviewed. 98. The reviewers provided input to the Study Work plan, which should be provided to the proposers as feedback. 99. An Interim report should be sent to reviewers. 100. TCC accepted the Proposal. 19 v). To identify factors responsible for CDDs attrition in Gombe state, Nigeria. Investigators: DR. Y. Fayomi, C. Okoronkwo & M.A. Igbe: Reviewer’s comments and conclusions: Context: 101. Very few studies have been conducted regarding attrition rates and reasons for attrition of CDDs. CDDs attrition of 40.6% was reported in Abia and Imo states CDTI project in Nigeria. 102. In Gombe State there have been reports that the CDDs selected by the communities for distributing ivermectin are opting out. 103. The State has begun co-implementation of Ivermectin and Albendazole for Lymphatic Filariasis. Justification: 104. Gombe state is making efforts to select more elderly persons for training as CDDs because they are of the belief that the elderly have lower tendencies of opting out as CDDs. 105. The outcome of this study will be used to address the problem of CDDs attrition to improve CDTI and will be beneficial to society at large. Observations: 106. The Proposal is highly relevant with a satisfactory Justification and review of recent literature. The Objectives and Research questions are clear. Methodology : Data collection/analysis/Quest/Consent form/Ethical considerations: OK (i) Give specific selection criteria for interview, (ii) Provide the CVs of investigators and their role in the study; (iii) Define ‘elderly person’. Conclusion: 107. This is a relevant and scientifically sound proposal although the budget was judged to be too high. Recommendations: 108. TCC accepted the Proposal subject to complementary information being provided on the CVs of the investigators and their role in the study and more detailed justification for the budget. vi). An assessment of counterpart funding for CDTI activities in Oyo State, Nigeria. Investigators: Adebayo A.M. et al. 109. Response to TCC 30 Reviewers comments: (i) The TCC30 reviewers comments were not adequately addressed; justification for the study remains weak; (ii) An effort was made to address gaps identified; however, the CV for the social scientist was not attached. 20 Introduction including Rationale and Literature review 110. The introduction and literature review were informative; however the existing reports for CDTI projects in Oyo State provide information on budgets for CDTI and amounts disbursed annually at each level. It would have been useful to at least cite the current level and pattern of funding for CDTI at LGA level to strengthen the justification for this study. Furthermore, the team has cited old literature – the review would have benefited from more recent and relevant publications. Objectives: (i) According to the general objective this study seeks to EVALUATE, the nature and extent of counterpart funding. (ii) Specific objectives are many, vague and repetitive; in our view, objectives 1 and 2 can be merged, objectives 3, 4 and 6 can also be merged to read ….. “To analyse the sources types and level of counterpart funding ….. and implications for sustainability for CDTI” (iii) There is lack of consistency in the duration of evaluation – is it over the last three or five months? Study design: 111. The design is weak; this type of study requires a combination of quantitative and qualitative study. To address the objective, which seeks to analyse the sources and level of funding, this will require documentation of quantitative data, using a checklist similar to the checklist in the APOC reporting format –Table 13. It is not clear why multi-stage sampling will be used for the sample population and the inclusion criteria are not necessary. Materials and methods: Study population: (i) Why limit the study population only to LGA management and the Oncho Control Officer. Are NGOs involved with CDTI? If they exist they should be surveyed as well; (ii) The number of people to be involved in the study is not provided (an estimate would have been useful); (iii) The data management process is not well articulated. For instance, it is stated that “all investigators will read through the transcribed noted and develop themes” – it is not clear how many researchers will be reading through how many transcripts. Data collection: 112. The proposed tool content for the informal interviews is rather vague, and needs to be developed further by adding probe type questions. 113. The interview guide is poorly constructed. It has many closed questions and does not address the key evaluation issue of sustainability. 114. The checklist should be carefully thought through and should build on APOC table 13: Obviously data to complete the checklist can be extracted from existing records maintained at LGA level and/or documented in APOC reports. Reviewer’s comments: 115. This proposal has not been clearly thought through. There is no reference to the current status of the project. The background information should have presented information on the current level of funding and the sources of funds. The objectives are not focused and this has resulted in a weak study design. A mix of quantitative and qualitative tools would provide a good understanding of the funding situation, while 21 holding in-depth discussions on the potential for leveraging counterpart funding. The current scope of the study does not fully justify a level of effort of up to six months duration of the study (roughly 6 months) and a budget close to US $10,000. 116. TCC does not accept the proposal. 117. The proposers will receive guidance from TCC members and may resubmit the proposal with no guarantee of acceptance. If relevant then TCC members should help to improve the quality of the proposal. If it isn’t relevant it will then be rejected. TCC members should be able to visit researchers to assist and guide them. c) Update of the A-WOL Consortium’s plans for implementation of macrofilaricidal drugs and regimes in targeted communities Presented by Dr David Taylor AWOLS Goals: (i) To find a new anti-Wolbachia treatment compatible with MDA programmes for onchocerciasis and lymphatic filariasis; (ii) To find the best regime with existing antibiotics for use in restricted settings (e.g. for use on potentially drug-resistant parasites, in Loa loa co-endemic areas, for the MDA end game); The following filarial parasites are targets:  Wuchereria bancrofti  Brugia malayi  Onchocerca volvulus  (Dirofilaria immitis – Heartworm) All populations Wolbachia +ve Loa loa has no Wolbachia Anti-Wolbachia therapy, consisting of a 4 week course of doxycycline results in: (i) Complete block of embryogenesis, (ii) Slow decline of microfilarial load, (iii) Blocks transmission, (iv) Permanent sterilisation, (v) MACROFILARICIDAL @ 12-24 months, (vi) Improves pathology:  Skin disease  Hydrocoele  Lymphoedema Key benefits to elimination programmes for LF and onchocerciasis: (i) Dramatically reduce programme timeframes, (ii) Sub-optimal efficacy or potential resistance hotspots, (iii) Usable in Loa loa endemic areas without risk of SAE, (iv) Improved morbidity management, (v) Endgame mop-up - where elimination is the goal. A∙WOL II - to deliver in 2017: (i) A∙WOL Hit-to-Lead-to-Candidate - Paradigm Shift, (ii) A∙WOL + A∙FIL - Optimized Regime, (iii) A∙WOL Implementation – Alternative or Complementary Control Strategy, (iv) A∙WOL Management, Advocacy & Outreach - Adoption by Control Programmes. 118. TCC noted the work on Wolbachia and encouraged the team to proceed with this work so that they can develop a safe and effective drug. 22 119. With respect to the independent work done in Littoral 2 in Cameroon, (Sam Wanji), TCC should be given the detailed results of this study where doxycyclin was used and later, ivermectin treatment was given. There should be a follow-up on the women who were given this dose and who may have been pregnant to see if there were any adverse effects. Training of NOTFs in management and analysis of data: Agenda item 12 120. Mr Zoure described activities for training NOTFs in the management and analysis of data. He noted that since data management training started, there has been a significant improvement in the availability of computer equipment for conducting training. (i) The general objectives of the training given were to improve the availability of CDTI data in countries and at APOC Management level and to strengthen the capacity of NOTFs in the management and statistical and spatial analysis of data. Specific Objectives were: (i) To support the NOCPs in developing standard forms for collection and reporting of data from community to national level.  Explain to project staff the definition and importance of key CDTI indicators/variables;  Agree with the NOCPs formats, chronograms and ways of regular channelling of data from the communities to the national and APOC levels;  Train the NOTFs staff in the use of a statistical software package;  Train the NOTFs staff in the use of a Geographic Information System software package;  Promote the use of data for decision-making in order to motivate sub districts or communities that do not perform well in terms of treatment coverage. 121. Mr Zoure described the types of software available for data management and analysis that are used during APOC training courses. Challenges to improve data management in countries included the capacity of NOTF secretariats to manage computerised databases, for which it is recommended that Ministries of Health recruit data managers with a degree in information technology. As software is expensive and not always available, it was advised that open-source software such as Quantum, GIS and R could be used as alternatives to ArcGIS and SPSS. Improved supervision and in-country computer training funded by APOC were measures that could be taken to improve the quality and reliability of data. 122. TCC advised that validation of data in country should continue to be emphasised during training; countries should validate their own data as they are more familiar with what is happening in the field. The elimination strategy would require a database system to be put in place in the field. 123. TCC noted that the emphasis was on quantitative data but it would also be useful to include more on qualitative data and to sensitise programme managers on this aspect which could be of benefit for reporting other activities such as CSM. 124. TCC thanked Mr Zoure for his presentation. Main findings of the CSA advisory groups: Agenda Item 13 125. An advisory group was set up with three sub-groups, to address the issues of elimination, co- implementation and options for the future of APOC respectively. The goal is to report back to JAF in December on each of these issues. The Chair of TCC suggested that it would be good for the sub-groups to present their work to TCC first and then CSA will consider this report when they meet in October and accept the report for presentation to JAF. The findings of the sub-groups touched on the future of 23 onchocerciasis control generally, not just on APOC. Dr Sam Adjei is the Chair of the advisory group and also chaired the external evaluation. 126. The Chair of the advisory groups introduced the presentations by each of the sub-groups. a) CSA Advisory group on elimination: Presented by Dr Hans Remme 127. Dr Remme presented the preliminary report of the advisory sub-group on elimination. The objective was to give some technical insight on predicting the end date of ivermectin treatment for APOC projects. The conceptual framework for elimination was reviewed to explain the process. The timeframe depends upon the initial prevalence level. The highest cmfl prevalence for a project is always taken for determining the timeframe. Treatment history, coverage and duration of treatment are the other important parameters for this analysis. Project treatment maps have been digitised and improve knowledge of treatment areas. Maximum nodule prevalence is known but has to be converted to cmfl. Treatment history reported is available in a database and Onchosim allows predictions to be made giving the end dates of ivermectin treatment. 128. The results show that only a few areas still need treatment (as indicated on overlaying maps). The next NOTF meeting will discuss each project map in detail so that they can be finalised. CMFL prevalence has been calculated using data to determine the relationship between the two. Then nodule prevalence map can be converted to a cmfl map. The results of this show that DRC is the most difficult area together with the Vina valley in Cameroon and the area of bad treatment coverage already discussed in the Centre 1 CDTI Project in Cameroon. In Ruvuma, Tanzania, there may also be a challenge due to the high prevalence of infection. 129. A database of corrected therapeutic coverage has been constructed combining therapeutic and geo coverage. The first years of a CDTI Project often have poor coverage but this then improves. Map of years of treatment are available. Only years with at least 60% coverage are used to create a second map, to calculate the average coverage which can be used as an indicator to predict the future outcome. 130. Onchosim has been used in collaboration with Rotterdam to give predicted probabilities of elimination – the model uses thousands of iterations. The predictions fit with observed data quite well. The projects can be classified in a similar way. 29 projects had a cmfl below 19; 43 fall below 10 and 30 cmfl so in all those it should be possible to achieve elimination within 15 years – that is 1/3rd of the APOC projects,14 Projects have a cmfl above 70; 12 of these are in DRC. A final map has been created showing the predicted end date of treatment. A treatment area map shows areas that should be treated but are not – there needs to be an investigation to see if these are transmission zones. They include areas of 10-15% prevalence and 5-10% categories. It was agreed that if prevalence was nowhere higher than 5% it cannot be a transmission zone. There is a map of these possible areas for extending treatment. Some of these areas may be artificial – some may be true foci. There are false ones in the Rufiji basin in Tanzania – so further investigations of such areas will allow the map to be improved upon. The estimated area contains about 5 million people - up to 20% of the number of people currently treated but it is likely to be much less. 131. TCC thanked Dr Remme for his presentation. 132. Discussion points: There are three determinants for stopping treatment. Progress and timeline towards elimination. APOC has evaluated this progress and data has confirmed modelling. Good progress towards elimination has been made in 23 projects and we are close to elimination in 16 projects. No country will be ready to achieve elimination by 2015. 133. Three years of surveillance are needed to certify elimination although some may be able to stop treatment. By 2020, treatment will be able to stop in a number of countries with national elimination. The periphery of the map will have shrunk but not the centre. 60 million people will have been protected by 24 2020 and in 11 countries, so the committee recommends extension of APOC from 2015 to 2020 to achieve this. Reviewing the status of each APOC country, TCC recommended continuing in countries not achieving elimination so as to prevent cross-border transmission. The analysis will also consider ex-OCP countries that were not yet included. There are challenges to this work. 134. Twice yearly treatment is recommended for some areas. Alternative strategies and the use of new diagnostic tests could contribute to elimination. The process of certifying elimination was described. As LF mapping has not been completed there needs to be more collaboration between the two programmes. 135. New strategies and twice-yearly treatment should be considered for countries that will not achieve elimination until 2025 so as to speed up the ending. If a 5-20% extension of the current population being treated will be needed TCC/APOC should look at ways of doing this and achieving results faster. It was noted, however, that more frequent treatment would not solve a compliance problem. It could be recommended that for specific areas like Benue, Ruvuma, etc, treatment could be intensified. Although 20 million additional people is a lot, it is the maximum. If moxidectin was on the market tomorrow it would speed up elimination. Maybe three years of twice-yearly treatment would be a big help. TCC noted that there has been progress in elucidating the correspondence between nodule prevalence and cmfl; most projects have no pre-control data on prevalence of infection and parasite loads – only standardised nodule counting. If treatment is extended to lower prevalence areas where nodule prevalence is below 5%, this can be matched with mf prevalence and there can be an expansion of such foci. This work should be expanded in both APOC and ex-OCP countries. 136. Expansion of NTD control could be a threat to onchocerciasis control and an extension of the APOC Programme to 2020 would enable renewed focus on onchocerciasis to be given. 137. Supervision and education are required to persuade people to take the treatment rather than 6- monthly treatments in most areas. Microfilaria prevalence is a more reliable indicator than the therapeutic coverage given in Annual Technical reports so it would be useful to reinforce epidemiological surveys. Entomological results will support this. There are few data at low levels of nodule prevalence to improve understanding of the nodule and cmfl relationship, consequently the Erasmus University, Rotterdam, are looking for more data for this purpose. At a prevalence of 5% it is possible to make a prediction but variability is high. b) CSA Advisory group on CDI and co-implementation: Presented by Prof Mamadou Traore 138. The Terms of reference of the group were to assist in developing strategies and plans to: Conduct a critical assessment of the CDI strategy; Develop a CDI framework for co-implementation and community health system strengthening (CHSS); Develop guidelines for a standardised CDI framework to be used by countries for co-implementation and CHSS in the African Region; and to Develop a communication strategy for the use of the standardised CDI framework for co-implementation at all levels. 139. Prof. Traore described the approach of the sub-committee to meet these terms of reference. This included costing the processes needed. Literature review, country visits, consultations and a deliberative dialogue were used to reach some conclusions. There is a huge body of knowledge and experience on CDTI but there is still a need for further research. The main messages are that it is complex with many challenges affecting the outcomes, determining delivery methods and related to the implementers and communities. For co-implementation, it has the potential to increase access to health interventions but should be in the framework of country ownership and a commitment to CDI and community engagement and empowerment. HSAM is of great importance to achieve this. Regarding the CDI curriculum, the group made several recommendations designed to help successful implementation. In particular, the MoH should be more involved as well as the deans of the educational Institutions. Finally, on the complex issue of health systems, CDI is not the answer to weaknesses although it can have positive effects and can 25 contribute in many ways as outlined in the Ouagadougou declaration. A framework for CDI implementation was discussed in general terms. 140. A Situational analysis is needed to determine countries preparedness for CDI and health system strengthening. Key points are integration; transfer of expertise in CDI to countries and political will and leadership. 141. The next step is the development of a tool for situational analysis and development of a costed work plan and communication plan designed to make stakeholders aware of usefulness of CDI. c) CSA Advisory group on Future of APOC: Presented by Dr Ilunga 142. The approach of the group was to have meetings, undertake individual tasks and conference calls and complete a literature review as well as conducting interviews with many countries and donors. Thirteen NTDs are targeted by AFRO and the sub-group looked at the global context of NTD control and specifically of APOC achievements. There will be limited resources for NTD control and onchocerciasis without external support. APOC should therefore complete onchocerciasis control and elimination whilst assisting with NTD control in close collaboration with AFRO. Donors are keen to provide support to APOC for elimination of onchocerciasis and integration of NTD control although programmes should remain country led. There are four Options for APOC; 1) As a Technical assistance agency; 2). As it is today; 3). As an NTD hub for Africa 4). Closing in 2015. Each option was reviewed in some detail. 143. TCC members expressed the opinion that the option of the closure of APOC should not be considered as there was still work to do in controlling onchocerciasis and that the option of APOC as a hub for NTD control was not realistic as partners in NTD control would be unlikely to accept APOC’s coordination as they already had powerful Institutions and structures for implementation of NTD control. 144. TCC thanked the presenters for the updates from the three CSA sub-groups. TCC input will enrich the thinking of the groups that will meet again this afternoon to finalise the reports for CSA. MANAGEMENT OF THE APOC TRUST FUND Report on the financial management of APOC funded Projects: Agenda item 14 145. The following update was presented to the TCC: (i) On the status of submission of PABs, 119 out of the 120 PABs expected were received as at 8th March 2011and DFCs prepared for all 119. The PAB that was not received for the Ituri Sud project that has not yet been launched; (ii) Out of the 963 financial returns expected 600 were received as at 31 August 2011 for both groups A and B countries; (iii) As at 31 August 2011, 40 projects with a total of 296 financial returns recorded delays of 6 to 7 months; (iv) On status of FACEs for 2008, 2009 & 2010, as at 31 August 2011 348 Funding Authorization and Certification of expenditure (FACE) were received out of the 442 expected; 22 of the 40 FACES received out of the 208 expected were in good order in 2011; (v) There were inconsistencies of financial data in technical reports that need to be addressed; 26 (vi) 11 out of the 18 financial certification missions planned were implemented and significant progress made on training on new financial procedures; (vii) Delays of APOC returns at district levels. 146. TCC thanked APOC for the update and made the following comments: (i) The delay in submitting financial returns often means delay in the disbursement of new funds which then leads to delays in implementation of distribution. A balance must be found as this affects coverage rate. There is a need to share information with all stakeholders about the consequences of not sending returns in time; (ii) APOC was commended for the timely disbursement of funds and for implementing the TCC recommendation to train countries in the handling of financial returns; (iii) Nigeria was commended for being prompt with their financial returns. Report on the review by the APOC Management of 1st, 2nd, 3rd, 4th, 5th, 6th, 7th, 8th, 9th, 10th and 11th year progress reports and subsequent year’s budgets: Agenda Item 15 147. The following update was given: (i) The total budget approved by JAF is US $27,585,000 for the implementation of 116 CDTI / HQ Projects + 4 ex OCP Countries; (ii) Amount forecasted for 2011 for the 116 + 4 projects was US $8,980,000 and a total of US $10,149,458 was released for 115 out of the 116 + 4 projects = more than 1 million US$ more than forecasted. This was due to the financing of epidemiological evaluations; (iii) Funding for the four ex-OCP countries in 2011 amounted to US $736,000; (iv) Surveillance activities were also financed in Burkina Faso, Mali and Guinea; (v) 91% of the total budget was obligated and 74% disbursed; (vi) Activities are planned that will be implemented in countries before the end of the year and the rest of the budget will be obligated; (vii) Some highlights: Uganda phase 5 CDTI launched as recommended by TCC 32; funds for Cote d’Ivoire released only in September because of the political unrest; second instalment funds for 2011 not released to 46 projects due to non submission of financial returns; only 65% of 2012 PABs received as at 12th September 2011; only 12 out of the 19 countries have opened special bank accounts for APOC activities, 6 countries have pool accounts that are managed at central level, in 11 countries NGDO partner is not involved in banking transaction; (viii) Appeal is made to TCC to ensure that the rules agreed upon are adhered to in order to avoid delays in the release of funds for implementation of activities. 27 148. TCC thanked the presenters and made the following comments and conclusions: (i) Guidance is needed for the utilisation of 2010 funds that were not used by the end of that year. With regards to unutilised funds from 2010, authorisation will be given for their use when financial returns are received; (ii) As regards submission of PABs, countries must comply with the timetable of APOC to avoid delays; (iii) As regards replacement of equipment, countries must comply with APOC rules; (iv) Countries should be informed that funds are available at APOC for scholarships for women to undertake studies; (v) As regards pool accounts, APOC coordinators must closely monitor all transactions and collection of expenditure reports, especially since they are not signatories to the accounts. Review of new Project Proposals and of 1st, 2nd, 3rd, 4th, 5th, 6th, 7th, 8th, 9th, 10th and 11th 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, 11th and 12th year implementation of the projects: Agenda item 16 Introduction to the review exercise: Summary budget of submitted proposals 149. The total budget submitted for six operational research proposals from Nigeria is US $78,448. DEMOCRATIC REPUBLIC OF CONGO Ituri South (DRC) CDTI Project proposal 150. This proposal for a new CDTI Project was sent to TCC for review and submitted for funding. 151. Ituri South is on the border with Uganda and Sudan. The proposed new Project is justified due to the fact that it is a hyper-meso-endemic zone, in a region surrounded by more or less well-treated foci between which there are numerous movements of the populations (Provinces of the Democratic Republic of Congo, North-west Uganda and South Sudan). 152. There has been a delayed introduction of CDTI due to armed conflicts, which are now said to have finished (Ituri-Nord has been under CDTI since 2007). 153. Two of the Health Districts concerned re-grouped 23 Health Zones and a population of 2,600,000 inhabitants; a denser population in the East (the Lake Albert Basin) than in the western forest zone. 12 Zones with 1,135,000 inhabitants selected as hyper and meso-endemic following REMO surveys. However, there is a contradiction between the insufficiently detailed maps that indicate that 10 more Health zones are eligible for CDTI. The Project was developed on scanty data and the area was delineated based on just 13 villages. There are places with isolated foci not included. The countryside consists of high plateaux covered by dense forest to the East and more cultivated degraded forest to the West (coffee, tobacco, and food crops). The climate is equatorial with four seasons and high rainfall, however, the hydrography (with the likely existence of several networks) is not described despite its evident link with the distribution of onchocerciasis; there is no reference to the vectors, and no more than epidemiological patterns of the disease. 28 154. The Region presents all the adverse factors to be found in equatorial foci for CDTI: extremely difficult means of movement/transport, seasonal or permanent, isolation and under-equipped and under- developed, aggravated by recent troubles, very diverse and fragmented populations with strong traditions. The north-west of the focus is a zone co-endemic for onchocerciasis and loiasis which make it necessary to ensure special medical vigilance during the initial distribution of Mectizan. The timeline for implementing treatment has been established for 3 years (2012-2014) with a rate of 4 additional zones per year (still only part of the text mentions a timeline 6-4-2), the progression of treatment will be done from East to West. 155. The organisation of all activities of the Project seems to conform closely to the procedures and specifications of APOC for CDTI (treating 84% of people and 100% of communities by 2015 and putting in place a sustainability mechanism by 2015). However, there remains some uncertainty concerning the endemicity of onchocerciasis in other health zones which are not included in the Project and a worry about starting on time, given the lack of a team already in place, delays in advocacy, training, sensitisation and census-taking; all activities which seem to start from zero and for the launching of which they must depend solely on the financial support of APOC. The support of senior central NOTF personnel and of personnel from the Congolese CDTI Projects already in place must be assured as well as that of an NGDO, which seems to be CBM. 156. The Project area is in a Loa loa zone. The main concern with this Project is therefore the danger of SAEs and possible deaths as there is a high prevalence and intensity of infection with Loa loa. The maximum of preparation is being made and intensive training must be given on management of SAEs. The Programme is advised to treat moving from savanna towards higher risk areas gradually so that team would gather experience. The region is about 2000 kms away from Kinshasa; technical advisers have experience with SAEs and a team is ready to support the project. In future there may be more activities. There should be zero deaths in this Project. TCC therefore request the programme or national coordinator to develop an action plan for SAE management so that any necessary additional resources can be identified. The new project could present an opportunity for research to be conducted. 157. TCC accepts the initiation of this new Project, but the Project should take the maximum of precautions in view of the co-endemicity of oncho/loiasis and to the high risk of SAEs. 158. TCC made the following recommendations and observations: (i) It is essential to refine the data and the mapping of onchocerciasis in this Region; (ii) The treatments must be spread out over time and space, beginning by the zones less likely to be affected by SAEs; (iii) Collaboration between all disciplines and putting in place a plan of action for the good management of SAEs is strongly recommended; (iv) This region must equally offer an opportunity for initiating operational research. Review of Annual Technical reports ANGOLA Bengo CDTI Project (Angola) 2nd year Annual Technical Report 2010 Reviewer’s comments and assessment: 159. The editing of the report is simple and easy to read. However the document has some gaps and inconsistencies. The analytical summary is too short and not consistent with regard to data given in the report. 29 Recommendations to improve the report: (i) Provide more information in the analytical summary. The Section “general information” is summarised too much for a project in its second year; (ii) Respond to all the elements in each section of the report; (iii) The following tables should be revised and/or completed: Tables. 1, 2, 4, 5, 7, 9, 12 and 13. The text should be revised, taking account of the new data; (iv) Disagreements between the summary and certain data of the document; (v) The principle of calculating the numerous parameters has not been respected; (vi) Elements of certain sections of the document are obscured. Recommendations to improve the Project: (i) Geographic and therapeutic coverage is difficult to assess as the basis for calculating it varies; (ii) The period of treatment was not satisfactory and had an impact on coverage; (iii) Some populations had little interest in what the monitors had to say and this probably resulted in some of the refusals and absentees; (iv) Follow-up the sensitisation of the populations so as to bring about a change of behaviour with respect to taking Mectizan. 160. TCC did not accept the report. 161. TCC asks the Management of APOC to provide support to the project for the writing of reports. Kuando Kubango CDTI Project (Angola) 4th year Annual Technical Report Reviewer’s comments and assessment: 162. The report is rather incomplete and has many errors. Notably, the incorrect data includes the rates of coverage, the UTG, the number of CDDs, number of Mectizan tablets received, used and remaining. There is no mention made of the recommendations of previous sessions of TCC. 163. The Project has a rather weak performance with a rate of geographic coverage of 62%, despite a ratio of 1 CDD : 50 persons. The cost of treatment is very high (US $3 per person treated) according to the Project manager. Recommendations to improve the report: (i) Give responses to recommendations of previous sessions of TCC, (ii) Re-do tables 1, 3, 4, 5, 6, 7 and 9, (iii) Explain the absence of data for the municipality of Nancova. Recommendations to improve the Project: (i) Improve geographic coverage; (ii) Start the process of CSM and of sustainability evaluations; (iii) Increase the initiatives to introduce co-implementation and integration of CDTI in the Public Health system; (iv) Initiate proposals for operational research. 164. TCC does not accept the report – it should be resubmitted to TCC taking into account the recommendations made above. 30 Huila CDTI project (Angola) 4th year Annual Technical Report Reviewer’s comments and assessment: 165. The editing of the report is simple and easy to read. However the document has some gaps and inconsistencies. The analytical summary is too brief. Geographical coverage is 74.6% and therapeutic coverage 69.9% if the data are correct. The period of treatment is not satisfactory, and is likely to have had an impact on coverage. Recommendations to improve the report: (i) Provide more information in the analytical summary, (ii) Ensure consistency between the data in the summary and that in the report, (iii) Respond to all the elements in each section of the report, (iv) The following tables should be revised and/or completed: Tables. 1, 4, 7, 10 and 13, (v) Disagreements between the summary and certain data of the document, (vi) Elements of certain sections of the document are obscured. Recommendations to improve the Project: (i) Follow-up sensitisation of the populations so as to bring about a change in behaviour with respect to taking Mectizan; (ii) Conduct treatment outside of the rainy season. 166. TCC does not accept the report and asks the Project to re-submit it after taking account of the above recommendations. 167. TCC invites APOC Management to provide support to the Project for the writing of reports. Moxico CDTI Project (Angola) 4th year Annual Technical Report Reviewer’s comments and assessment: 168. The Project of Moxico in Angola is in its 4th year of distribution in a Portuguese speaking country and in a Region which has many migratory movements. For a population of 248,341, the geographic coverage is 66%, with a rather low therapeutic coverage of 51.4%. The report has been written in Portuguese and translated into French for TCC. This report is rather poor in its editing, but nevertheless provides the necessary information for the review. Recommendations concerning the report: (i) Address the previous recommendations of TCC which was not done in the report of the previous year; this is very important and could justify not accepting the report, but in view of the effort made by the Project to produce the report and with the difficulties regarding human resources in Angola TCC insists that the next report takes account of the present recommendations; (ii) Ensure that the figures mentioned in the summary are consistent with the rest of the text; (iii) Completely fill all the tables, especially tables 3, 6 and 7; (iv) Verify the calculations made so as to avoid errors of calculation which are numerous in this report; (v) Provide explanations for choosing the period of distribution from October to November in the rainy season rather than May to September; (vi) Be precise about the health centre in which the remaining drug stocks are kept 31 Recommendations concerning the Project: (i) Improve the geographic coverage (to 100%) and therapeutic coverage (>80%), (ii) Avoid carrying out Mectizan distribution in the rainy season, (iii) Look for an NGDO as a partner, re-contact World Vision, (iv) Intensify advocacy towards the donors in order to have financial resources available for April, (v) Improve the ratios of CDD/persons treated and of female to male CDDs, (vi) Involve more health workers from the Project zone, (vii) Improve the writing of the report. 169. TCC did not accept the report and asks for it to be resubmitted after addressing the points raised above. CAMEROON Littoral 1 Province (Cameroon) 6th year Annual Technical Report Reviewer’s comments and assessment: 170. This is a Project in its 6th year of existence but only in its 5th year of mass distribution of Mectizan. The Project and the focal person for SAEs are to be congratulated for the good performance of surveillance and management of the SAE detected in the course of the year 2010. The Project is also congratulated for the good writing of the report, which is easy to read and provides the necessary information for the review. In the course of 2010 the therapeutic coverage was 65.9% and the geographic coverage was 100%; this last rate has been maintained since 2008. This Project has a high rate of absenteeism (25% of the total population). Nevertheless, we have the following recommendations: Recommendations to improve the Project: (i) Systematically organise CSM in the communities where the rate of absenteeism is high, so as to identify the problems and resolve them through mobilisation and sensitisation, above all in the Districts of Moungo and Nkongsamba; (ii) Aim for a ratio of 1CDD/100 inhabitants (in place of 1 CDD/216 persons in 2010 which is high); (iii) Intensify mobilisation of the political and administrative authorities and of opinion-leaders for effective disbursal of the budget line allocated to onchocerciasis; (iv) Continue to involve and train health workers in the other Districts and insist on the importance of supervision and retrieving missing information. It would be judicious to report on measures taken in respect of this in the next report; (v) Continue to intensify mobilisation/sensitisation in order to reach therapeutic coverage of at least 80%; (vi) Closer national coordination is recommended to solve the problem of distributing Mectizan in urban zones and the high rate of absenteeism. Recommendations to APOC: (i) Investigate the possibility of addressing the request for a vehicle and 5 motorbikes as well as for replacement of office equipment. 171. TCC accepted the report. 32 NOTF/HQ (Cameroon) 12th Year Annual Technical Report Reviewer’s comments and assessment: 172. This was an excellent report which demonstrates a good understanding of CDTI Projects. TCC congratulates the NOTF for the quality of the document and the presentation of performance trends of treatment coverage of each project. TCC regrets that the table providing information on SAEs has some gaps (incomplete information regarding clinical symptoms and the burden of Loa loa). Because of the large number of refusals and absentees, TCC invites the NOTF to encourage sensitisation to decrease this number. TCC draws the attention of the NOTF to the fact that CSM and SHM must be improved. Recommendations to improve the report: (i) Complete the table of SAEs with data on clinical symptoms and burden of Loa loa, (ii) Include a coverage map in the report. Recommendations to improve the Projects (i) The NOTF should encourage the Projects of Adamaoua, Centre 1, 2 and 3 and Sud Ouest to improve the ratio of CDDs to the population; (ii) Conduct sensitisation activities in the Centre I and III, Est, Littoral 1 and 2, Nord-Ouest, Ouest, Sud, SW1 and 2 projects so as to reduce the number of refusals and absentees; (iii) Conduct CSM and SHM in a larger number of villages. 173. TCC accepted the report. COTE D'IVOIRE Cote d'Ivoire CDTI Project (Comoé, Bandama, Sassandra, Cavally and their affluents) 3rd year Annual Technical Report 2010 Reviewer’s comments and assessment: 174. This report is very exhaustive, of very good quality despite some minor faults which were already pointed out. 175. Efforts are being made to re-launch the system but the work required is huge and the events in the country have negatively impacted the field activities. It seems that the problem for the programme is at the peripheral level of census taking and distribution of Mectizan and probably much of the population doesn’t benefit from that distribution. There is a need for training and a system of incentives that could be put in place at the national level would be beneficial. 176. The disease is not totally controlled and there is a high risk of recrudescence and it is important that the authorities are made aware of this and can take action. It is essential that the national blindness control programme gets external support from an NGDO for example otherwise there will be difficulties so we should actively look for support for them. 177. APOC should maintain its support for the Project especially as it is resuming and has faced difficult circumstances. The country has a strategic role and threatens recrudescence of infection in the region. Cross border issues are important. 178. APOC management informed TCC that for the past two years contacts have been made with SightSavers and activities were on track until the recent fighting. SightSavers made some financial contribution to carry out evaluation activities in Burkina Faso and northern Cote d’Ivoire. It is fortunate 33 that SightSavers is now present in Burkina Faso and may still support Cote d’Ivoire until that country’s problems are resolved. Conclusion: 179. TCC accepted the report without reservation and noted the analyses and recommendations within it. DEMOCRATIC REPUBLIC OF CONGO Masisi Walikale CDTI Project (DRC) 3rd year Annual Technical Report, 2009 Re-submission Reviewer’s comments and assessment: 180. The analytical summary is complete and succinct but inconsistent with the text as for example, regarding the provision of Mectizan tablets from MDP. Data on population figures are inconsistent as are those for the numbers of districts and communities. Information is missing, especially on feedback from the communities. Given all these errors and inconsistencies, the reviewers did not accept the report and again ask for it to be resubmitted after receiving support from APOC to help them complete a good report. Conclusion: 181. TCC did not accept the report and recommended that APOC provide some support in writing a good report. The report should be resubmitted for review by TCC. Masisi Walikale CDTI Project (DRC) 4th year Annual Technical Report, 2010 Reviewer’s comments and assessment: 182. There were no responses to the previous recommendations of TCC. The summary is concise and understandable; the data are consistent with those given in the report with the exception of the rate of therapeutic coverage and the UTG. The communities are not differentiated into meso and hyper-endemic ones. Details of advocacy are not provided and the project has no IEC materials. There is a very weak ratio of CDDs to population (1 CDD: 276). 183. 12 SAEs were reported and managed. All finance is coming from APOC. 184. The report is well written but has some errors on the UTG, Therapeutic coverage and Mectizan stock. Recommendations regarding the report: (i) Give some response to previous TCC recommendations; (ii) Redo the calculations of UTG, Therapeutic Coverage and stocks of Mectizan. Recommendations to improve implementation of the Project: (i) Improve Geographic Coverage, (ii) Improve involvement of women, (iii) Improve SAE management, (iv) Improve Mectizan management, (v) Start CSM, (vi) Take actions to improve sustainability, (vii) Initiate operational research, (viii) Increase initiatives for integration. 34 185. TCC recommends accepting the report provided the corrections are made through APOC management. 186. TCC recommendation: APOC management and the DRC NOCP should help the person write the report. The area is difficult with the occurrence of side effects resulting from drug distribution – the project therefore needs to be monitored closely. Butembo-Beni CDTI Project (DRC) 3rd year, 2010, Annual Technical Report Reviewer’s comments and assessment: 187. The Project is in its 4th year of funding but 3rd year of implementation. Not all areas were reached for drug distribution in all years however, so the situation regarding coverage is complicated. The report is written in a simple way, but overall they respond very carefully to the specifications of APOC. 188. Taking note of the adverse conditions identified and given the information provided in the report there is no reason to think that the Project team does not carry out the CDTI activities in an optimal manner. However, the results, in particular for the coverage, above all the therapeutic coverage, are not good enough for a project in its third year of implementation. 189. The chronogram/timeline is without doubt over optimistic in a mountainous equatorial forest zone which suffers from chronic insecurity and civil war. Not all the zones treated have had three years of CDTI because of the trials with moxidectin. 190. The Project should urgently conduct an exhaustive census of the villages in the treatment zone and a reliable census of villages and of populations eligible for CDTI given that the existing data are still partial and not reliable. Technical and financial support from APOC will certainly be essential. 191. There is, without doubt, at the same time a necessity for a big effort in training and supervision so as to improve and strengthen the activities of the peripheral front line health services regarding monitoring and supervision. These health workers together with the NOTF teams, the MOSOs and the village committees must play a determining role in the sensitisation of communities and the motivation and engagement of CDDs, as currently this supervision is weak. 192. Mobilisation must go beyond the limits of the two districts and the support of an NGDO (Lions Club?) must be actively sought at the national level. Advocacy must be addressed to the Government with respect to the current low financial contributions, which do not encourage a solid partnership. 193. APOC is the only provider of support for a difficult project. It is recommended, that a group of specialists from this troubled region assists APOC to develop a set of specific and precise operational recommendations making best use of the resources available. Recommendation regarding the Project: (i) The map of Loa loa distribution, presented by APOC, showed that the project is on the border of Loa loa so there is a risk of adverse reactions following treatment, thus care needs to be taken and further surveys should be undertaken to define the areas of co-endemicity more precisely; (ii) The Project should urgently conduct an exhaustive census of the villages in the treatment zone and a reliable census of villages and of populations eligible for CDTI; (iii) Conduct training to strengthen monitoring and supervision by the front line health facilities; (iv) Seek the support of an NGDO partner (Lions Club?); (v) Address advocacy to the Government for increased financial support. 194. TCC accepted the report. 35 Lubutu CDTI Project (DRC) 4th year Annual Technical Report Reviewer’s comments and assessment: 195. The report is well edited and the analytical summary is concise and understandable, but there are some points which are not consistent compared to the data in the report. Tables 1, 12, 18a, 18b and 18c were incomplete and/or to be checked. Report related recommendations: (i) Revise the summary taking account of the corrections to be made to the tables in the document; (ii) Verify and/or complete tables 1, 12, 18a, 18b and 18c; (iii) Increase CSM and SHM activities; (iv) Fill all sections in the different parts of the report. Project related recommendations: (i) The performance of the project has improved with the treatment of all the 4 Health Districts affected by onchocerciasis: the geographical coverage was 100% and therapeutic coverage 79.5%. There was a significant improvement in the ratio of CDDs/population (1 CDD/99 persons); (ii) Light increase in the number of women involved in CDTI activities (15.65 in 2010 compared to 12.7% in 2009) the involvement remains low, however; (iii) CSM and SHM activities started in villages of four Health Districts Conclusion: 196. TCC does not accept the report as there are questions that require clarification. 197. TCC and APOC management should visit DRC and the Project to investigate what is going on and develop recommendations based on this visit. Mongala CDTI Project (DRC) 6th year Annual Technical Report Reviewer’s comments and assessment: 198. The report is easy to read, however, there are too many gaps for a project in its 6th year. 199. The total population is 1,289,433 inhabitants, distributed in 1286 villages (of which 80.6% are in the hyper-endemic zone, 19.4% in the meso-endemic zone). Geographic coverage is 100%. The average therapeutic coverage is 77.2%; 70% (899/1286) of communities have a therapeutic coverage greater than 80%. 200. The financial contribution of the Government and/or interventions by other donors is one of the major challenges of the project. Despite the difficulties of the terrain, the quality of this report could have been better if not equal to that of the preceding report. 201. TCC requested that the report be improved, completed and re-submitted to the reviewers. Recommendations to improve the report: (i) Reduce and improve the presentation of section 1.1, which, at 6 pages is too long; (ii) Recalculate the UTG given in the executive summary; 36 (iii) Provide the figures for the numbers of health workers and of CDDs in the executive summary; (iv) Give more precise data on the nature of the 4,733 political decision-makers sensitised in the villages. What exactly did this consist of? (v) The organisation of an Oncho Day (section 2.3) is it a suggestion or did it take place? If yes, give precise information on the results obtained; (vi) Give precise information on the way the results of mobilisation were quantified (number of radio broadcasts, number of schools…); (vii) Verify table 11 (the total number of communities having conducted CSM. 385 in place of 440); (viii) Provide information in table 13 (a; b; c). Recommendations to improve Project performance: (i) Put in place a sustainability plan. APOC management must follow-up its efforts with respect to this if this is not already done; (ii) Follow-up efforts of distribution so as to increase therapeutic coverage. 202. TCC did not accept the report, major changes need to be made. Equateur Kiri CDTI Project (DRC) 6th year Annual Technical Report Reviewer’s comments and assessment: 203. Despite several omissions, the report is well presented and this project is well directed. The strong level of female CDDs is appreciated. 204. The support of APOC management must be maintained, if not reinforced, notably by putting in place a sustainability plan. Recommendations concerning the Rrport: (i) Re-do tables 13a, 13b, 13c and attach the year concerned and give the financial contribution of the Government. These figures were, meanwhile, well presented in the previous report; (ii) Explain why $8,100 dollars have been spent on the management of SAEs (section 3.4) when no SAEs are indicated and that the management of minor adverse effects has been given free of charge at the level of the health centres (section 2.2 concerning advocacy); (iii) In the tables in section 3.4, give the grand total of all the costs of activities. Recommendations concerning Project implementation: (i) It is necessary to maintain the good results of previous years and avoid the lowering observed in therapeutic coverage; (ii) The supervision by members of the community must be sought and encouraged, notably for sustainability; (iii) Advocacy at the highest provincial level (the Provincial Assembly) may provide funds for mobilisation and sustainability. 205. TCC accepted the report with minor revisions to be made as indicated above. 37 Tshuapa CDTI Project (DRC) 6th year Annual Technical Report Reviewer’s comments and assessment: 206. The summary is concise; however, because of this it lacks certain useful information such as geographic and therapeutic coverage. However, the information provided, is consistent with the data in the report. (i) The summary indicates that the treatment cycles differ between the Health zones (minimum: 1; maximum: 5) and this information is not clearly highlighted in the report; (ii) The tables are complete and the calculations are correct, except for table 7, for which the columns for SAEs need to be completed; (iii) Geographic coverage is 100%; (iv) Therapeutic coverage is 75.6%, varying from 60.6% to 85.3%; (v) The performance of the Project is good. The geographic coverage has increased from 19.7% in 2006 to 100% in 2010. During the same period, therapeutic coverage has increased from 11.7% to 75.6%. Recommendations to improve the Project: (i) Conduct treatment during a good period (not the rainy season) so as to avoid absenteeism and inaccessibility of certain communities; (ii) Oversee the management of ivermectin so as to avoid large losses; (iii) Follow-up advocacy so as to increase the Government contribution; (iv) Consider developing a sustainability plan as 7 of the 12 Projects are reaching 4 years of distribution; (v) Consider the development of proposals for operational research. Recommendations to APOC: (i) Take action on the Plans for CSM, notably, the training of trainers; (ii) Resolve the problem of equipment for the Project; if not there is a risk of delay in activities; (iii) APOC should consider providing equipment even though the evaluation of sustainability has not been completed as equipment will not necessarily be working after 5 years. 207. TCC accepted the report. Bas-Congo CDTI Project (DRC) 6th year Annual Technical Report 2010 Reviewer’s comments and assessment: 208. This Project in its 6th year shows good performance; despite the difficulties of the terrain and the lack of financial resources the therapeutic coverage is constantly increasing. The report is well written overall but must still be improved. Recommendations to improve the report: (i) Insert a more detailed map allowing the Project location to be more easily located (particularly at the border with Angola and Congo-Brazzaville) and also to show the hydrographic network; (ii) If the partnership with HKI was not effective in 2010, it should not appear as the financial and technical NGDO partner; (iii) Correct the UTG: 704,179 in place of 745,328; (iv) Correct the figures concerning the population of Mont Ngafula and Nsélé (There is disagreement between tables 2 and 7); (v) Give the results of advocacy conducted towards the political decision-makers; (vi) Complete table 10 (quantity of the drug requested). 38 Recommendations for the improvement of the Project implementation: (i) An evaluation of sustainability should be put in place and a sustainability plan should be developed for this Project which is coming into its 7th year. TCC requests urgently, the support of APOC management on this point; (ii) Look for a solution to «seeking out and treating » people who are absent from treatment; (iii) Conduct CSM and SHM; (iv) Integrate CDTI supervision in the supervisory activities planned at the central level. TCC would like to see the intervention of the Provincial coordinator on this point; (v) Plan for a cross-border meeting with the teams from Congo Brazzaville and Angola; (vi) Reinforce advocacy at the highest level in order to obtain effective financial support from the Government. 209. TCC accepted the report. Lualaba CDTI project (DRC) 6 or 5th year Annual Technical Report 2010 Reviewer’s comments and assessment: 210. The report is well edited, concise and understandable. 211. Clear responses to the recommendations of previous sessions of TCC must be given in the next reports. It is not sufficient to say that the National Office of the NOTF/Kinshasa has not transmitted the recommendations of TCC. The Project has had quite good performance and the coordination is to be congratulated for the rate of therapeutic coverage which has been constantly greater than 72% since 2006, the geographic coverage of 100% was reached in 2010 and the number of female CDDs is increasing. Recommendations concerning the report: (i) Provide the complete data on the financial contributions of all the partners including the State (Table 13b); (ii) Provide the correct data on the management of Mectizan (Table 10): The number of tablets given to other CDTI projects must figure clearly in the table and be explained simply below the table. Recommendations concerning the Project: (i) Make efforts to improve the ratio of CDDs/Population; (ii) Plan activities for the periods which are more convenient for the populations; (iii) Improve the rate of release of the State budget allocation; (iv) Start the process of CSM and of evaluation of sustainability; (v) Initiate co-implementation activities and integration of CDTI in the National Health system; (vi) Initiate operational research projects; (vii) Reinforce advocacy to attract NGDOs. 212. Questions arose concerning the size of the population refusing treatment for religious reasons. The number of people was not given, but is likely to be small. The partner NGDO was Lions Club International and the Foundation said they would support the Project for a five year period. Since this is the 5th year, this needs to be followed up with the officials of Lions Club. If their support has ended, UFAR is also interested in supporting projects in this region, which is far from Lubumbashi. Support to the project would be a beneficial factor. 213. TCC accepted the report subject to minor corrections that should be submitted to APOC. 39 Ubangi Nord CDTI 5th year 2010 Annual Technical Report (DRC) Reviewer’s comments and assessment: 214. The report is satisfactory even though improvements are possible at the level of the presentation of the focus. Abbreviations are used extensively and should be controlled in the text, as should the abuse of photos (too many) and of empty tables without any explanation and no map. 215. After 6 years of implementation, the project gives no impression of stability and there is a long way to go with the Project. 216. The coverage is not equal across villages and across years, without doubt for reasons that are varied and acceptable. Therapeutic coverages are below the minimum required, local censuses are unreliable and the rates of refusals and absenteeism are high. 217. The efforts at training are insufficient and the impact of sensitisation of communities and engagement of CDDs who are not motivated is inadequate. The CDDs are not integrated in collective remuneration activities. 218. The management of SAEs has improved despite a limited budget, but to the detriment of treatment coverage. 219. The budget deficit is a concern as the financing depends largely on the contribution of APOC, that of the Government being stagnant, very insufficient and marked by a low rate of release which is often delayed. 220. There is an issue of capital equipment that needs to be replaced. Training and engagement of stakeholders is affected. 221. The intensification of advocacy is indispensable, including at the higher levels as is the intensification of all training activities (beginning with training of trainers); sensitisation, engagement and supervision. 222. TCC accepted the report, with the urgent recommendations and close supervision by APOC, as in the context of current national and external participation, the suspension of financing by APOC would result in the stopping and death of the Ubangi-Nord Project. Ubangi Sud CDTI Project (DRC) 6th year 2010 Annual Technical Report Reviewer’s comments and assessment: 223. The report is well edited, concise and understandable but lacks certain information, notably on the numbers of meso and hyper-endemic communities (data in table 2 which is missing), the updating of censuses of the population covered by the Project and the UTG. 224. The Project has a relatively weak performance with geographic coverage that has never passed 60% and therapeutic coverage with a maximum of 60%. The team is, however to be congratulated for the efficient management of SAEs. Recommendations to improve the report: (i) Insert table 2 in the report, (ii) Provide information on the updating of population censuses. 40 Recommendations for improving the Project: (i) Improve the rate of geographic and therapeutic coverages, (ii) Improve the participation of women in CDTI, (iii) Improve the ratio of the population:CDDs, (iv) Improve the rate of release of the State budget, (v) Start the process of CSM and sustainability, (vi) Increase initiatives of co-implementation and integration of CDTI in the Public Health System, (vii) Initiate operational research projects, (viii) Sensitise the population with the aim of motivating CDDs. 225. TCC accepted the report with minor correction to be submitted to APOC management. DRC NOTF/HQ 11th Year Annual Technical Report Reviewer’s comments and assessment: 226. This is a report of the secretariat of an NOTF in its 11th year of existence. The report is well written with figures and maps giving a synoptic view for which the NOTF is to be congratulated. The report allows the performance of the secretariat to be evaluated. It is noted that the performance of the projects in DRC are improving from year to year and that it is necessary that the NOTF continues to support these projects so that the final objective of elimination of onchocerciasis, which is in sight, can be achieved. Nonetheless, there are some insufficiencies on which the following recommendations are made. Recommendations concerning the report: (i) Next year, inform TCC of the actions taken by the 10 Projects with respect to the meso or hyper-endemic communities; (ii) Provide a table on the distribution of the health zones by Project; (iii) Revise the timeline for better synchronisation with Project activities given that the NOTF only does supervision and monitoring; (iv) Mention all the partners including PDM and indicate their roles; (v) Propose concrete actions for the Projects which do not have good coverage and inform TCC of these actions in the next report. For example, training of Lab technicians for the management of SAEs so as to make good calibrated thick smears; (vi) Explain: “Absence of cost-recovery of costs of distribution by the village” in the results of supervision on page 48 of the report; (vii) Inform TCC on the validation of cases of SAEs notified in Masisi Walikale in the next report; (viii) Complete table 10 in a better way and give a more explicit inventory of Mectizan by including the tables in landscape layout. (ix) Re-do and fill in tables 13.a, 13.b, 13.c, and 14 correctly and verify the calculations. Recommendations concerning the Secretariat (NOTF): (i) Read all the recommendations of TCC33 for each Project and support them in implementing these recommendations; (ii) Make a table to follow-up the Projects above regarding the monitoring and evaluation; (iii) Systematically carry out an annual survey of coverage of all Projects and carry out advocacy towards APOC and other partners for assistance; (iv) Closely follow the management of Mectizan so as to have a good inventory and let this inventory become part of good medical practice. 227. TCC accepted the report with minor changes. 41 SOUTH SUDAN East Bahr El Ghazal CDTI Project (South Sudan) 4th year Annual Technical Report, 2010 Reviewer’s comments and assessment: 228. The report was, on the whole, well written with clear and concise content. The Project area has changed, altering the population size, and this was explained adequately in the Executive Summary. The NGDO partner is cbm. There have been security issues which have had an adverse effect on coverage. Recommendations to improve the quality of report: (i) Update glossary of terms to include (OV, CBM etc), (ii) Under table 1- replace curved with carved. Recommendations to improve Project implementation: (i) Take necessary action to improve training coverage especially for CDD and/ or set realistic targets; (ii) Develop a workable strategy to address treatment needs for Nomads; (iii) Improve IEC messages and materials using data gathered during supervision visits; (iv) Take urgent steps to improve the male/female CDD ratio, and female overall participation in CDTI activities; (v) Need for continued advocacy at State level for financial support for other CDTI activities so as to ensure sustainability; (vi) Make available sustainability report for TCC 35. Develop and share sustainability plan; (vii) Increase the percentage of Health workers involved in CDTI; (viii) Pay attention to poor performing areas especially Rumbek. Recommendations to APOC: (i) APOC HQ and EBEG to re-examine CSM and SHM concepts, establish current status and plan strategically to consolidate foundation activities, and scale up implementation if this is feasible; (ii) Provide TCC34 with report on evaluation of sustainability. 229. TCC emphasised that population census data is critical for accuracy of coverage data. The project had used the 2004 census data as a basis to estimate the population. Censuses are usually done by CDDs and the Project Coordinators should be aware that this is one of their functions. 230. In South Sudan, Health staff of the MoH have not been paid so there are difficulties and some support must be given. This is one of the functions of the APOC TA in South Sudan. 231. TCC accepted the report. East Equatoria CDTI Project (South Sudan) 5th year Annual Technical Report 2010 Reviewer’s comments and assessment: 232. This was a well written report which demonstrates programme improvement through consistent advocacy, innovation and community engagement. This has contributed to achieving 100% geographic coverage for the first time in the project and is commendable. Recommendations for improving the report: (i) Ensure that the list of Acronyms given in the report is updated; (ii) Provide information on the condition of the 10 bicycles provided by the NGDO in table 12; 42 (iii) Clarify why a 1% increase in population was used in the executive summary for population growth which contradicts the 2.9 projection stated on page 12; (iv) Correct the figure of total population of Meso and hyper endemic communities on table 1.2, page 7. Recommendations for improving project implementation: (i) Sustain advocacy on absorption of CDTI staff and CDTI into the Health service system; (ii) Ensure early commencement of distribution to allow for high coverage and reduction in the distribution period; (iii) As earlier recommended by TCC 30, conduct an operational research on whether or not kindred system exist in the project and possible use of it in CDD selection and distribution; (iv) APOC to consider the replacement of the project vehicle and motorcycle for improved monitoring and supervision. 233. TCC accepted the report. Upper Nile CDTI Project (South Sudan) 5th year Annual Technical Report 2010 Reviewer’s conclusions and assessment: 234. This is a well-written report. The project has continued to improve its treatment coverage amidst several challenges including poor road network and limited support from the Government. Recommendations to improve the Project: (i) Conduct a census to provide realistic figures and estimations. Relying on data generated in 2004 presents many limitations; (ii) Seek and invest in alternative means of transport to ensure that all communities are reached with information and services; (iii) The team could consider investigating as an OR on the role technology or other relevant issues; (iv) Empower County Health Department and County Supervisors to undertake some of the responsibilities of the Project Coordinator to expedite project activities; (v) Increase the proportion of communities with Supervisors; (vi) Increase the number of CDDs in order to reduce the CDD population ratio and to mitigate attrition; (vii) The Project should initiate CSM activities; (viii) Intensify training of CDDs on record keeping. Recommendations to APOC: (i) Conduct mid-term evaluation or if this has been done, to share the report with TCC and the country team; (ii) Plan for and implement sustainability assessment (this was supposed to be done at the end of year 3 of implementation). 235. TCC accepted the report. West Bahr El Ghazal CDTI Project (South Sudan) 5th year Annual Technical Report 2010 Reviewer’s conclusions and assessment: 236. This was a concise and well written report. A message was going round that Mectizan could cause severe illness and this would have affected therapeutic coverage so the reviewers considered it important to highlight this point. 43 Recommendations for improving report: (i) Provide clear reason why drug balance is high; (ii) Provide more information on whether the project was able to retrieve the funds provided to Aweil East where county supervisor could not implement activities; (iii) Provide explanation on the reason for high refusal in year 2010. Recommendations for improving project implementation: (i) There is the need for participatory monitoring/Sustainability Evaluation of the project since it is already in year 5; (ii) Ensure that training targets are realistic; (iii) Improve community participation through CSM and SHM; (iv) for better programme management and supervision, APOC to kindly consider having 3 separate CDTI projects instead of having one huge one. 237. TCC accepted the report. West Equatoria CDTI Project (South Sudan) 6th year Annual Technical Report, 2010 Reviewer’s conclusions and assessment: 238. This is a well written report which demonstrates programme managers commitment to the improvement of their CDTI programme. The use of mobile phone to disseminate messages is equally commended. The project complained about IPM reports – they don’t have a copy of that report. Recommendations for improving report: (i) Project to ensure that Acronym list is updated. Recommendations for improving project implementation: (i) Intensify effort to achieve and maintain 100% geographic coverage as well as 80% therapeutic coverage; (ii) Ensure that training targets are realistic and achievable. Issues for clarification by APOC: (i) Was there any particular reason for budget cut in 2010? (ii) Has there been any progress at ensuring that the project gets a copy of the Independent participatory monitoring report of their project? 239. TCC accepted the report. SSOTF CDTI Project (South Sudan) 5th year Annual Technical Report, 2010 Reviewer’s conclusions and assessment: 240. The Executive summary of the report was comprehensive providing information on relevant aspects. Whilst data given in the executive summary of the report was consistent with the data in the body of the report, information given on training performance did not give the correct picture. Emphasis was on the number of CDDs trained and the increasing trend of CDD : population ratio and not on the very low training rate of 22.8%. 44 Recommendations to improve quality of report: (i) Update glossary of terms to include (OV, CBM etc), (ii) Cross check Mectizan management data especially for WBEG. Recommendations to improve Project performance: (i) Take necessary action to improve training coverage for health workers and CDD and or set realistic targets; (ii) Develop a workable strategy to address treatment needs for Nomads; (iii) Carry out a simple assessment to confirm reasons for refusals for WBEG and improve the IEC; (iv) APOC HQ and SSOTF to establish whether it is feasible to undertake CSM and SHM, if so, plan strategically to initiate and consolidate foundation activities; (v) Take urgent steps to improve the male/female CDD ratio, and female overall participation in CDTI activities; (vi) Need for continued advocacy for government to provide financial support for other CDTI activities to ensure sustainability; (vii) APOC and SSOTF to examine whether conducting independent monitoring is feasible. If so, APOC to provide the necessary guidance and support to implement what is feasible; (viii) Use available funding to repair faulty photocopier, rather than rely on counterpart funding which may not be forthcoming in foreseeable future; (ix) Ensure anticipated support from government accountants is carried through, to facilitate timely release of funds. Then work with communities to reach consensus for a shift of treatment timelines to the dry season, so as to improve coverage; (x) TCC noted that no census had been conducted since 2004 and as there has been an influx of people into the area from Uganda and Kenya it is advisable to estimate the population data as if the CDTI Projects are starting afresh. Recommendation to APOC: (i) A monitoring evaluation team should go to each Project separately to ascertain their needs. 241. TCC accepted the report. SUDAN Sudan CDTI Project 10th year Annual Technical Report Reviewer’s conclusions and assessment: 242. This report needs substantial inputs to bring it up to the required standards. The Executive summary was rather scanty, not covering all the salient points. Some of the data was questionable; in particular, the population estimate provided in the executive summary section was inconsistent with the estimate provided in Table 2. The format and reporting style used made the report difficult to read. Background information was only partially covered. 243. TCC recognised the effort made by the Project to re-establish a link with APOC by sending in a report in 2011. Nonetheless, the current report needs substantial inputs to improve on the clarity of content. TCC understands that a lot of work has been going on with this project since its inception and the project is already earmarked for elimination of onchocerciasis. However, the authors did not give sufficient background information regarding what happened since the last report was sent in 2006. This would have provided reviewers with a context and helped to explain some of the perceived data inconsistencies. 45 Recommendations to improve the quality of the report: (i) Improve general editing, for example: under General Information 1st sentence, change ‘lunched’ to ‘launched’; (ii) Improve background information using to cover all salient aspects; (iii) Improve background information so as to give better perspective of the evolution of this project and the current status; (iv) Based on the background – Re-do tables to address inconsistencies. Where appropriate, use footnotes below table content to provide further clarification, if necessary; (v) Explain “inconsistencies” in population estimates (refer tables 2, 7 and executive summary); (vi) Provide rational for high number of CDD population, given the size of the target group. ( 8-14 CDD/community); (vii) Correct total number of CDDs in table 4. The number of CDDs engaged with CDTI is 3312 and not 5336, then correct estimate for CDD population ratio; (viii) Provide therapeutic coverage for ABU HAMMAD for both rounds independently; (ix) Compute % achievement for training for all cadres and update table 6; (x) Complete table 9 (treatment achievement over time). And if need be adjust total population in meso and hyper areas to match tables 2 and 7; (xi) Update table 10 (MECTIZAN) to provide information by district and LGA and reconfirm consumption data; (xii) Provide more information about CSM and supervision as required by the report guidelines; (xiii) Update table 13 series (FINANCIAL INFORMATION) to complete all columns, .in so far as possible. Provide justification for under reporting; (xiv) Fill in all sections- Sustainability, Unique features, strengths, weaknesses etc. If not done or information not available – please state this; (xv) If no operational research activities were conducted, it is important to state none in the appropriate space. Likewise for unique features; (xvi) Projects must self-assess their Strengths, weaknesses, challenges and opportunities and fill in Section 5. 244. TCC did not accept the report – TCC and APOC were pleased to receive the report but would like the additional information and reports for the previous years that were not received. The Project should be encouraged to maintain links with APOC. Conclusion: (i) A detailed report is needed from the reviewer, (ii) The Project should provide complete information for the last 6 years, (iii) Discuss in person subsequently, (iv) Scientific meeting on twice-yearly treatment could be held later. 46 TANZANIA Tunduru CDTI Project (Tanzania) 6th year Annual Technical Report Reviewer’s conclusions and assessment: 245. The executive summary is well written; the involvement of health staff is satisfactory. The population at risk is given as 300,000 however a census has not been carried out recently as the last one was done in 2002, so there is a need to update the census. There has not been enough sensitisation and involvement of the communities. There is a good male to female ratio of CDDs. There has been no CSM and there were too many Mectizan tablets remaining; this needs explanation and avoidance in future. From the data given the estimated cost per treatment was found to be US $0.90 cents, which is high. 246. Previously the Project had been asked to give some information explaining why attrition of CDDs was so high but they did not supply this information. Apparently there has been an influx of people for mining in the Project area and this raises further concern over the fact that no census has been done since 2002. Recommendations to improve the Project: (i) Update the census, (ii) Improve sensitisation and mobilisation of the communities. 247. TCC accepted the report. NOTF/HQ Project (Tanzania) 12th year Annual Technical Report Reviewer’s comments and assessment: 248. The concerns and recommendations of TCC32 were not addressed e.g., the supplementary reporting on co-implementation recommended by TCC32. The therapeutic coverage was good, reaching between 80% and 92.6%, however, there are discrepancies regarding the ‘at risk’ population; Table 2.7.1 gives 2.3 million instead of 4 million for the 7 CDTI Projects. There is a problem of absenteeism reaching 20% in Mahenge yet therapeutic coverage is reported as being 79%. The geographic coverage remains at 100% despite the number of communities having increased. The reason for the increase was unclear and needs some explanation. There was no map showing all the CDTI Projects. Training not done by NOTF. The NOTF received 1 million more tablets than needed. Insufficient supervision of CDTI is provided by the NOTF and CSM is not carried out. The report described what the NOTF proposed to do rather than what they had done. There was no narrative describing co-implementation of NTD control as requested by TCC32. 249. Conclusion: The report was not satisfactory and did not address previous TCC requests. 250. TCC did not accept the report and asks the NOTF to re-submit and strongly requests the Project to comply with TCC requests. 47 Review of the 7th, 8th, 9th, 10th, 11th, and 12th year Annual Technical Reports ANGOLA Lunda Norte Project (Angola) 7th year Annual Technical Report Reviewer’s conclusions and assessment: 251. The editing of the document is simple. However there are some points to improve upon: Report related: (i) The executive summary is too concise; It should provide more information, (ii) Verify and/or complete tables 1, 2, 5 and 10, (iii) Revise the idea of strengths and weaknesses of the project, (iv) The elements of certain sections of the document are obscure, (v) Respond to all elements of each section of the report. Project related: (i) Geographical coverage of 96.38% and therapeutic coverage of 70.62%; (ii) The period of treatment is unsatisfactory, which results in a negative impact on coverage. Conduct treatment outside the rainy season; (iii) Empower the community supervisors; (iv) Increase the number of CDDs; (v) Conduct sensitisation to reduce the number of refusals and absentees; (vi) Look for an NGDO partner. 252. TCC accepted the report and requested APOC to see if it is possible to equip the Project with office equipment and others (motorbike, bicycles, computer equipment…). Lunda Sul Project (Angola) 7th year Annual Technical Report Reviewer’s comments and assessment: 253. This is the report of a Project in its 7th year in a zone where movements of the population are frequent, but which has good geographic coverage of 96% and therapeutic coverage of 77%. This report which has been written in Portuguese and translated into French for the review, provides all the elements required to judge the performance of the Project. As with most of the reports coming from Angola, this report is not well written but provides the necessary information for review. Recommendations concerning the report: (i) Address previous recommendations; (ii) Verify the consistency of the figures given in the summary with those given in the body of the report; (iii) Completely fill the tables as indicated; especially tables 2 and 5; (iv) Verify the calculations; (v) Provide more information on the fact that the human resources are insufficient and competent so as to indicate the specific needs. Recommendations concerning the project: (i) The previous recommendations should be responded to in the next report otherwise the report should be returned to the Project; (ii) Increase geographic coverage to 100% and therapeutic coverage to at least 80%; 48 (iii) Improve the ratio of CDDs/persons to treat and of female CDDs; (iv) Intensify sensitisation and mobilisation towards APOC to obtain financing on time. 254. TCC recommended sending the report back to the Project for corrections whilst following the recommendations above. DEMOCRATIC REPUBLIC OF CONGO (DRC) Bandundu CDTI Project (DRC) 7th year Annual Technical Report Reviewer’s comments and assessment: 255. The reviewers questioned why a 2009 report was being reviewed in 2011. There was no follow-up of the recommendations made by TCC previously; the Table was empty. The summary was not very informative. The Annual treatment Objective (ATO) of 84% was 1,015,466 people but there was confusion over the population targeted. 256. The description of the project highlighted the difficult conditions of forest cover, difficulties with mobility an equatorial forest environment (forest cover, difficulties with mobility, and the human and economic consequences of isolation etc). There was no reference to the hydrology-hydrography or its epidemiological impact. IMA has been the NGDO partner since 2009, but left the Project temporarily in 2010. MEMISA is a Belgian NGDO giving support to health programmes globally. 257. There are 9 health zones and 213 health centres involved in CDTI and the density of the human population in the Province (6,053,000 inhabitants) is 20 per km2. Conclusion: 258. The quality of editing of the Report was very average, with some serious gaps that have to be corrected. Although a fair impression of dynamism comes from reading the report, the quality of execution of the CDTI appears satisfactory if one considers the progress with coverage; but there remain concerns concerning the sustainability of the project in a national context. Recommendations to improve the report: (i) Improve and expand the presentation of the Report, (ii) The summary of activities should be more informative, (iii) Table 2: There was duplication of the columns; this should be corrected, (iv) Provide information on follow-up of TCC recommendations. Recommendations to improve the Project: (i) Sensitisation of the Local Government authority and health agents, (ii) Improve the motivation of CDDs to reduce the level of attrition. 259. TCC accepted the report but requests the Project to take note of the comments given above. Bandundu CDTI Project (DRC) 8th year Annual Technical Report Reviewer’s comments and assessment: 260. This report is only for three months which is evidently not the case. 49 261. Although none of the tables of results are dated, reading it indicates clearly that it is a report for 2010; but it is presented as that of the 7th year of treatment. The actual report of the 7th year (2009) was also submitted to the same 33rd session of TCC. Conclusions and evaluation of the reviewer 262. This Project has 8 years of experience of CDTI in the difficult conditions of an equatorial forest environment, which is an asset. Its presentation must be improved and expanded, and the summary of activities must be more informative. 263. In the first analysis CDTI is carried out according to its principles and the results are satisfactory. The required minima have been reached for the last 5 years for geographic coverage and for the last two years for therapeutic coverage. 264. However, the text of the Coordinator reporting the evaluations undertaken by the coordination cast doubt on the data for the populations and the numbers of treatments; this is such a challenge regarding the rates of coverage of the tables. The number of health workers engaged and of CDDs is also a concern. The rate of participation of health personnel and the network of CDDs and their rate of attrition are certainly insufficient. 265. These remarks call for a resumption of an evaluation of the sustainability evaluation of 2006 and a verification of the baseline CDTI data especially as the coordinator asks the question of the limits of the Project whilst raising that of the co-endemicity of onchocerciasis and loiasis. 266. In a general manner the general analysis of the situation by the coordinator is pertinent and underscores the need for advocacy, mobilisation and sensitisation over time as well as the fragility of the Project which practically depends upon APOC, practically without NGDO support or financial contributions of the Government for its functioning. 267. TCC recommends accepting the report provided the Project responds to the specific questionnaire regarding the highlighted comments of the reviewer and asks for an external evaluation of sustainability which shall analyse the data and the solutions proposed by the coordinator. The results should help to determine the amount and nature of the financing from APOC which would be necessary to help the Project reach its objective. Tshopo CDTI project (DRC) 7th year Annual Technical Report Reviewer’s comments and assessment: 268. This is a project established 8 years ago but in its 6th year of distribution of Mectizan and which is in a zone co-endemic for loiasis. The coverages are still low with 71.5% for geographic coverage (15 health zones/19 health zones of the Project) and less than 65% therapeutic coverage in 2010. For the moment, the Project has been the subject of very little evaluation or monitoring. However, the Programme must be congratulated for the ratio of persons treated/CDDs, which is 128, but must continue to have less than 100 per CDD; for the efforts of supervision and verbal retro-information as written, that it is necessary to maintain, and above all for the integration of sensitisation activities, for vitamin A and vaccination which are made with the CDDs. Nevertheless, we make the following recommendations: Recommendations for improving the report: (i) Verify and re-read the reports for consistency above all with the figures. The figures produced are not consistent, and the calculation of the UTG is not well done; (ii) Re-do tables 4,5 and 7 which are badly filled in; 50 (iii) Give the results and the progress made with evaluations and monitoring which was carried out previously and indicate the state of progress in relation to the recommendations made annually in future reports. Recommendations concerning the Project: (i) Verify and investigate the figures/data on communities at the level of the CDDs notebooks, above all the figures for the population which constitutes the basis for a better estimation of the needs and for a better management of Mectizan in order to avoid tablets remaining at the end of the distribution. Concerning the management of Mectizan, indicate the measures that the Project has taken for that.; (ii) Improve coverage and carry out advocacy towards donors; (iii) Intensify sensitisation so as to increase the contribution of communities and of the local and National Government including the effective inclusion of CDTI activities in the local health budget; (iv) Improve the maintenance of equipment and indicate these measures of improvement in the report; (v) Programme and implement CSM and SHM in all villages and monitoring by the NOTF at least. 269. TCC accepts the report subject to the changes that have been suggested and ask the Project to follow these recommendations in order to improve future reports as well as performance of the Project. Sankuru CDTI Project (DRC) 8th year Annual Technical Report Reviewer’s comments and assessment: 270. The recommendations of TCC have been taken into account. The summary is not always consistent with the report, notably regarding some of the figures that it contains. The report sometimes contains very detailed information that dilutes the document. Some of the tables need to be verified and/or completed: tables 2, 4, 7, 13a, b and c. Recommendations for improving the report: (i) Verify and/or complete the tables mentioned above in the “Project related” section (pay attention to copying and pasting); (ii) Take actions to avoid a large number of wasted tablets; (iii) Limit to the essential the problems revealed from supervision, and list the strengths and weaknesses of the Project. 271. TCC congratulated the project for the good ratio of the population to CDDs for most of the communities and for the good geographic coverage (100% throughout) and therapeutic coverage (about 80% in 9 out of 10 Health Districts). Recommendations concerning the Project: (i) Follow-up the sensitisation so as to reduce the number of refusals and absentees, (ii) Plan to implement CMS and SHM, (iii) Review the measures adopted to sustain CDTI after the cessation of APOC funding, (iv) Suggest at least one operational research project. 272. TCC accepted the report with minor changes indicated above. 51 Kasai CDTI Project (DRC) 10th year Annual Technical Report Reviewer’s conclusions and assessment: 273. The report is well written and the team must be congratulated on this point. All the recommendations of TCC have been followed up. The inclusion of a map of the hydrographical data is appreciated. The essential information was well presented in the executive summary. The tables were clear and in agreement with the data in the summary, however, the report lacks clear information on the financing by partners for the year of the report (2010). Substance of the report: (i) Compared to the report of the preceding year, the performance of the Project has improved; (ii) The geographic coverage has increased from 92 to 100%; the therapeutic coverage from 70 to 76%. 32% of communities have local supervisors (compared to 20% in 2009); 1 CDD/494 persons (compared to 1827 in 2009); (iii) The rate of implementation of the training targets remains low (less than 45%); (iv) The implementation of CDTI is disturbed by other activities (vaccination) and a delay in the release of funds; (v) The ratio of male to female CDDs remains high: 5.7/1; (vi) The NOTF has not met for 5 years due to a lack of financial resources; (vii) The major challenges are insufficient numbers of CDDs, ownership by the front line health workers from the health zones and by the communities, financial contributions from the Government…). Special aspects of the Project 274. It is the biggest in DR Congo (68 health zones for a population estimated at 9,677,513 persons). Recommendations to improve the report: (i) Provide the financial contribution for the current year from partners, (ii) Revise the calculation of the UTG (84%). Recommendations for improving the Project: (i) Follow-up efforts of sensitisation so as to recruit many more CDDs and thus improve the ratio of CDDs/population; (ii) Follow-up efforts to conduct training at all levels; (iii) Improve the therapeutic coverage. 275. TCC accepted the report subject to minor changes. 52 CENTRAL AFRICAN REPUBLIC (CAR) CAR 9th year CDTI project Annual Technical Report 2010 Reviewer’s comments and assessment: 276. The Report is relatively well written, concise and understandable. The errors found in the previous report have been corrected. The performance of the Project seems to have been improving over the course of the last two years. Recommendations to improve the report: (i) Correct the figures in table 10 on the management of Mectizan and complete table 14 on the expenses incurred according to the headings; (ii) The section on description of the country must be more concise than presented in the report. (iii) The organogram of MSP is not legible; (iv) The presentation of tables (double numbering of tables, table 1 overloaded, tables 3, 5 and 5, 10, 11 and 15 illegible because of the colours. TCC recommends continuing efforts to: (i) Improve the rates of geographic and therapeutic coverage, (i) Improve the involvement of women in CDTI, (ii) Improve the ratios of CDDs/population, (iii) Validate the sustainability Plan, (iv) Intensify advocacy, IEC, sensitisation and mobilisation. 277. TCC accepted the report with minor changes. 278. There is insecurity in CAR preventing them from carrying out some recommendations of TCC. There is a devolution plan into which a lot of effort has gone. This should be retained as the plan is even more valid now than last year. LIBERIA Northwest CDTI Project (Liberia) 9th year 2010 Annual Technical Report Reviewer’s conclusions and assessment: 279. This was a well written and concise report. The project has made good progress towards using CDTI structure for other interventions which is commendable. The Report is an improvement on the submission of 2009, which was rejected. Efforts to improve CDTI project performance through advocacy, planned GIS treatment coverage and WHO/APOC direct technical assistance to Lofa, Nimba and Bong County health teams to increase their competencies are commended. Recommendations for improving the report: (i) The Project submitted two different versions of the same report. This needs to be explained by the project and the correct version of the final report identified; (ii) Correct Geographic coverage total on Table 7. 53 Recommendations for improving project implementation: (i) Conduct CSM and SHM to improve community involvement and supervision; (ii) Efforts should be made by the project to ensure that ivermectin treatment coverages remain high despite the use of the CDTI platform for other NTD interventions; (iii) Mectizan use and inventory management need to be monitored closely. 280. TCC accepted the report. TANZANIA Mahenge CDTI Project (Tanzania) 12th year Annual Technical Report Reviewer’s conclusions and assessment: 281. The Executive Summary provided adequate information on geographic and therapeutic coverage and documented the actions taken to resolve the challenges faced. The information in the summary was consistent with that contained in the main body of the report. Recommendations to improve the quality of report: (i) Compute the percentage achievement for training for all cadres and update table 6; (ii) Consult with APOC to confirm computation for absentees and correct table 7; (iii) There is need for further clarification regarding data in table 10- Mectizan inventory. The Reviewers queried the fact that all 857,718 tablets available for Kilombero were used yet at least 13,000 persons (225,458 – 212,039) based on the reviewers count were absent. Were they treated during mop-up exercises? If so then the number of absentees should be adjusted downwards accordingly. Recommendations to improve Project implementation: (i) Provide more information about CSM and SHM activities. What was done, how it was done and follow up actions taken by communities if any; (ii) APOC should provide guidelines for computation of number of absentees as is the case for computation of other parameters. – Table 7; (iii) APOC to explore possibilities of replacing vehicle and motor bike/ or providing funds to meet repair costs. 282. TCC request to APOC: (i) TCC asked APOC to provide an update regarding the fact that funds were approved by APOC to purchase a motorbike for Kilombero according to TCC 32 but the District did not receive it. 283. TCC accepted the report subject to minor corrections. Kilosa CDTI Project 9th year Annual Technical Report (Tanzania) Reviewer’s conclusions and assessment: 284. This is a well-written report. The team should be commended for retaining CDDs with no reported attrition during the reporting period. This is also one of the project sites where NTDs have been integrated and has the potential of providing lessons to APOC and other programme teams in the move towards co- implementation. 54 Recommendations on the report: (i) The report indicates that the drugs were delivered directly from MDP and the quantity was way beyond that requested for. Furthermore, there were many drugs remaining (over 1 million tablets) following treatment. It is critical that issues around drug management are addressed to avoid over-stocking and the risk of expiry; (ii) The budget table (13a) should be reviewed. There was a high increase in funding from APOC that went beyond the budget for training, which is not discussed. The government’s funding reduced in 2010 but no explanation has been provided in the report. Recommendations to improve performance of the project: (i) Increase the proportion of health personnel involved in CDTI activities. This is critical especially as the country has adopted basket funding and is co-implementing NTD control; (ii) Ensure that drug distribution does not spread too long to avoid spilling over into the events of the subsequent year; (iii) This project should be aiming at 80% treatment coverage but not 65% as stated in the report. (iv) There is need to train the communities in CSM to factor in issues on co-implementation of NTDs; (v) There is need for the project team to find ways of maintaining or replacing equipment; (vi) The slight reduction in treatment coverage should be addressed to ensure that the project sustains a coverage level above 80% (this was previously attained in 2008 and 2009). Recommendations for APOC management: (i) Clarify whether Year 5 sustainability plan was conducted and whether the report has been shared with the project team; (ii) Donor reporting requirements (including APOC) should be harmonised to ease the burden on projects that have integrated NTDs. It is important for APOC to provide some guidance on this to the project teams. 285. TCC accepted the report subject to minor changes. Ruvuma CDTI Project (Tanzania) 12th year Annual Technical Report Reviewer’s conclusions and assessment: 286. Ruvuma is one of the projects in which co-implementation with NTDs has been implemented. The report provides information on the challenges of co-implementation that could guide the overall discussions on this issue. These include timely delivery of drugs and adherence to the MDA timeframe. Recommendations concerning the report: (i) There are inconsistencies between the information in the Executive Summary and what is in the main body of the report. This information should be harmonised; (ii) Table 5 has conflicting information with the Executive Summary; (iii) Table 10 indicates that the project had over 1.6 million tablets in stock and it eventually used 844,000 for treatment yet the delay in drug delivery is given as a reason for the late implementation of the programme. This issue should be clarified; (iv) The figures in Table 10 differ from those in the Executive Summary; (v) In Table 13a the percent disbursement of funds by the Government is wrong (it is 59% instead of 81%). Effort should be made to present the correct calculations; (vi) It is important for the project team to recognize and report on the support provided from the communities (section 3.3). 55 Recommendations concerning the project: (i) The high rate of refusals and absentees in Namtumbo should be examined and addressed; (ii) The project team should prioritize the implementation of onchocerciasis MDA in a timely manner. There are complaints that a delay was occasioned by delayed receipt of Ivermectin yet there were 1.6 million tablets in stock (the team eventually used half of this). Furthermore, timely implementation of treatment will avoid spill-over of treatment into the subsequent year; (iii) Efforts should continue to reduce the CDD-population ratio (the current level is 1:221); (iv) It is critical for the project to confirm whether it distributed both mebendazole and albendazole. This is a key conceptual issue. 287. TCC accepted the report subject to minor changes. Tukuyu CDTI Project (Tanzania) 10th year Annual Technical Report Reviewer’s conclusions and assessment: Recommendations concerning the report: (i) Tables 10 and 12 are incomplete. Care should be taken during the preparation of reports to ensure that all the tables are complete before report submission; (ii) Clearly indicate the currency used to report budgets in the report; (iii) Table 10 is incomplete. In addition, the average use of drugs is very high - 6.4 in Rungwe, 8.7 in Kyela, and 38.8 in Ileje. This could be due to poor record keeping or poor compilation of the reports, which should be addressed; (iv) The project team should acknowledge the contribution of the community to the project. Recommendations concerning the project: (i) Implementation of project activities should be planned in a realistic manner. It is not possible to undertake training, CDD updates, training, treatment and supervision within two months; (ii) Increase the proportion of health staff involved in CDTI. The current level of 11% is too low for this project; (iii) Attention should be paid to the activities in Kyela, which recorded the lowest treatment coverage and had the least attainment of training objectives. This area also reported the highest level of absenteeism; (iv) The Project should check the number of tablets per treatment actually used. Recommendations for APOC: (i) It is important for APOC to assess the process of co-implementation so as to draw lessons for other programmes. Such an assessment could also guide the project teams in various ways including recording and sequencing of activities; (ii) The team needs assistance with reporting. The format for reporting co-implementation does not allow them to report the data properly and needs to be adapted. (TCC sub-group to look into issues of reporting co-implementation). 288. TCC accepted the report subject to minor changes. 56 Reports of TRC Review Committees: Agenda Item 17 Report on the 5th Session of the Technical Review Committee of Cameroon 289. Dr Aboutou presented the TRC report from Cameroon. The fifth TRC meeting of Cameroon was held from 11-12 August 2011. Discussion: (i) There are issues related to incentives paid to CDDs that are specific to Cameroon. A difficulty is that payment is undertaken by the Government and it is made after distribution and may occur late. Payment is made to regional delegates and it can take one or two years for them to receive payment, which creates problems and mistrust. In addition to Government provision, TCC would like communities to give incentives – not necessarily financial. However, this is difficult as communities think CDDs are paid by the Govt. Project officers and coordinators don’t participate in the TRC sessions – this is done by regional delegates. The Ministry of Health (MoH) would like biannual treatment wherever necessary. TCC therefore discussed what criteria would be used to decide on this and whether MDP would endorse this idea. Two- yearly treatment should be conducted as a pilot study in the north with Carter Centre. A study showed that a lot of onchocerciasis decision makers accepted the demand for two rounds of treatment. Arrangements will be made for ordering the drug. Conflicted reports of Progress for the Centre 1 CDTI Project were discussed. The Project is apparently performing poorly, however the TRC reviewed it and find it excellent! (ii) It was noted that sustainability plans had already been prepared but because of the shift towards elimination the TRC felt that these could be resubmitted to check programmes and maintain sustainability. The issue of Operational Research has been a recurrent issue and was discussed. It was recommended that the Project staff collaborate with the University Faculties of Medicine and Sciences. The Country has submitted proposals but the procedure for submitting them was not followed and the new Coordinator did not forward the proposals for review. These projects will therefore be reviewed in TCC34. There are some political threats to Centre 1 Project due to redeployment of health workers. The Director of Disease Control believes that the CDTI strategy can apply to nomadic populations. It is difficult for CDDs to cover the necessary distance on foot but nurses from the FLHF could reach those communities. The nomads always go to the same places. The question of Vector control to avoid nuisance biting was raised as there are some major infrastructure projects and policy makers believe that when constructing them in onchocerciasis areas, Simulium may develop and vector control may be necessary to target the fly in these areas. 290. The Director of APOC suggested that: (i) APOC should collect information on factors causing poor performance and provide feedback to the Cameroonian authorities; (ii) As the Programme moves towards elimination there will be an increasing need for evaluations, which require expertise and resources. 291. TCC took note of this. Cameroon should develop a proposal for a pilot study of twice-yearly treatment. 292. TCC accepted the report and thanked Dr Aboutou for her presentation. 57 Report on the 2nd meeting of the Uganda Technical Review Committee (TRC) 293. Dr Dawson Mbulamberi presented the report of the 2nd meeting of the Ugandan TRC, which was held between 18th and 20th July 2011, at the Conference Hall of the Vector Control Division (VCD) of the Ministry of Health, Kampala. 294. The meeting reviewed four technical reports on CDTI projects, phases 1-4; two reports on Post- Elimination Surveillance Activities in Itwara main focus and its sub-foci of Aswa and Siisa, Kabarole District, Western Uganda; and Mpamba-Nkusi focus, Kibale District, Western Uganda; and Guidelines for the Certification of Onchocerciasis elimination in Uganda. Unfortunately, there was no operational research proposal to be reviewed. 295. These reports and the guidelines had been earlier assigned to specific members of the TRC for review and compilation. The subsequent reports were presented to the TRC for critical discussion and decision-making. Recommendations were made by the TRC in respect of each of the reports. Salient findings on the four CDTI project reports, the two post elimination surveillance activity reports and the guidelines on the certification of onchocerciasis elimination in Uganda: a) CDTI Phase I Project report: 296. The Report was found to be adequate in form and content and was accordingly recommended for acceptance with the following suggestions for improvement: Report related recommendations: (i) All the tables and figures in the executive summary and main body of the report required to be corrected; (ii) Cost per treatment to be computed correctly; (iii) Data on CDDs to be disaggregated by gender in each of the districts; (iv) APOC reporting format should be followed. Project related recommendations: (i) Advocacy for CDTI to be intensified at the national level, (ii) Operationalise CSM, (iii) Operational research should be conducted on: – Cost per treatment, • CDTI alone, • CDI co-implementation, – Merits and demerits of school-based and community-based MDA, – Factors affecting sustainability of CDI. b) CDTI Phase II Project report 297. The Report was recommended for acceptance with the following suggestions for improvement: Report related recommendations: (i) Update executive summary to capture all the main issues raised in the report; complete the list of acronyms and decongest the table of contents; (ii) Follow APOC reporting format; (iii) Describe the road network as well as the cultural characteristics in the country. Project-related recommendations: (i) Intensify social mobilization and sensitization of the youth using peer groups, (ii) Conduct KAPB study in onchocerciasis endemic communities. 58 c) CDTI Phase III Project report: 298. The Report was found to be adequately comprehensive and accordingly recommended for acceptance with the following suggestions for improvement: Report related recommendations: (i) Reformat the report, complete the list of acronyms and revise the titles of tables; (ii) Provide explanation for low therapeutic and geographical coverage as well as failure to treat in Bondo, Koboko district for 3 years; (iii) Make concrete proposals for cross-border collaboration. Project-related recommendations: (i) Strengthen advocacy using Civil Society Organizations (CSOs), (ii) Follow-up the implementation of NGDO resolutions. d) CDTI Phase IV Project report: 299. Report recommended for acceptance with following suggestions for improvement: Report related recommendations: (i) Complete list of acronyms and revise both the text and tables to eliminate errors, repetitions and ambiguity; (ii) Provide concrete information on population reductions in Moyo and Adjumani districts following the return of South Sudanese refugees to their country following independence of the country. Project-related recommendations: (i) Conduct operational research on the high CDD attrition rate in post-conflict situation e) Post elimination surveillance activity reports: (ii) The executive summaries should include strengths, challenges and solutions; (iii) Maps of the foci should be provided to enhance clarity; (iv) Background information on socioeconomic status should be strengthened; (v) Historical perspective of the foci should be provided as well as the strategy for vector elimination in them; (vi) Information on the age group with residual microfilaria in the Mpamba-Nkusi focus should be provided; (vii) Quarterly surveillance for vectors and crabs should be maintained along the main transmission rivers in all the foci. f) National Guidelines on the Certification of Onchocerciasis elimination in Uganda: (i) Revisit the list of acronyms and decongest the table of contents; (ii) Transfer appendices 4 and 5 to the main body of the document; (iii) Revise some of the appendices so as to bring them in line with the Standard Operating Procedures (SOPs). 300. It was noted that the Guidelines need to be updated. WHO/HQ should set up an expert committee on this global issue. A teleconference will be organised with all regions involved. TCC endorses. All decisions should be made by all partners including the NGDO. 59 Report of the 7th Technical Review Committee, Nigeria 301. Professor Idyorough presented a report on the 7th Technical Review Committee of Nigeria. A total of 33 Technical Reports were received and reviewed but no operational research proposal was reviewed although Nigeria submitted proposals to TCC for review. Presentations were made on the following: (i) Achievements and issues in UNICEF-assisted State, (ii) Extent of implementation of TRC6 recommendations, (iii) Updates on Advocacy and Monitoring activities in 2011 by NOCP HQs, (iv) CDTI in Akwa Ibom State, (v) Updates on advocacy and monitoring activities in 2011 by Zones A, B, & D, (vi) 2010 Status/Update on financial returns of CDTI projects in Nigeria. a) Presentation on achievement and Issues in UNICEF Assisted States. 302. The Consultant to UNICEF on Onchocerciasis Control made a presentation on the achievements and issues in 10 UNICEF-assisted States, and highlighted the following: (i) 24,119 health workers and 92,695 CDDs trained, (ii) RAPLOA surveys conducted in 8 out of 10 States. Problems identified: (i) Rapid assessment survey in communities previously tagged hypo-endemic now found to be hyper-endemic in B Zone; (ii) Outcome of monitoring & supervision in B & D zones shows that implementation is inadequate. Actions to be taken: (i) NOCP & NGDOs to intensify monitoring; (ii) Programme to ensure that treatment is initiated and sustained in communities previously tagged hypo-endemic now found to be hyper-endemic in B Zone; (iii) Programme to train more CDDs. Recommendations by TRC: (i) NOCP to ensure that approved entitlements get to health workers at LGAs and FLHFs; (ii) UNICEF should continue support for activities that will improve effectiveness and efficiency in UNICEF assisted states; (iii) NOCP to ensure appropriate change of the principal signatory in B zone states. b) Presentation on the extent of implementation of the TRC meeting recommendations (Appendix 5) 303. The National Coordinator made a presentation on the extent of implementation of the recommendations from TRC5 and TRC6. Challenges identified: (i) Recommendations of TRC were not fully implemented by APOC regarding procurement of a vehicle for the NOCP zonal office. c) Presentation 3. Advocacy & Monitoring Activities by APOC HQs (Annex 6) 304. The National Coordinator made a presentation on advocacy and monitoring activities by NOCP HQs. 60 Challenges identified: (i) Lower coverage for household treatment compared with reported coverage; (ii) Projects do not report the actual situation on the field. Higher coverage figures than actually achieved are reported by projects. Action to be taken: (i) Advocacy and monitoring should be intensified at all levels; (ii) APOC should release report of Geographical coverage survey conducted in Nigeria to enable projects to improve coverage where necessary. d) Presentation 4. CDTI in Akwa Ibom State (i) The State Coordinator of Akwa Ibom State CDTI Programme made a presentation on CDTI in Akwa Ibom State; (ii) N3 million and a Hilux vehicle were provided in 2010 by the State Government. N3million again provided in 2011 by State Government; (iii) Discontinued support from NGDO (HKI); (iv) TRC urge NOCP to table evidence of discontinued support for Onchocerciasis control in Nigeria, at the proposed meeting with the new Country Director of HKI. e) Presentation 5. Advocacy & Monitoring Activities by the Zonal Offices (i) The Zonal Coordinators of A, B, & D made presentations on advocacy and monitoring activities carried out at the zones; (ii) UNICEF released funds in 2011 for rapid assessment survey in B zone as a follow up to the entomological & epidemiological surveys results of 2010, revealing hyper-endemic communities; (iii) The zonal coordinator was requested to ensure the capacity building of SOCTs on technical report writing in his zone. f) Presentation 6. 2010 Status/Update on Financial Returns of CDTI Projects in Nigeria (i) The NOCP Accountant made a presentation on 2010 status/update on financial returns of CDTI projects in Nigeria; (ii) All projects are up to date with their financial returns except Zamfara CDTI that still has outstanding returns from July – December 2010. General Recommendations: APOC (i) In order to improve project implementation, TRC urges APOC to assist projects to implement CSM / SHM in all CDTI communities by end of 2012; (ii) TRC expresses concern over non-implementation of sustainability plans by most projects. The meeting therefore urges APOC to fund monitoring of implementation of sustainability plans of projects that are 7 years and above in 2012; (iii) TRC observed with utmost concern that operational research proposals forwarded to APOC Management have not received adequate attention. TRC therefore decided to stop further review of operational research proposals until the committee receives appropriate response from APOC. NOCP (i) NOCP is urged to initiate the process of changing the principal signatory to APOC accounts for UNICEF-assisted States in B zone; 61 (ii) In order to ensure that Policy makers live up to their responsibilities on CDTI, NOCP is requested to produce twice a year fact sheets reflecting information on the performance of endemic States and LGAs in terms of counterpart funds released, treatment coverage, etc. The fact sheets should be forwarded to the governors, commissioners of health, public health directors and the media houses; (iii) Considering the generous and consistent financial contributions of State Governments of Delta, Akwa/Ibom and Jigawa States to CDTI in the past 2 -3 years, NOCP is requested to write commendation letters to the governments of these States; (iv) NOCP should inform projects to provide in their annual technical reports information on sustainability indicators reflected in the new format for the review of technical report of projects that are 7 years and above; (v) In order to enhance effective follow up by the zonal coordinators at lower level, NOCP HQs should copy the States all relevant mails sent to the zonal offices; (vi) TRC 7 expressed serious concern that the projects in C zone have not received adequate attention from the zonal office. NOCP is requested to follow up and ensure that the situation is normalized; (vii) NOCP should arrange for special interventions for projects where personnel require training on technical report writing, accounting, Mectizan inventory management, etc. The NOTF partners are requested to collaborate in this respect; (viii) TRC notes the conduct of training of all project accountants, sponsored by UNICEF/Nigeria, which enabled projects to be up to date in their financial returns. TRC commends UNICEF for this support and notes that such training would be more beneficial if conducted before TRC meetings. The NGDO chair is requested to approach other NGDO country representatives for funding of subsequent training sessions; (ix) NOCP is to ensure that zonal review meetings are held as recommended to review technical reports. TRC will no longer review any technical report without evidence of having been considered at a zonal review meeting. The next TRC Nigeria meetings will take place as follows: (i) TRC8 - February 13 – 17, 2012, (ii) TRC9 - July 10 - 14, 2012 in Obudu, Cross River State. Discussion: 305. The issue of repeated rejection of Reports was discussed e.g. from Kebbi and Kogi. With respect to resubmitted reports, once a problem is identified it will take a long time for a State to resubmit the next report. There is no basis for accepting later years Reports until a previous one is accepted so the cycle continues. It was suggested that an internal workshop could be held using available in-country expertise to improve reporting capacity. 306. There was concern over the problem of defining hypo and hyper-endemic areas and the need for further epidemiological evaluations was expressed. Finally, TRC Nigeria was asked to look at implementation rate of their recommendations by Projects in the same way that APOC management does with TCC. 62 307. TCC accepted and noted with satisfaction the report from Nigeria, and thanked Prof Idyorough for his presentation. (i) TCC noted that it is important that they should follow up on decisions made and the TRC are strongly recommended to have a policy for resubmission and review of rejected reports so as to resolve that situation; (ii) TCC is concerned over the change from hypo- to hyper-endemic areas and requests the APOC Epidemiology Unit to validate the epidemiological evidence and verify whether this actually is the case or not; (iii) The TRC should present a table of implementation of recommendations to future TCC meetings. Other matters: Agenda item 18 a) Presentation of CDTI implementation in Burundi Efforts and opportunities to strengthen CDTI integration within the community health system in Burundi 308. Dr Baza explained the locations and history/background of the Burundi CDTI projects. The three projects have been making good progress since being initiated in 2005. Dr Baza explained in detail the functioning of the health system in relation to community-based health interventions. The country has a national health policy and poverty reduction strategic framework, health development plan, NTD master plan as well as operational plans at lower levels. Its Master plan includes onchocerciasis and should soon be endorsed. The presenter highlighted the ongoing health reforms, particularly decentralisation and performance based financing and community-based intervention through polyvalent health workers, free health care for all under fives and pregnancy related problems. A mechanism to acknowledge good performance, especially from CDDs was recommended. 309. The TCC Chair acknowledged the presence of the Rutana Governor and MP, Mme Ciza. 310. Mme Ciza thanked APOC for the invitation to the Burundi delegation commenting that the Burundi Administration strongly supports the APOC programme and had accompanied the former APOC Director on a field visit in Burundi. b) Issue of rejecting or accepting reports 311. Terminology: 1. Accept, 2. Accept with minor changes (submit to APOC management), 3. Accept with major changes (submit for review by reviewers), 4. Deferred to the next TCC (in essence polite for reject), 5. Reject (especially (predominantly for research proposals). 312. After discussion of the proposed decisions that TCC could make regarding Annual Technical Reports it was agreed to amend the above suggested terminology and to use the following: 1. Accept, 2. Accept with minor changes (submit to APOC management), 3. Accept with major changes (submit for review by reviewers), 4. Not accepted, resubmit to the next TCC (in essence polite for reject), 5. Reject (especially (predominantly) for research proposals). c) Evaluations of sustainability in South Sudan 63 Situation in South Sudan 313. Dr Ndyomugyenyi presented a summary of the evaluations of sustainability of three projects in South Sudan. Coverage was low at all levels. In East Equatoria none of the indicators scored the minimum of 2.5 at any level so all projects failed and the evaluation team recommended that the projects need to start afresh and implement CDTI; but this must be done at all levels with knowledgeable persons whose skills can be built. 314. A sub-committee was set up to assess the status of CDTI in South Sudan based on a review of their Annual Technical Reports and results of recent evaluations of sustainability and to make recommendations for improving CDTI in the country. Members: 1. Dr Amuyunzu-Nyamongo, Dr Kisito Ogoussan, Prof Idyorough, Dr Fatu Yumkella, Dr A. Yebakima, Mrs F. Olamiju and Dr G. Fobi. Context: 1. Burden of onchocerciasis is quite high; 2. Co-endemicity of onchocerciasis with Loa loa in some parts of the country; 3. Weak programme/weak record keeping; and 4. Rapid population expansion due to returnees (from different areas which would require some time to generate a community sense of belonging). Issues: 1. Well written reports which do not reflect the facts in the project sites as opposed to reports from independent evaluation/monitoring. What should be done to ensure that the project teams appreciate the seriousness with which APOC and TCC take regarding submission of inaccurate (falsified) reports? 2. The need to initiate CDTI afresh? How should this be initiated? Who will bear the responsibility of doing this? What would be the role of CBM, APOC and other partners? 3. Need to explore extra sources of financing (USAID and NTD partners). 4. Review the TOR of technical advisor in view of the issues noted above. 5. What is the view of the team about twinning South Sudan with Uganda NOTF and project teams? Quick analysis on the current status of monitoring No. Project Age Independent monitoring Mid-term evaluation Sustainability evaluation Any other form of visit 1 East Bahr El Ghazal 6 years √ ? √ ? 2 East Equatoria 5 years x x x ? 3 Upper Nile 5 years x x x ? 4 West Bahr El Ghazal 5 years ? ? √ ? 5 West Equatoria 6 years ? ? √ ? 64 Discussion by the group 315. The team recognized that South Sudan is a new country and there is a need to re-introduce CDTI. Although CDTI was introduced in Southern Sudan in the late 1990’s it was re-launched about 6 years due to the conflict that eroded most of the efforts put in place especially by APOC. The team was of the view that the country should be treated as a post-conflict country for the next two years because any structures put in place now may not be sustainable. The focus should be on compliance. (i) APOC management, NGDOs (especially CBM) and TCC should conduct a high-level advocacy to South Sudan to sensitise the Government on the programme (given the new leadership in the country); (ii) Hold detailed discussions with the technical advisor regarding the current programme status and on issues around oversight. What are the key challenges? Why isn’t he picking issues that are apparent to independent monitors? What are his terms of reference? How should this TOR be amended to meet the needs of the programme? How to assist the Technical Advisor towards solving the problem? This position should be performance based; (iii) Conduct census in each project site before the next round of treatment. This could be done by the CDDs with the support of the programme team; (iv) Re-launch CDTI in all the project sites in view of the influx of returnees and the current treatment approach (passive treatment); (v) APOC should invest in independent monitoring until the gaps in the various projects are streamlined (including rectifying the falsification of reports); (vi) Conduct further analysis of the RAPLOA and REMO data and plan accordingly for expansion of MDA to the unreached areas; (vii) Invest in capacity building to improve data quality (focus on record keeping at all levels) ; (viii) Explore ways of linking the South Sudan NOTF and the project teams to their counterparts in Uganda; (ix) Explore ways of bringing other partners on board given the potential high costs of having meaningful interventions in the country (including World Bank, USAID, European Union, UN agencies, NGDOs, etc). Additional discussion during plenary: (i) Trypanosomiasis is co-endemic with onchocerciasis; (ii) Hold a workshop in Juba involving NGDOs, TCC, and APOC management to introduce CDTI to them; (iii) NGDOs should discuss this issue in the Nairobi NGDO meeting:  The Projects need more help in South Sudan (CBM cannot do it alone); (iv) Management should put in place a taskforce which will then plan for a workshop in Juba. 316. Because of the issue of epilepsy and maybe sleeping sickness; there is a need to concentrate efforts in this area. cbm is working in these projects. Sudan needs to be supported and TCC should invite more NGDOs to support this big country. CBM should have read these reports and discuss them. The TA in Southern Sudan should assist with this. There is also a need to explore ways of reaching nomadic populations. 317. TCC recommends holding a workshop in Juba if APOC management can approach the Government officially to organise this with many NGDOs. Dr Ukety, TCC members and others 65 would be involved. The workshop would also discuss issues of Loa loa and sleeping sickness and then bilateral discussions can be held to re-launch CDTI. Currently the authorities would not appreciate the problem. Advocacy and sensitisation should be made to the highest level (President). It was noted that the same approach would be applicable for DRC and Angola in order to improve their situations. Recommendation to APOC: (i) APOC management should put a task force together and then idea of workshop in Juba as soon as possible. The Director of APOC should approach the President and the Ministry to explain the problem and express APOC’s keenness to do something about it. The situation should be presented to the forthcoming NGDO meeting and feedback should be obtained from them. d) Discrepancy between reported and actual coverage – Littoral 2 and Centre 1 318. The issue of inaccurate coverage reporting was discussed with the aim of developing solutions to overcome this. 319. Dr Fobi showed figures of therapeutic coverage for the two projects and described the history of treatment coverage from epidemiological evaluations. Community members aged above 20 years were interviewed but this was not done in a standard way. Data coming from this survey gave a lower coverage by village – the highest (87%) was in Centre 1. For Littoral 2 CDTI Project, the data have not yet been analysed but coverage was good, as noted in the field. 320. The Reports of both Littoral 2 and Centre 1 Projects have all been accepted in the last 5 years. Questions to be addressed are as follows: (i) Are there discrepancies between reported and actual coverage data? (ii) Do epidemiological surveys provide a proper estimate of coverage or not? (iii) How can we do this as a routine (confirmation of coverage)? 321. The procedures followed for assessing coverage are that the treatment coverage team goes from house to house interviewing individuals. Alternatively, a second method is to review treatment registers. Interviews are relied on most of all as they reflect reality. There are new updated guidelines for a treatment coverage survey as presented at the last TCC. Results of treatment coverage have correlated well with mf prevalence. Independent monitoring is likely to be more reliable than data obtained from the Project staff. Coverage surveys need to be conducted wherever APOC does epidemiological evaluations although there is an issue of cost. The epidemiological evaluation guidelines are provided as the minimum standard to be followed. 322. A recommendation concerning coverage surveys was deferred to be discussed in TCC34. 323. TCC members are encouraged to visit sites – invitation by APOC or initiative of TCC members? e) Issue of changing the age for mature Projects to be reviewed separately from 7 to 5 years and changing the review format to present just critical issues 324. Following discussion it was agreed that: (i) TCC members don’t want to change from 7 years to 5 years; (ii) The question of reducing the format for presenting to critical issues should be an issue for the next TCC (TCC34). 66 f) NTD co-implementation issues 325. The issue of co-implementation and the need to properly report these activities and have adequate training and data recording was discussed. 326. Discussion: Countries undertaking co-implementation should revise training materials to include NTDs as well as developing treatment registers, as Tanzania has done. It would be beneficial to document the processes, policy reviews etc. This would need a comprehensive review. This is also the concern of an APOC monitoring report that was done after first year of co-implementation. 327. TCC should also review the NTD reports for countries undertaking co-implementation. It was suggested that TCC members should take part in the next assessment of the Tanzania co-implementation Programme and that it could also look at the broader issue of integration. g) LF and Onchocerciasis collaboration 328. Lymphatic Filariasis (LF) elimination and Onchocerciasis control programmes are using ivermectin as a common tool for the control of the two diseases which are co-endemic in many areas. In the context of stopping ivermectin treatment in areas where one of the diseases has been eliminated, cooperation/dialogue should be engaged to agree on the way forward. It is observed however that there are difficulties at country level and even at WHO/HQ, WHO/AFRO and APOC levels concerning this dialogue. Communication should therefore be improved. (i) APOC should be represented at LF meetings and the LF coordinators should be represented at APOC meetings; (ii) How can that be facilitated? 329. It was suggested that the issue be put on the agenda of the Nairobi NGDO meeting. It was also recommended that an APOC representative should attend meetings of the strategic NTD committee of WHO and vice-versa. 330. TCC Decision: Drs Kisito and Fobi will draw up a list of meetings and indicate those for which LF representatives should attend at APOC. h) Issue of internships for APOC 331. The possibility of APOC taking on interns was discussed and it was concluded that the idea should be supported. APOC should announce it but shouldn’t pay as it should be for those who are genuinely interested in working with the Programme. Suitable intern candidates should have finished a Masters degree but APOC should consider the criteria and decide upon clear objectives as well as determining how easy it would be to implement. 332. TCC accepts the proposal and decided that APOC should develop the criteria and methodology to apply it, including issues of finance, implications for staff time and costs and should present a plan of action to TCC. APOC should therefore correspond on this issue between the Chair and Prof Mamadou Traore. It was considered useful to include MDSC in the use of interns. i) Country visits 333. TCC members are asked to write to APOC management with a copy to Chair if they plan to make country visits. 67 Date and place of thirty-fourth and thirty-fifth sessions of the TCC: Agenda item 19 (i) The 34th Session of TCC will take place in Ouagadougou from 12 to 16 March 2012, (ii) The 35th session of TCC will take place in Ouagadougou from 10 to 14 September 2012, (iii) The Report (Conclusions and recommendations of TCC 33) was reviewed and adopted. Closure of the session: Agenda item 20 334. Mme Ciza made closing remarks on behalf of the Burundi delegation. She expressed her profound gratitude to the APOC Director, the Chair of TCC and its members for having invited the Burundi delegation. She noted that the former APOC Director, Dr Amazigo, had visited Burundi and seen for herself the progress made. Mme Ciza also thanked APOC management for the bicycles that had been distributed. The attendance of the Burundi delegation at the TCC meeting had resulted in a better understanding of the shift from control to elimination and of the tasks of advocacy, sensitisation and mobilisation, and of trans-boundary issues for onchocerciasis control. Non-involvement of the administration leads to setbacks for the programmes. Mme Ciza invited members of TCC to visit Burundi to see what is being carried out and the challenges faced. She also remarked that exchange visits with neighbouring countries would be useful. Mme Ciza again thanked APOC for the technical support provided and noted that Burundi maintained its commitment to the Programme. 335. Dr Lusamba-Dikassa thanked all TCC members for their participation and contributions to a successful meeting. He noted that he had doubts at the start of the meeting as to whether the group would be able to exhaust the agenda in 5 days but hadn’t realised the skills of the chair and experience of members. There had been rich discussions and useful recommendations made during the meeting which was held under a cordial ambience. Dr Lusamba was impressed by the openness of the TCC. He noted that much information had been asked for from APOC management. Some issues were not immediately addressed and promised that the Management will supply this information. He asked for TCC’s contribution to a specific concern – problems of financial returns and the common basket founds at countries’ levels. He said that the Management would be grateful if TCC could help with concrete suggestions to deal with the matter. Dr Lusamba-Dikassa thanked the Governor and the representative of Burundi for sharing experiences in her country. He also thanked the Advisory group for giving their findings. Finally, He thanked all contributors to TCC, including Drs Domingo, Wanji and Taylor. 336. The TCC Chair, Professor Mamoun Homeida, thanked Mme Ciza, and all TCC members for their hard work and for attending the TCC meeting. Professor Homeida thanked the APOC director and all the team from APOC. Finally, the Chair thanked the translators for working for long hours over the five days and declared the meeting closed. 68 Annexes Annex 1: List of participants 33rd SESSION OF THE TECHNICAL CONSULTATIVE COMMITTEE Ouagadougou, 12-17 September 2011 TCC MEMBERS 1. 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: amst33@hotmail.com 2. Prof. Mamadou Souncalo Traoré, Département d’Enseignement et 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 – E-mail: traorem@afribonemali.net 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, E-mail: kogoussan@taskforce.org 4. 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 - E-mail: yebakima@cg972.fr and yebakimakebara@yahoo.fr 5. 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; E-mails: Mnyamongo@aihdint.org and Manyamongo@yahoo.com 6. 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 : mitosath@hotmail.com; franciscauk@hotmail.com 7. Dr Bernard Philippon, 35 Avenue Jean Moulin, Paris, France - Tel : (00331) 40 44 94 04/ (00331) 44 12 41 90 - Fax : 44 12 23 01- Email: abphilippon@yahoo.fr; opc@opc.asso.fr 8. Fatu Yumkella, Managing Director, Dalan Development Consultants (DDC), 12A King Street, The Maze, Wilberforce, P.O. Box 491, Freetown, Republic of Sierra Leone – Phone: 232-33- 851405, 232-76-627878, 232 77 641736 - E-mail: dalanconsult@yahoo.co.uk; fyumkella@dalanconsult.com – Website: www.dalanconsult.com TECHNICAL ADVISERS 9. Dr Michel BOUSSINESQ, Institut de Recherche pour le Développement (IRD), UMI-233, 911 avenue Agropolis, BP 64501, 34394 Montpellier Cedex 5, France, Tel: +33 675139151-Email: michel.boussinesq@ird.fr 10. Prof. Daniel A. Boakye, Head, Parasitology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, P.O. Box LG581, Legon, Accra, Ghana - Tel: +233 302 501178 - Mob: +233 205 826868 - Fax: +233 302 502182 – Email: DBoakye@noguchi.mimcom.org 69 WHO/GENEVA 11. Dr Tony Ukety, Responsible Officer, NGDO Coordination Group for Onchocerciasis Control, World Health Organization (WHO), 20 Avenue Appia, 1211 Geneva 27, Switzerland - Tel: +41- 22-791-1450 – Fax : +41-22-791-4772 - E-mail: uketyt@who.int 12. Dr Annette KUESEL, Scientist, WHO/TDR, 20 Avenue Appia CH-1211 Geneva 27, Switzerland – Tel: +41 22 791-1541 – Fax: +41 22 791 4774 – E-mail: kuesela@who.int WAHO 13. 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 E- mail : wahooas@wahooas.org; bayesacko2000@yahoo.fr PATH 14. Dr. Gonzalo Domingo, Senior Research Scientist, PATH, PO Box 900922, Seattle, WA 98109, USA, Tel: 206-3024741 - FAX 206.285.6619, - E-mail: gdomingo@path.org LIVERPOOL SCHOOL OF TROPICAL MEDICINE 15. Mark Taylor PhD, Professor of Parasitology, Director of A-WOL, Head, Molecular and Biochemical Parasitology Group, Liverpool School of Tropical Medicine, Liverpool, L3 5QA,UK - Phone: 0044 (0)151 705 3112 -Fax: 0044 (0)151 705 3371 – Email: Mark.Taylor@liverpool.ac.uk 16. Prof Samuel WANJI, University of Buea & Executive Director Research Foundation for Tropical Diseases & Environment, P.O. Box 474, Buea, Cameroon - Email: swanji@yahoo.fr INVITED 17. 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, E-mail: pefoungo@yahoo.fr 18. Prof. Alamveabee Efihraim Idyorough, Sociology Department, University of Jos, Jos. Plateau State. Nigeria - Tel. + 2347037997744 E-mail: aeidyorough@ymail.com 19. Dr Aboutou Rosalie Louise, Coordonnatrice Adjointe, du Programme National de lutte contre l’Onchocercose, Ministère de la Santé Publique, Secrétariat Exécutif du GTNO, B.P. 155, Yaoundé, Cameroun, Tel/Fax : (00237) 22 22 69 10, Cellulaire : +237 99965410 – E-mail : aboutourosalie@yahoo.fr 20. Dr Dawson Bob Mbulamberi, Ministry of Health, P.O. Box 7272, Kampala, Uganda. Tel. (256 772) 508 919, Fax (256 414 ) 231584 - Email: mbulamberidawson@yahoo.com 21. Honorable Mme Virginie CIZA, Gouverneur de la province de Rutana et Président du Groupe de Travail Provincial sur l'Onchocercose - Téléphone: +25779990405 (mobile) +25722505025 - 70 Email: cizavirginie@yahoo.fr 22. Dr Jean Claude NAHISHAKIYE, Médecin Directeur de la Province Sanitaire de Bururi, Burundi, et Vice-Président du Groupe de Travail Provincial sur l'Onchocercose - Téléphone: +25779980915 et +25776493300 (mobiles) - Email: nahiclaude8@yahoo.fr 23. Monsieur Nathanaël NDIMURUVUGO, Coordonnateur du projet TIDC Bururi, Rumonge - Tel. +25777769737 – Email : ndimuruvugonathanael@yahoo.fr CSA ADVISORY GROUPS MEMBERS 24. Dr Jan Hendrik Frederik Remme 120 rue des Campanules 0120 Ornex, France – Tel: +33 64 545 74 04 – E-mail: hansremme@gmail.com 25. Dr Richard Ndyomugyenyi, c/o National Onchocerciais Control Programme Secretariat, Ministry of Health, 15 Bombo Road, P.O. Box 1661, Kampala, Uganda, Tel. + 256 772457980 - E-mail: richardndyomugyenyi@yahoo.com 26. Dr Sam Adjei, formerly Deputy Director General, Ghana Health Services. Currently Chief Executive, Centre for Health and Social Services (CHeSS), Ministry of Health, Accra, Ghana – Tel. 233 244 691625 - Email: drsamadjei@yahoo.com 27. Dr Ali Mzige, Public Health Consultant, Director International Medical Technological University Hospital, Dar-es-Salaam. Former Director of Preventive Services, Ministry of Health, Tanzania, Email: amzige@hotmail.com; amzigetz@yahoo.com – Tel. 255 754 495 998 28. Dr Tshinko Bongo Ilunga, Public Health Specialist, 25 B.P. 229, Abidjan 25, Côte d’Ivoire – Tel: (+225) 06913132 – Fax: (+225) 22430602 – E-mail: ilungatb@yahoo.com 29. Dr Anthony Theophilus Seddoh, Director, Operations, Center for Health and Social Services and a Health Policy Specialist, Accra, Ghana – Tel. 233 268187259 / + 233 2794 – Email: tseddoh@yahoo.co.uk 30. Dr Catherine M. Hodgkin, Mauritskade 63, P.O. Box 95001, 1090 HA Amsterdam, The Netherlands, E-mail : chodgkin@xs4all.nl; c.hodgkin@kit.nl; WHO/BURUNDI 31. Dr Dismas BAZA, NPO MALARIA / APOC-NTD Focal Point, WHO, Boulevard de l'UPRONA, PO Box 1450 Bujumbura-BURUNDI, Tel office: +257 22 231447, Mobile: +257 77 769 680, Fax: +257 22231771, GPN: 33410, E-mail: bazad@bi.afro.who.int; dismas.baza@yahoo.fr WHO/MDSC 32. Dr Evariste Mutabaruka, Director a.i., MDSC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29 53, Fax: (226) 50 34 28 75, E-mail: mutabarukae@oncho.afro.who.int 71 33. 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, E-mail: toel@oncho.afro.who.int 34. Dr. Yiriba Bissan, Medical Entomologist, MDSC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29 53, Fax: (226) 50 34 28 75, E-mail: bissany@oncho.afro.who.int 35. 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, E-mail: adjamiga@oncho.afro.who.int 36. Mr Moussa Sanfo, MDSC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29 53, Fax: (226) 50 34 28 75, E-mail: Sanfom@oncho.afro.who.int WHO/APOC 37. Dr Paul-Samson Lusamba-Dikassa, Director, APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29 53, Fax: (226) 50 34 28 75, E-mail: lusambap@oncho.afro.who.int 38. Dr Laurent Yaméogo, COORD/APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29 53, Fax: (226) 50 34 28 75, E-mail: yameogol@oncho.afro.who.int 39. Mr Honorat Zouré, BIM/APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29 53, Fax: (226) 50 34 28 75, E-mail: zoureh@oncho.afro.who.int 40. Dr Afework Hailemariam Tekle, EPI/APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29 53, Fax: (226) 50 34 28 75, E-mail: afeworkh@oncho.afro.who.int 41. Dr Grace Fobi, COP/APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29 53, Fax: (226) 50 34 28 75, E-mail: fobig@oncho.afro.who.int 42. Mrs Zainab Akiwumi, ACO/APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29 53, Fax: (226) 50 34 28 75, E-mail: akiwumiz@oncho.afro.who.int 43. 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, E-mail: agblewonuk@oncho.afro.who.int 44. Mr Tendainashe Siwombe, ITO/APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29 53, Fax: (226) 50 34 28 75, E-mail: siwombet@oncho.afro.who.int 45. 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, E-mail: niandouy@oncho.afro.who.int 46. Dr Raogo Augustin Kima, TRAD/APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29 53, Fax: (226) 50 34 28 75, E-mail: kimar@oncho.afro.who.int 47. Dr Stephen Leak, Technical Officer/APOC, Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29 53, Fax: (226) 50 34 28 75, E-mail: leaks@oncho.afro.who.int 48. Mrs B. Savadogo, AHR/APOC, Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29 53, Fax: (226) 50 34 28 75, E-mail: savadogob@oncho.afro.who.int 72 49. Mr Edward Lloyd-Evans, APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29 53, Fax: (226) 50 34 28 75, E-mail: lloyd-evanse@oncho.afro.who.int 50. Mr Daouda Diop, Gender Specialist APOC, P.O. Box 549 Ouagadugu, Burkina Faso, Tel: (226) 50 34 29 53, Fax : (226) 50 34 28 75, E-mail: diopd@oncho.afro.who.int 51. Mr Ibrahim Touré, AO/APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29 53, Fax: (226) 50 34 28 75, E-mail: tourei@oncho.afro.who.int 52. Dr François Sobela, Health System Specialist, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29 53, Fax: (226) 50 34 28 75, E-mail: sobelaf@oncho.afro.who.int 53. Mme Guissou Thérèse, FO/APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29 53, Fax: (226) 50 34 28 75, E-mail: guissout@oncho.afro.who.int 54. Mr Yaovi Aholou, Programme Officer, Meetings/APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 50 34 29 53, Fax: (226) 50 34 28 75, E-mail: aholouy@oncho.afro.who.int INTERPRETERS 55. Mrs Safiétou Barry, 09 BP 526 Ouagadougou 09, Burkina Faso, Tel: (226) 70 21 41 14, Email: barrysafietou@gmail.com 56. Mr André Nikiéma, 01 BP 922, Ouagadougou 01, Burkina Faso, Tel : (226) 50 33 03 12, Mobile : 78 80 90 53, Email: andren@fasonet.bf; andrenikiema51@yahoo.fr 57. Mr Djerma Sita, 01 BP 1771, Ouagadougou 01, Tel 50 34 23 10 / 50 34 43 26, Mobile: 70 20 00 58, Email: sitadjerma@yahoo.fr 58. Mrs Monique Sanou, 09 BP 1082 Ouagadougou 09, Burkina Faso, Tel. (226) 50 32 47 34 à 37 (Bur.) (226) 70 23 07 17 (Cel.) – Eamil : smonical@hotmail.com PRO/APOC- 14.09.2011 73 Annex 2: Agenda TECHNICAL CONSULTATIVE COMMITTEE Thirty-third session Ouagadougou, 12 – 16 September 2011 Revision 1 PROVISIONAL AGENDA 1. Opening 2. Adoption of the Agenda Information 3. CSA: matters arising from the 132nd and 133rd sessions 4. NGDO: update on activities of the NGDO group 5. TCC: follow-up of the key recommendations of the thirty-second session Strategic and technical issues 6. Consultations on Community Self Monitoring 7. Feasibility of elimination of onchocerciasis infection and interruption of transmission in Africa: (i) Elimination of Onchocerciasis with ivermectin - update (ii) Delineation of transmission zones – the example of Malawi (iii) Entomological studies: Working Group plans; study protocol; on going activities (iv) Elimination of O. Volvulus infection: New diagnostics of PATH 8. 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 9. Report on the 45th Mectizan Expert Committee meeting 10. Report on the joint APOC/Mectizan Donation Programme mission on SAEs management in DRC. 11. Review of operational research proposals 12. Training of NOTFs in management and analysis of data 13. Main findings/recommendations of the CSA Advisory groups: (i) Group on Elimination (ii) Group on Co-implementation (iii) Group on the future of APOC Management of APOC Trust Fund 14. Report on the financial management of APOC funded Projects Reviews 74 15. Report on the review by the APOC Management of 1st, 2nd, 3rd, 4th ,5th, 6th and 7th , 8th , 9th , 10th, 11th, 12th years progress reports and subsequent years budgets 16. Review of 1st, 2nd, 3rd, 4th ,5th, 6th and 7th , 8th, 9th, 10th, 11th, 12th years annual technical reports 17. Technical review Committee : Nigeria, Uganda and Cameroon 18. Other matters : 19. Date and place of the thirty-fourth session of the TCC 20. Conclusions and recommendations of TCC33 21. Closure of the session DIR/COORD/APOC/22.08.2011 75 Annex 3: Follow up of the key recommendations of 32nd session of TCC Recommendations of TCC 32 on Strategic and technical issues (1) Subject/Topic Action to be taken Status of implementation Matters arising from JAF16. Epidemiological evaluation results TCC recommended that a small group should be set up to discuss the issue of the Vina Valley and approaches to onchocerciasis control with the Carter Center to resolve the cause of confusion currently prevalent in Cameroon (para.8 (i)) Not implemented. Suggest that it is done during TCC33 Matters arising from JAF16. Preparation for JAF17 TCC also encouraged APOC management to use the platform of JAF 17 in Kuwait to increase awareness of onchocerciasis and advocate for new funding opportunities among Arab countries. (para.8 (ii)) On going. - Other Arab countries are being invited. - A film is being produced to be broadcasted by Aljazeera, TV5 Monde in Arabic and projected during JAF17 Matters arising from JAF16. Treatment of transmission zones TCC recommended that the guidelines should be followed when treating onchocerciasis in hyper and meso-endemic areas and if hypo-endemic areas are treated in transmission zones for purposes of elimination then care should be taken in areas endemic for loiasis and no treatment should be given in such areas if the prevalence of loiasis is 40% or greater (para.8 (iii)) Ongoing. Care is being given to the use of the guidelines. - Identification of loiasis areas hypo for oncho is on going Follow-up of the key recommendations of TCC 31 • Modification of the presentation of the follow-up actions on TCC key recommendations (para.12 (i)) • Re-orientate and sensitize countries to consider SHM and CSM as integral part of CDTI process for sustainability reasons (para.12 (ii)) • Find a way of selling CSM and SHM to other programmes as an integrated activity (para.12 (iii)) • Cameroon TRC should adopt the same reporting format as Nigeria and Uganda (para.12 (iv)) • The need to have additional Technical Advisor in DRC (para.12 (v)) • With regards to the Closantel issue, TCC/APOC should prepare a paper on the efficacy of ivermectin and not on Closantel. The paper could be published on the APOC website (para.12 (vi)) Implemented. See presentation Ongoing. Consultations on CSM in countries Burundi and Congo; - Consultations on CSM in Ouagadougou 23-25 May 2011, - conclusions & recommendation shared with Countries Recommendation shared with the country Ongoing. Best way of addressing the issue is being discussed Shall see with Dr Aboutou’s presentation • One TA recruited by CBM/APOC • Recruitment of 02 more TAs envisaged Not implemented. Paper by Cupp et al. In Research & Reports in Trop. Med. 2011 76 Subject/Topic Action to be taken Status of implementation It is critical to develop a textbook on CDI to ensure that the training is uniform (para.15 (i)) Ongoing. Compilation workshop on CDI Manual write up organized, August 2011& first draft of handbook available. CDI curriculum & training manual To continue advocating for CDI to be adopted in the curriculum of medical institutes by underlining its core value to strengthen the PHC (para.15 (ii)) Ongoing. Follow up actions are being taken and will be strengthened following the recruitment of an HSS On the issue of stopping treatment in areas of co- endemicity of lymphatic filariasis and onchocerciasis, it was noted that in areas considered feasible for elimination, the long-term ivermectin treatment at high levels of therapeutic coverage would most likely have already eliminated LF but that data needs to be collected to confirm this.(para.17.iii) Ongoing. Proposal development is ongoing for Operational Research in Nigeria and Tanzania The Committee emphasized the desirability of entomological studies along with epidemiological evaluations based on nodule prevalence and skin-snip data (para.17.iv). Ongoing. Training of technicians and Entomological assessments launched in Nigeria & Chad Conceptual and operational framework of oncho elimination using ivermectin It was concluded that elimination in some African countries is now proven rather than just being considered feasible but caution should be taken regarding the message given to donors as all APOC projects are still in Phase 1 of the conceptual framework and increased funding would be required to take projects through to Phase 3. (para.18). Ongoing. It has been brought to the attention of the CSA and same will be done at JAF Guidelines for epidemiological evaluation and therapeutic coverage surveys Although a nation-wide REMO was carried out in Mozambique, there was a need to complete the mapping; however this should be approached from the Malawian side of the border. (para.21. i) APOC should provide guidance on the method of reporting the results of the skin snip tests back to the population (para.21. ii) To increase the number of epidemiologists if an Onchocerciasis/Lymphatic filariasis survey was considered essential. (para.21. iii) APOC should look into the possibility of conducting research to assess the impact of ivermectin treatment on Loa loa (para.21. iv) Ongoing. Recommendations shared with the country. Implemented. Individual and NOCP are informed on the status of the prevalence and microfilariae loads in each village evaluated. Ongoing Ongoing. Experts on loa loa have been consulted to bring a proposal 77 Subject/Topic Action to be taken Status of implementation To explore the possibility of PATH evaluating the test in collaboration with MDSC. These evaluations should be designed to determine the adequacy of the tests specificity, sensitivity and its suitability for use in the Phase of surveillance in elimination in which prevalence of Onchocerciasis is low (para.27 ii & iii). Ongoing. Presentation by Gonzales will update us on the situation Development of a rapid antibody- based diagnostic test for Onchocerciasis To provide regular update on progress of the development of the OV16, and invite Dr Gonzales to future sessions of TCC.(para. 27. iv) Implemented. Dr Gonzales is present for the update TCC strongly supports continuation of development of moxidectin considering that it will be of particular value for endemic areas which initiated onchocerciasis control relatively recently and that onchocerciasis control is currently dependent on a single drug (para. 31.i) Ongoing. Dr Kuesel will provide an update TDR was requested to report back to TCC on Pfizer's engagement in moxidectin development and to provide an updated plan of activities for the availability of moxidectin to control programmes including funding of remaining clinical and community studies (para. 31.ii) Ongoing. Dr Kuesel will provide an update Macrofil and Research TDR needs to ensure that further delays in development are avoided and the safety of moxidectin in subjects with Loa loa is evaluated. (para. 31.iii) Ongoing. Dr Kuesel will provide an update TCC recommended APOC to resume technical and financial assistance to the projects, and training of health professionals. (para. 93.ii & iii & iv) • MDA resumed • Missions undertaken by APOC • 150 Bicycles and 150 mobile phones are being purchase (for use by CDDs) for each project to improve reporting of SAE (pilot) Joint APOC/MDP mission to investigate SAE management in North and South Ubangi CDTI Projects in DRC ii. The committee decided that TCC should also look at the costing and the role of partners who are going to give technical support. Members of the community should also be informed of what they need to do since SAEs generally start in the home. Training of relatives in managing encephalopathy is very important. (para. 94) Not implemented. TCC to advise