Report on fourth session of Technical Review Committee (TRC) meeting on Onchocerciasis in Uganda: 21 - 23 August 2013, Kampala

{World l'lealth 0rga nization Report on Fourth Session of Technical Review Committee (TRC) meeting on Onchocerciasis in Uganda 2L - 23 AUGUST 2013, KAMPALA, UGANDA I {'1 itUitnN T]8, n il) #,::., 5{" i;t'!. ,!,",, A. I l I u... :..+ lr .i "*- Table of Contents Abbreviations / Acronyms ....,....... Agenda Item l: Welcome remarks Agenda ltem2: Adoption of Agenda Item item item item item item item item 3: TRC Objectives and Expected Outcomes 4:TRC Procedures and ToRs.... 5: TCC extract from TRC3. 6: CDTI Phase I Project report,........ 7: CDTI Phase II Project Report 8: CDTI Phase III Project Report...,.... 9: CDTI Phase [V Project Report........ l0: CDTI Phase V Project Report Agenda Agenda Agenda Agenda Agenda Agenda Agenda Agenda .. 1 .. I .. 1 .,2 ..J ..J .,4 ..5 .....6 .....7 ,....7 .....8 ,....8 Agenda item I 1: Post - Elimination surveillance activities in Mpamba-Nkusi focus in Kibaale District, Western Uganda......... 6 Agenda item 12: Post-Elimination surveillance activities in Itwara Main Focus and sub foci of Aswa and Siisa in Kabarole district, Western Uganda Agenda item l3: Flow chart and research agenda....... Agenda item I 4: General recommendations................ Agenda item 15: Date and venue of 5th TRC session .. Agenda item 16: Closure of Forth TRC session Anncx 3: Reviscd CDTI Flow chart........... .............1 .............1 Abbreviations / Acronyms Assistant Commissioner for Health Services (of MoH) African Programme for Onchocerciasis Control Christofel Blinden Mission Community Drug Distributor Community Directed Treatment with Ivermectin Assistant Commissioner for Health Services (of MoH) Civil Society Organization ACHS APOC CBM CDD CDTI ACHS - CSO DC&CHS DPC FM GoU GTZ HSSIP - ICT IHP+ LC LF MDA - MOH - NDC NGDO. NOCP- NTD NTDCP - PM RTI SAEs - SOPs - SS SWOT - TCC ToR TRC VCD UTG VHT wHo - Director for Clinical and Community Health Services Disease Prevention and Control (of WHO) Frequency Moderator Government of Uganda German Technical Cooperation Health Sector Strategic and Investment Plan International Certification Team International Health Partnership Plus Local Council Lymphatic filariasis Mass Drug Administration Ministry of Health (Uganda) NationalDisease Control (of MoH) Non-Government Development Organization National Onchocerciasis Control Programme Neglected Tropical Disease Neglected Tropical Disease Control Programme Programme Manager Research Triangle Institute (International) Serious Adverse Events Standard Operating Procedures Sightsavers Strengths, Weaknesses, Opportunities and Threats The Carter Center (of USA) Terms of Reference Technical Review Committee (of Uganda) Vector Control Division Ultimate Treatment Obj ective Village Health Team World Health Organization I Agenda Item 1: Welcome remarks l. The TRC of NOCP held the fourth annual meeting from 2l - 23 August,2013 at VCD, MoH in Kampala, Uganda. In his remarks, Mr. Tom Lakwo, PM of NOCP, warmly welcomed TRC members to the meeting. He informed that TRC meeting was aimed at critically reviewing CDTI reports of progress achieved towards elimination of Onchocerciasis. He added that CDTI reports under review had already been forwarded to APOC and comments of reviewers would be presented to TCC of APOC by Dr. E. M. Tukahebwa, Chair of Uganda TRC and ACHSA/CD/Ir4oH, in Septembe r,2013 in Ouagadougou, Burkina Faso. To-date, Uganda is one of the three countries in Africa supported by APOC/WHO to establish and operationalize TRCs, he explained. 2. Mr. Lakwo noted that a TRC member was absent with apology: Mr. M. Mugaga, Statistician of MoH. Despite his absence, he was confident of abilities and commitment of reviewers present to accomplish the task at hand. Finally, he wished the meeting productive discussions and invited Dr. E, Tukahebwa, Chair, TRC/ACHSA/CDA4OH, to make her opening welcome remarks. 3. In her remarks, Dr, Tukahebwa thanked the members of Uganda TRC. She noted the great achievements of NOCP recorded towards elimination of onchocerciasis. She thanked the partners of NOCP for their support in NTD elimination. She asked the TRC to capture all relevant issues in the meeting so that they could be reported to in 37th TCC of APOC in 2013 in Ouagadougou, Burkina Faso. She sought clarification on the relationship between Uganda TRC and Uganda Expert Elimination Committee in order to assist in streamlining NTD coordination mechanism and structures. 4. She anticipated that the TRC would be able to accomplish the task at hand within the three days. Finally, she argued the TRC to critically review the reports and opened the meeting. Agenda Item 2: Adoption of Agenda 5. The provisional agenda was adopted by the members with amendments. Agenda Item 3: TRC Objectives and Expected Outcomes 6. The PM of NOCP presented the objectives and expected outcomes of the fourth session of Uganda TRC Agenda item 4: TRC Procedures and ToRs 7. The PM of NOCP presented the procedures and ToRs for TRC based on what APOC Management recommended in earlier correspondence. Agenda item 5: TCC extract from TRC3 8. Dr. Tukahebwa, the Chair of Uganda TRC presented the extract from the Technical Consultative Committee (TCC35) of APOC to the forth TRC meeting. She informed the meeting that TCC appreciated the good work done by Uganda TRC. She affirmed that TCC argued other APOC-supported countries to adopt the work being done by Uganda TRC. She noted that TRC had recommended halting mass treatment for onchocerciasis in two additional foci and conducting Post Treatment surveillance in these foci. She reminded the meeting that research proposal reviewed by the TRC in 2012 was rejected on scientific and ethical grounds. I Agenda item 6: CDTI Phase I Project report 13. The l3th project report was comprehensive. High geographic and therapeutic coverage achieved without any reported serious adverse effects were commendable. A high level of dependence on NGDOs threatens sustainability of CDTI when support ends. Report takes into consideration comments made in TRC3 meeting. 14. The report was accepted by the TRC with recommendations and suggestions for improved reporting and programme implementation as follows : Report-related: (i) Eliminate errors and clarifu on narrative. (ii) Insert an updated flow chart of supervision hierarchy (see Annex 3). (iii) Tables 3, 5,7 ,9, 12 l3a - c should be reviewed and completed correctly. (iv) All partners should be acknowledged. 2 Project-related: (i) NOCP should intensity advocacy for more GoU support to ensure sustainability (ii) Report format should be updated to capture the two rounds of CDTI. (iii). Cross-border issues merit attention of NOCP and partners. Agenda item 7: CDTI Phase II Project Report 15. This is the l3th year project report. The executive summary was comprehensive with improvements on facts, content and style of writing. Phase II Project targets l2 districts: Mbale, Bududa, Manafiva, Sironko, Mitooma, Rubirizi, Buhweju, Bushenyi, Kabarole, Kyenjojo, Kamwenge and Kabale. To-date Onchocerciasis transmission has been interrupted and treatment halted in nine (75%) out of l2 districts: Mbale, Bududa, Manafiva, Sironko, Kabarole, Kamwenge, Kibaale, Mitooma and Bushenyi. Continued Government and NGDOs support is needed to sustain CDTI and interrupt Onchocerciasis transmission in the remaining three districts, and implement or maintain post-treatment activities in the other nine districts. 16. The report was accepted by the TRC with the following recommendations: Report-related: (i) Provide a complete list of abbreviations, eliminate errors and improve narrative. (ii) Reference data sources, incorporate acknowledgements and re-paginate correctly. (iii) Tabulate the health system and health care delivery at national, regional, district levels including PNFP and PFP in the project area. (v) Revise and correctly complete Tables 2, 5,6,9, 10, I 1 with l3a - c adjusted to fit on one page per table. (vi) Outline strengths and weaknesses in Section 5. (viii) Account for non-implementation of operational research in2012. (x) Up-date supervision flow chart (see Annex 3). (xi) Summarise outcomes of supervision at district and sub district levels in a table (2.9.4). (xii) Provide a narrative on feedback mechanism on CDTI performance (section 2.9.6). (xiii) Clarifu content on conditions (i) equipment (section 3.I ) Project-related: (i) Conduct the pending proposed TRC2 KABP studies on CDTI. To APOC:(D APOC should consider developing a suitable report format to be used in areas where transmission has been interrupted and PTS is on-going. In such areas, classifications like hyper-, meso- and hypo-endemic are no longer relevant. Agenda item 8: CDTI Phase III Project Report 17. The report was comprehensive. Issues raised in TRC3 were addressed. CDTI activities performed were described and executive summary is satisfactory. Challenges and solutions were indicated in report. VHTs as CDDs have contributed to weakening CDTI. J 18. The report was accepted by the TRC with recommendations and suggestions for addressing issues of concern in order to improve reporting and programme implementation as follows: Report-related: (i) Correctly update Table of Contents, eliminate errors, and truncate long sentences for clarity. (ii) Supply source(s) of information in Tables I - 2, and clarity on data in Table 3. (iii) Account for variability in number of targeted trainees in Tables 5, exclusion of supervisors in the training session on data collection in Table 6, correct errors in Table 7, and clariff on therapeutic coverage in Table 9. (iv) Provide the numbers of people reached against targets during mobilization and sensitization activities in Section 2.3, and indicate whether religious leaders are targeted or not. To APOC and MOH: (i) Conduct operational research on: (a) Factors influencing women participation in CDTI, and (b) Factors affecting motivation and retention of CDDs in CDTI. (ii) Vector monitoring should be strengthened along R. Nyagak in Zombo district to track impact of the new hydroelectric power dam on onchocerciasis transmission potential. Agenda item 9: CDTI Phase IV Project Report 19. The report was comprehensive. CDTI activities done, challenges and how they were addressed are described satisfactorily. Support of partners and Government is needed for CDTI sustainability. 20. The report was accepted by the TRC with suggestions and recommendations for improving reporting and programme implementation as follows: Report-related: (i) Clarifu on date and name of National Coordinator on title page; and correctly update Table of Contents with a consistent pattern of sections and subsections. (ii) Eliminate grammatical errors, use formal language, punctuate appropriately, and cite authoritative source(s) of information for clarity. (iii) Update Table I on page 4 and correct error in checking the box on page 6. (iv) Supply a revised Table 6 with complete and accurate information; and entire ATO formula should be visible on page 16. (v) Revise Table l3 to reflect the correct total number of assets donated by APOC and their current functional status. (vi) Supply missing information on page 7 and definition of a community/village, and distinguish between unstable populations in districts with international borders and stable populations in Gulu, Amuru and Nwoya. (vii) Clarifu on why attrition of CDDs is not problematic in Phase [V districts. (viii) The two unique features under section 6 should bulleted and highlighted because each marks and important step in the road map for onchocerciasis elimination. 4 (ix) Incorporate non-adherence to timelines as one of the challenges on pages 22 & 3 1, and supply the required list ofchallenges on page 35. (x) Incorporate NTD Secretariat in the supervision flow chart on page 36. Project-related: (i) NOCP and partners should share financial information. (ii) Pharmaco-vigillance should be strengthened to track, manage and report side effects during CDTI implementation. To APOC and MoH: (i) APOC and MOH should strengthen capacity of NOCP Secretariat through provision of adequate staffing and resources, (ii) Operational research should be conducted on factors associated with retention of CDDs or VHTs. Agenda item 10: CDTI Phase V Project Report The report is comprehensive, captured activities done in second year of CDTI implementation that were supported by APOC but treatment started in 2009 with support of ENVISION/RTI. Low therapeutic coverage (5 8%) is a key constraint on pace of onchocerciasis elimination. Support of Government and partners is needed to strengthen and sustain CDTI activities. The report was accepted by the TRC with suggestions and recommendations for improving reporting and programme implementation as follows: Report related: (i). Eliminate grammatical and typographic errors; and repetitions. (ii). Complete the list of acronyms, insert a list of tables after an updated Table of Contents. (iii). Revise and complete Tables 3,'7,8, 12,l3a and l3b with correct information. Project related: (i). All partners' contributions should be recognised and partners should s hare financial information. (ii). NOCP and partners should intensiff advocacy, social mobilization, health education and other factors to increase therapeutic coverage. (iii). NOCP and partners should strengthen active pharmaco-vigillance in districts to enhance tracking, documentation and reporting of side effects during CDTI. (iv). Community self monitoring teams should be strengthened to improve timely tracking, reporting, and management of any adverse events that may occur during CDTI. To APOC: (i) Report should be review the reporting format to allowing capturing April and October CDTI cycles' 5 Agenda item 11: Post - Elimination surveillance activities in Mpamba-Nkusi focus in Kibaale District, Western Uganda 25. The report is comprehensive on issues of post elimination surveillance activities especially vector elimination in the focus. All issues raised in the TRC3 were addressed and resolved. Although CDTI was implemented in 2012,itwas halted in 2013. 26. The report was accepted by the TRC but suggestions and recommendations made for its improvement as follows: Report-related: (i) Executive Summary should be revised to comprehensively capture the purpose, methodology, key findings, challenges, recommendations and conclusion. (ii) The report should be revised with inputs of the two reviewers and published in an internationally peer- reviewed journal. Project-related: (i) NOCP and partners should strengthen PTS in the focus. (ii) NOCP and partners should encourage districts to embrace PTS. (iii) NOCP and partners to sensitise communities properly on the interruption of transmission and vector elimination (iv) MoH should promptly release funds for timely implementation of post-elimination surveillance activities. To APOC and MOH: (i) APOC should consider replacing the old vehicles at NTD Secretariat because post-elimination surveillance activities require robust means of transport. (ii) APOC and partners should consider recognising and rewarding the vector elimination teams. Agenda item 12: Post-Elimination surveillance activities in Itwara Main Focus and sub foci of Aswa and Siisa in Kabarole district, Western Uganda 23. The report is comprehensive. Post treatment surveillance should continue in Itwara main (Itwara) and the two sub foci (Siisa and Aswa). 24. The report was accepted by the TRC and suggestions and recommendations made for reporting and programme improvement as follows: Report-related: (i) Correctly update Table of Contents, eliminate errors and repetitions for clarity. (ii) The purpose of post-treatment surveillance should be articulated (iii) Explain how post-treatment surveillance of CDTI is performed on page 12, acknowledge all partners, and supply the correct title of Figure I on page I 5. (iv) Paraphrase historical perspective and improve on narrative. (v) Report should contain overall objective and specific objectives, Project-related: 6 (i) Post-elimination surveillance should continue in Itwara focus and sub-foci (Siisa and Aswa). To APOC: (i) Conduct operational research to determine cause of disappearance of fresh water crabs in foci under review and other foci in Uganda (e.g. Mt. Elgon, Budongo and Bwindi foci). Agenda item 13: Flow chart and research agenda The revised flow chart of CDTI supervision is presented in Annex 3. TRC identified the following thematic research areas for supporl: (l) Gender, socio-culturaland economic dynamics and how they impact on CDTL (2) Impact of onchocerciasis control on epidemiology, disease burden, and socio-economic dynamics. (3) Factors influencing CDD motivation and retention in different phases of CDTI. (4) Factors influencing adherence/compliance to CDTI under different phases of program implementation. (5) Factors determining crab disappearance within and between different ecological zones and foci. (6) Factors influencing/hindering timely retrieval and reporting of NTD data. (7) Emerging health conditions or situations in CDTI, e.g. nodding syndrome. (8) Monitor efficacy of Ivermectin/Mectizan in onchocerciasis and Lymphatic filariasis treatment. Agenda item 14: General recommendations The TRC made the following general recommendations: (l) Partner's contributions to CDTI (under integration framework) should be accurately reflected and acknowledged. (2) Human resource capacity in NOCP Secretariat should be strengthened to improve program performance. (3) TCC /APOC shoutd consider updating the report formats for Phase I - V in order to create room for capturing data on semi-annual CDTI and other relevant issues. (4) There is a need to sensitize and mobilize communities to support CDDs in order to improve their motivation and retention (5) APOC should consider replacing old vehicles at NOCP Secretariat and endemic districts to improve CDTI implementation, monitoring, evaluation and reporting. This is particularly important because vector elimination and CDTI require robust means of transport (6) For adequate implementation of program activities, there is urgent need for timely release of program funds from MoH. (7) MOH and partners including APOC should consider reviving provision of adequate facilitation commensurate with the status and work of the TRC. (8) MOH and partners including APOC should consider recognizing/rewarding the tremendous achievements made by Simulium vector elimination teams. 7 Agenda item 15: Date and venue of sth TRC session 29 . The fifth session of the TRC witt take place from 2l - 23 July, 2014 at Vector Control Division, Ministry of Health in Kampala, Uganda. Agenda item 16: Closure of Forth TRC session 30. Dr. Abbas Kakembo, Session Chair, thanked TRC members for good work done and for successfully concluding the 4th sessions of TRC and declared the meeting closed at 13: 45 hours. Annex 1: Participants of the Technical Review Committee meeting Technical Review Commiuee (TRC) Members l. Dr. Edridah Tukahebwa: Chair of TRC in Uganda, Head of VCD and ACHS/VCD/I\4oH, P.O. Box 1661, Kampala, Uganda. Mobile: 0772 443 659. Email: edmuheki@gmail.com. 2. Dr. Ambrose Onapa: Resident Technical Advisor, ENVISION/RTI, NTD Control Programme, Kampala, Uganda. Mobile: OTOl 497 080;0772 497 180. Email: aonapa@ug-ntd.rti.org; kwibalel@yahoo.co.uk 3. Dr. Narcis Kabatereine: Representative of Schistosomiasis Control Initiative, Vector Control Division, Ministry of Health, P.O. Box 1661, Kampala, Uganda. Mobile: 0772 492 078. Email: vcdmoh@gmail.com 4. Dr. Peter Langi, Retired Senior Medical Officer, Mobile: 0717 553 654, Email: peter.langi@health.go.ug 5. Dr. Abbas Kakembo: Retired Principal Medical Officer, Vector Control Division, Ministry of Health, P.O. Box 1661, Kampala, Uganda. Mobile: 0771 828 378. Email: kakemboabbas@yahoo.com 6. Mr. Tom Lakwo: Programme Manager, National Onchocerciasis Control Programme, Vector Control Division, Ministry of Health, P.O. Box 1661, Kampala, Uganda. Mobile: 0772 438 311. Email: tlakwo@gmail.com 7 . Dr. M. Nanyunja, Representative of WHO in Uganda; Mobile: 0772 721 979. Email: nanyunj am@ug. afro.who. int 8. Dr. P. Bukuluki, Lecturer, Faculty of Social Sciences, Makerere University, P.O. Box 7062,Kampala, Uganda. Mobile: 0772 462 l00.Email:pbukuliki@gmail.com Observers 1. Ms. Peace Habomugisha, Country Representative of The Carter Center in Uganda. Mobile: 0755 414 982 Email: provias@hotmail.com 2. Ms. Juliet Sentongo, Programme Officer, National Office of SightSavers, Kampala, Uganda. Rapporteur l. Mr. Patrick Buyinza: Scientific Officer, Vector Control Division, Ministry of Health, P.O. Box 1661, Kampala, Uganda. Mobile: 0772 878 286. Email: p.buyinza@yahoo.com 8 Annex 2: Table 1: Adopted Agenda for TRC, Uganda TIME ACTIVITY RESPONSIBLE DAY ONE: Wednesday 21 August 2013 9:00 - 9:55 Registration & prayer NOCP Secretariat 9:55 - 10:00 Welcome remarks PMA{OCPA{OH l0:00 - l0: l0 Opening remarks Chair, TRC/ACHSA/CDA,IOH 10:15 - l0:45 TEA BREAK All l0:45 - 10:55 Adoption of agenda All l0:55 - ll:00 TRC objectives PM/ONCHOA4OH ll:00 - ll:10 TRC procedures & TOR PM/ONCHO/MOH I l:10 I I :40 CDTI phase I project Dr. M. Nanyunja ll:40 - 12:00 Discussion All 12:00 - 12:40 CDTI phase II project Dr. P. Langi 12:40 - l:00 Discussion Ail 1:00 - 2230 LUNCH BREAK All 2:30 - 3:00 CDTI phase III project Dr. P. Bukuluki 3:00 - 3:30 Discussion All 4:00 4:30 TEA BREAK AI 4:30 - 4:35 Group photograph NOCP Secretariat 4:35 Close Day I DAY TWO: Thursday 22 August,2013 9:00 - 9:40 CDTI phase [V project Dr. A. Kakembo 9:40 - l0:00 Discussion All 10:00 - 10:30 TEA BREAK Ail l0:00 - I l:30 CDTI Phase V Dr. E. Tukahebwa ll:30 - 1l:20 Discussion All ll:20 - I 1:50 Vector Elimination - Itwara Dr. A. Onapa I l:50 - 12:45 Discussion All 12:45 - 2:30 LUNCH BREAK Ail 2:30 - 2:45 Vector Elimination-Mpamba Dr. N. Kabatereine 2:45 - 3:00 Discussions All 3:05 - 3:45 Flow chart and research agenda Dr. P. Langi 3:45 - 4:30 TEA BREAK - CLOSE Ail 9 TIME ACTIVITY RESPONSIBLE DAY TIIREE: Friday 23 August 2013 9:00 - l0:00 Adoption of report (Conclusions & Recommendations) Rapporteur 10: 00 - 10:20 TEA BREAK Ail 10:20 - 3:00 Adoption of report (Conclusions & Recommendations) Rapporteur 3:00 - 3: 05 Date and place of next 5tn TRC meeting Chair TRCI 3:05 3:15 Closure of the 4'd TRC session Acting Chair TRC ' chair TRC: Dr. Edridah. Tukahebwa 10 t- m U) z o tu zD (-) -l U F -to O. Fz EI =z& ET o -l (J o -l &lII -tt{ a lllc U F -1 lII FIlll EI -l t- () B tr F Q o ah () & (.) xo ct) tll -F -z) E =oU -*(J rlr& oF tt) FI EI2z -rlU V)t!(, JJ (t) Fz oL) ca t) Fz oU F &FV) A J zo F z t\o* >E!4:i E3 z F Qo o ()rq -lz >t-F5ZL)DrqOXut! E€ aa Fz E] A Fld z S rrr a7 EOor! 3il Fl .,F AZvIIJ t?> AHfiz-> =g O F zD o(.) mDa EDa a & Fr rrl z Fr DOHX rrl U Fl € (J FT U Ft EEg gEH Dv) O n na aH F z oO O F. ( I I I I