Experiences and perspectives of tb-work in Malawi Lars H. Vorland - PowerPoint PPT Presentation

Experiences and perspectives of tb-work in Malawi Lars H. Vorland CEO Helse Nord RHF

Helse Nord Tuberculosis Initiative (HNTI): College of Medicine 2011-2016

Importance TB HIV • 9.6 million new cases • 2.1 million new HIV infec>ons • 1.5 million deaths • 1.2 million deaths • 33% of HIV deaths due to TB • ↑risk of TB cases and deaths, drug interac>ons TB Research priori>es HIV Research priori>es • New diagnos7cs • New vaccines • New drugs • Cure • New vaccines • GeIng to 90-90-90 targets • Basic research to guide above • Combina7on preven7on • Implementa7on science & • NCDs and aging with HIV impact evalua7on: what can we do with exis>ng tools?

Helse Nord TB Initiative • Capacity building grant to College of Medicine • Helse Nord RHF and University of Tromso • Support for all stages of post grad research training Lars Vorland L LL – Senior Leadership – PhD and Masters training – Short Course training • Funding a suppor>ve environment Hanne Haukland L LL L LL – Strong scien7fic administra7ve capacity L LL – Research infrastructure including laboratory – Networking Jon Odland

HNTI: BACKGROUND • Joint College of Medicine (COM) and Malawi Liverpool Wellcome (MLW) TB laboratory • 2010: Grant applica7on – Catherine Grey, Geoffrey Chipungu Microbiology unit of the Pathology Department COM – Liz CorbeX: MLW • 2011: COM HNTI started its ac7vi7es • HNTI cons7tutes a Secretariat and Steering group.

Vision • To produce and support interna7onally excellent collabora7ve and mul7disciplinary TB and HIV research within MLW and the College of Medicine • To have a broader impact on na7onal and global health policy • To invest in local scien7fic capacity-building

Specific Objectives • Strengthening HR (Capacity building) to form a research and training group • Postgraduate research training --- Short courses • Establishing clinical liaison scheme with QECH • Networking , collabora7ons and mee7ngs • Inves7ng in infrastructure and capital equipment

Research strategy • Forma>ve research and trial of community-level HIV/ TB interven>ons , linked mathema7cal modelling • Clinical trials: to reduce high early TB mortality • Linking molecular and clinical pharmacology to support Phase II and III clinical trials of TB • Consolidate emerging strengths in qualita7ve research, health economics, and popula7on sciences • • Build on MLW strengths in genomics • • Chronic lung disease in HIV-infected adolescents

2010-13: getting started • Basic capacity within Dept of Microbiology – Malawian lead (Geoff Chipungu) – Scien7fic administrator (Mphatso Mwapasa), lab tech, driver – Post Grad Fellows (PhD, Interns): 2 stage compe>>ve process – Distance-based Masters in Epidemiology • Research infrastructure – Laboratory equipment / Office Space / Vehicle – Data management & connec7on • Postgraduate research training – Short courses • Networking and crea>ng demand to do TB research studies – Networking mee7ngs, small grants, clinical liaison

2013-16: consolidation • Human Resources – Malawian leads: Tamiwe Tomoka & Chisomo Msefula – Scien7fic administrator: Mphatso Mwapasa – Clinical Microbiology specialist training – 2 further PhD Fellows: – 2 Distance-based Masters in Clinical Trials and Epidemiology • Research infrastructure – Biosafety Level 3 Modular Lab with MLW • Postgraduate research training – Ins7tu7onalise Post Grad 01-03 Short courses • Networking and crea>ng demand to do TB research studies – Networking mee7ngs, small grants, clinical liaison

Blantyre Field sites ACF area: 
 Laboratories 114k adults MLW • College of Medicine • Field sites Blantyre urban • – Field site of 108,000 adults – High HIV/TB – Extended M+E via TB Officers Thyolo Thyolo rural • – 12 Primary Care Clinics – NIH-funded CHEPETSA study – Xpert MTB/RIF vs iLED microscopy

HIV/TB in Malawi Uniquely placed High disease burden Southern Region • Interna7onal leadership in HIV/TB • Adult Smr+ve TB case-no>fica>on policy and prac7ce rates in Blantyre, 2010-15 Policy-makers very pro-research • – Open to innova7on Case-finding Simple, robust, reproducible M+E • interven>on World class laboratory facili7es • – MLW & HNTI ini7a7ve in College of Medicine Major collabora7ve input • Non-interven>on – MLW & College of Medicine Blantyre City – Na7onal TB programme – District Health Office

PhD Fellows & MSc Studentships Wellcome Trust PhD HNTI/Commonwealth Distance Masters 1. Tamiwe Tomoka 2. Mphatso Mwapasa 3. Lingstone Chiume 4. McEwen Khundi Augus>ne Kruger Thandie Moses Ankur Gupta- 5. George Sinjani Choko Kaswaswa Mwalukomo Kumwenda Wright 6. Lucky Ngwira 7. Aaron Mdolo 8. Deus Thindwa 9. Augus>ne Choko Peter Jamilah Marriof Noel Victor MacPherson Meghji Nlawisa Kayange Ndlovu

Short Courses in Postgraduate Research Methods (PRM) • Highly successful • Each session is aXended by 30+ candidates • Delivered in collabora7on with MLW, LSHTM, The Ethox Centre.

HNTI � S VISION 2016 and BEYOND • To support Malawi's role interna7onally as a � Pathfinder � country for the WHO Global Ac7on Framework for TB Research, and lead the first term of the Na7onal TB Research Network within Malawi • To invest in local Postdoctoral clinical scien7sts, and in postgraduate research training

Malawi as a � pathfinder � country • To be awarded a Pathfinder status – Already have substan7al research capacity – May be able to develop and implement a na7onal TB research plan rapidly – These countries will achieve milestones more quickly and will serve as path finding or model countries for TB research • Other Pathfinder countries: Peru, South Africa, Indonesia, Vietnam, Ethiopia

Current grants UNITAID: HIV Self Tes7ng BREATHe Trial STAMP Trial ACF in the community Helse Nord TB Initiative Biosafety 3 TB lab

Collaborative CoM/MLW TB lab MLW COM TB Research Group • 6 WT Fellows n EDCTP: – Liz CorbeX n PanBIOME – Henry Mwandumba – Kondwani Jambo n TESA – Hannah Jary n HNTI Fellows – Jamilah Meghji n TB in prisons – Andy McCallum n MSF • Other Funders – NIH – FIND – TREAT TB

Thank you!

Strengt engthening hening HR HR to o for orm m a a res esear earch h and and training aining group oup • Research Group Director ( Dr Tamiwe Tomoka) • Microbiology Lead ( Dr Chisomo Msefula) • Scien7fic Administrator ( Mr Mphatso Mwapasa) • Data Officer ( Ms Kumbukani Komakoma) • Mentors: – Liz CorbeX – Anthony BuXerworth

Infrastructure & Equipment Modular CL3 Laboratory work in progress q With the financial investments from : i. Wellcome Trust ii. Helse Nord RHF, Norway iii. HNTI ( USD 55,000.00) q Expected to Increase the capacity in securing grants GeneXpert Procured – with four modules OMR – Teleform system installed. q Used by both the CoM and MLW.

3 pillars of the End TB Strategy • Integrated, pa7ent-centred care and preven7on • Old policies and suppor7ve systems • Intensified research and innova7on: through: – WHO Global Ac7on Framework for TB Research • Describes how to strengthen TB research in all countries

Key external collaborators LSTM NTP and HIV Dept & DHO Steve Ward, Ber7e Squire, WHO Carmen Gonzalez LSTM Haileyesus Getahun UoL Rachel Baggaley Saye Khoo Policy Gerry Davies CoM maker Peter MacPherson MLW U of Warwick CoM Hendy Maheswaran Nigel Stallard Tamiwe Tomoka Petrou Stavros Victor Mwapasa UK, US, Peter Dodd SA, LSHTM Norway LSHTM USA: John Hopkins Uni Richard Hayes, Dick Chaisson, David Dowdy Helen Weiss Norway Katherine Fielding South Africa Jon Odland, Anna Vassalls UCT Helen McIlleron Hanne Haukland Richard White Mark Nicol

Postgraduate Training PhD Fellows MMED (UCT) DBL MSc Epi Aaron Mdolo Kruger Moses Margaret Kaswaswa Kumwenda Khonga Tamiwe Tomoka DBL MSc CT (LSHTM) Marriof Victor Nliwasa Ndhlovu Mphatso Mwapasa

Establis blishing hing Clinical linical Liais Liaison on Scheme heme • Established in 2011. • CoM/MLW TB laboratory receives samples of TB suspects (QECH). • At least 40 samples go through this scheme every month.

Collaborations beyond the COM/MLW lab Groups and organisa7ons doing TB Work – Na7onal TB control program – Dignitas – Challenge TB – KNCV TB founda7on – MEIRU (Karonga preven7on study) – UNC

WHO Global Action Framework for TB Research • May 2014 WHO members states adopted the End TB strategy – Serves as a blue print for countries to end global TB epidemic – Target by 2035: • Reduce TB incidence by 90% • Reduce TB deaths by 95% • Eliminate catastrophic costs for TB affected households by 2020

WHO Global Action Framework for TB Research • Has 3 parts • Part 1: How to strengthen research in low and middle income countries: The role of � pathfinder � countries • Part 2: How to enhance TB research globally • Part 3: WHO support

How to strengthen research in low and middle income countries: • Na7onal TB research network • Country specific TB research network agenda • Capacity building in TB • Research funding • Advocacy for public support • Monitoring and evalua7on