Upda Update e of TB po polici cies in n Brazil and nd in n the he Worl rld The Tuberculosis Research Agenda in Brazil Dr. Afranio Kritski, REDE TB Brasilia, November 3rd, 2016
Outline Rede TB Activities 2001-2016 Brazilian Response to End TB Strategy 2013-2016 National TB Research Agenda Interaction between Rede TB and NTP-MoH Final Remarks
P E S Q U I S A E C O M B A T E A T U B E R C U L O S E Coordinating Areas Research Sites
TB RESEARCH IN BRAZIL (2001-2016) • Researchers from Universities and • Private and public • Research Institutes industry Civil • Research MDIC MST Institutes Society • Stop TB Partnership • NGOs-Advocacy • Biomedical Associations • NIH • E.U. Int. Rede TB • PAHO Org Universities NTP– SVS MoH MEd Technology Decit-SCTIE MSD Schools Fiocruz MCT: Ministry of Science and Technolgoy; MoH: Ministry of Heatlh MEd : Ministry of Education; MDIC : Ministry of Industry and Trade ; MSD: Ministry of Social Development; Civil Society: NGOs, Health Council, Professional Associations
Research Platform s - Rede TB Fundamental Translational Research Clinical Research Implementation Research Health System Research Research Capacity Building and Training
Port rtfolio RE REDE TB ( B (2001-2016) 016) Fundamental Research Translational Research Operational /Implementaion Clinical Research • New PPD • New PPD Health System Research • Linezolid/Levo/Gati/M • Bacfil (manual) • Kit SIRE Nitratase New Diagnostic Tests oxi PK and EBA studies • MLPA • Q3 /Real time PCR • RIF vs INH for LTBI • Moxifloxacin trials for • Proteomic and • Bacfil automated • Xpert vs AFB for TB active TB lipidomic plataform • TB sprint plus • MGIT vs LPA vs Xpert - • TMC 207 trial -MDR-TB • Fusion Proteins • MLPA MDRTB • Rifabutine and RIF • BioMarkers • Detect MDRTB • MGIT vs LJ for DSTB trials fo LTBI • New drugs • 45 lidipic fractions • Detect-TB kit /Clinical Score • STAND (PAMZ) Trial • Mucosal rBCG 5 Fusion proteins • Detect-TB kit study Moreau RDJ Vaccine • New drugs (IQG 607) Effectiveness of TB control in (with brazilian • Auxotrophic MTB • Primary Health Care Level industry) vaccine • INCT-TB • Vulnerable Populations • INCT-TB • INCT-TB (CNPq- 2001) • Pediatric TB /DR/MDR-TB (CNPq-2001) (CNPq -2001) • TB and co-morbidities • Report Project (NIH) • Report Project (NIH) • Research Training • Research Training • Research Training • Research Training Long Term Medium Medium Short term Projects term term projects projects projects
CAPACITY BUILDING FOR TB RESEARCH – 2002-2015 FMT=AM IEC- MS UFCE- SES-CE Escola Bahiana de Medicina e Saúde Pública UFBA- Gaculdade de Medicina FIOCRUZ- Centro de Pesquisa Gonçalo Muniz PNCT - UFES-Dep. de Medicina Socia/Nucleo Ministério da Saúde de Doenças Infecciosas UF Dourados Sec. Municipal de Saúde do Rio de Janeiro USP-Fac. de Medicina de Rib. Preto SES- Rio de Janeiro USP-Escola de Enfermagem de Ribeirão Preto UFRJ-COPPE -ELÉTRICA UNICAMP-Instituto de Saúde Coletiva UFRJ-Instituto de Estudos de Saúde Coletiva SES-IAL-Instituto Adolfo Lutz UGF-Fac. de Medicina da Universidade Gama Filho SES-SP-Centro de Ref. Trat. de AIDS HUCFF- Hospital Universitario Clementino Fraga Filho SES- Programa de Controle da TB UFRJ-Instituto de Microbiologia UFRJ- Faculdade de Medicina UFRJ-Instituto de Doenças do Tórax UFPR- SES-PR FIOCRUZ- Instituto Oswaldo Cruz FIOCRUZ-Instituto de Pesquisa Clínica Evandro Chagas FIOCRUZ- Centro de Referência Prof. Helio Fraga/ENSP SMS-Porto Alegre-PCT FEPPS-Fundação Estadual de Pesquisa e Saúde SES- Rio Grande do Sul – PCT Hospital Partenon UFRGS-Faculdade de Medicina 7 UFPEL- Faculdade de Medicina
Participants in I COHRTA Courses Oct 2002/ Jul 2015: 2300 Health Professionals at: Level 4 Family Health Program Msc, PhD (n= 65) Health Center Unit Hospital Prison Level 3: TB Laboratories User of Health System Advanced Training Courses (JHU/UCB) NGOs, Health Council (n= 124) Level 2 (80hours): Fundamentals on Scientific Methodology - (Quantitative / Qualitative) (n= 649) Level 1 (8-40hours): Research awareness for the Community (N= 1462) 8
TB RESEARCH IN BRAZIL according to Institutions (1990-2015)
TB RESEARCH IN BRAZIL according to Institutions (1990-2015) Rede TB (>80% of publications)
Br Brazil azilian Response se to o "Global En End TB B Strategy 2013 201 • Brazilian TB Research Roadmap • carried out by REDE TB, NTP and WHO in Sao Paulo City • Use Research Platform Approaches to achieve a National consensus
10 year vision: Specific Objectives Globally: 1. Global TB Research Networks (STAG-WHO, 2015 & 2016) 2. New diagnostic tests – Point of care; 3. New drugs – Short treatment of DR-TB (and DS-TB) 4. New vaccine(s) – infancy, childhood and adolescents 5. Implementation Research (biomedical and biosocial approaches) – Impact evaluation of incorporation of new tools
5 year plan: By 2020 what is needed? In middle income countries with TB burden 1. Establish National TB Research Network 2. Develop National TB Research Agenda 3. Plan to build and maintain capacity for TB Research 4. Develop National funding mechanism for TB Research 5. Integrate research communities at regional and international collaboration level
Research & Innovation for r Impact Pillar 1 Integrated patient- centred TB care & prevention Pillar 2 Pillar 3 Bold policies & Intensified research & supportive innovation systems IMPACT How to incorporate Pillar 3 ?
5 year plan: By 2020 what is needed? In middle income countries with TB burden 1. Establish National TB Research Network (2001) 2. Develop National TB Research Agenda (2015) 3. Plan to build and maintain capacity for TB Research 4. Develop National funding mechanism for TB Research 5. Integrate research communities at regional and international collaboration level
Consensus us 2013 2013 - 2016 2016 • Going beyond the NTP • Government advocacy (interaction with Congress) • NTP has incorporated Research and Social Protection as High Priority • Intersectorial Approach: include Ministry of Education, Science Technology, Social Development, Justice, Labor, Trade and Foreign Affairs • Promoting interaction of Pillar 3 with Pillars 1 and 2 through implementation science to induce policies changes inside the NTPs
Congregate seetings, Active Case Finding Ministry Prisons and Molecular Tests, Justice, Social Patient Centered Development Care and Social Support Tertiary level TB Transmission Control, Diagnosis and Ministry of Treatment Cascade Health Secondary level National TB Program Primary Community Level Level
Implementation Research in Health One of the greatest challenges is how to take proven interventions and implement them in the real world. Implementation research is particularly important in supporting the scale-up of interventions and their integration into health systems at the national level. Foster interaction between NTP and Academia
Interaction with TB Transmission Civil Society Pillar 1 Control, Diagnosis and TB Programmes Treatment Cascade Health System /Epidemiology Research Pillar 2 Research Capacity Building and Bold Policies Implementation Training Research Pillar 3 Research
How to include Fundamental, Translational and Clinical Research in the National TB Plan ? Research Capacity Building and Training Clinical Research Pillar 3 Research Fundamental/ Translational Research Diagnostic /Drug /Vaccine Innovation Development Interaction with Industry
RePORT Brazil (NIH-MoH) Research Capacity Building and Clinical Research Training Pillar 3 Research Fundamental/ Translational Research Diagnostic /Drug /Vaccine Innovation Development Interaction with Industry
Report International Projects - 2015 • Focus on Integrating Fundamental, Translational and Clinical Research Platforms • Brazil, India, South Africa • Cohort TB cases and Close Contacts • Use Common Protocol • Central Data Managament • Central Biorespository
RePORT Brazil Re Study sites es / / 3 regions (2015) North Region Manaus/Amazonas Marcelo Cordeiro Santos Northeast Region Salvador/Bahia – Bruno Bezerril Andrade Southeast Regiong Rio (UFRJ/Caxias) Afranio Kritski Rio (Rocinha) Betina Durovni Rio (IPEC-Fiocruz) Valeria Rolla Funds from (50% each) USA – P.I. Timothy Sterling – Vanderbilt Univ Brazil Government – D it M H
Principal a areas for c cooperation • Translational studies M. tuberculosis transmission Role of mixed infection Biomarkers to identify patients at risk for active TB and infection TB Risk factors for tuberculosis recurrence, • Epidemiologic studies TB comorbidities, ( HIV, Diabetes , Mental Diseases , Hepatitis, other Tropical diseases) TB in Women/Children Nutritional status • Clinical trials (diagnosis and therapeutics)
Recommend
More recommend
