Lymphatic Filariasis Elimination in the Americas 6 th

Lymphatic Filariasis Elimination in the Americas 6 th Regional Program Managers Meeting San José, Costa Rica, October 2005 Scaling Up MDA and Incorporating Salt Strategy in the LF Program in Haiti San José, Costa Rica 25 October 2005 Presented by Dr. Marie Denise MILORD Regional LF Program Managers Meeting, San José, Costa Rica, 2005

Haiti Map Regional LF Program Managers Meeting, San José, Costa Rica, 2005 2

Health Infrastructure Nord-Ouest 31 Nord-Est Artibonite 80 Centre Ouest Grande Anse Sud Regional LF Program Managers Meeting, San José, Costa Rica, 2005 Sud-Est 3

Human Resources Per 10, 000 inhabitants l Physicians: 2. 3 l Nurses: 1 l Nurses aid: 3 l Dentist : <1 l 88% of human resources are concentrated in the West department (38% of the total population ) Regional LF Program Managers Meeting, San José, Costa Rica, 2005 4

Partners Represented in the Country l OPS-OMS l Hôpital Sainte-Croix de Leogane l Hôpital Sacré-Coeur de Milot l MSPP Regional LF Program Managers Meeting, San José, Costa Rica, 2005 5

National Task Force Another intersectoral committee to be constituted for vector-borne diseases. Members MENJS Environment USG team MICT Ministry of Culture FSGB TPTC OPS-OMS MSPP MAS French Coop. Regional LF Program Managers Meeting, San José, Costa Rica, 2005 6

Program Org. Chart Minister DG Executive Direction of Global Funds programs DC Coord. HIV/AIDS Coord. Malaria/LF Regional LF Program Managers Meeting, San José, Costa Rica, 2005 Coord. Tuberculosis 7

Synergies l School health program with its deworming component l Program against iodine deficiency with its fortified salt distribution Regional LF Program Managers Meeting, San José, Costa Rica, 2005 8

Transmission Epidemiology Number of Communes 16 (12%) 0 84 (63%) 0. 1 – 4. 9 13 (10%) 5. 0 – 9. 9 20 (15%) 10 – 45 Regional LF Program Managers Meeting, San José, Costa Rica, 2005

2002 MDA Ile de la Torture (35 433) Port de Paix (112 116) Plain du Nord (36 924) Quartier Morin (19 796) Chansolme (14 043) Limonade (44 119) Caracol (6 236) Terrier Rouge (21 328) Milot (28 802) Verretes (90 226) Saut D’eau (42 180) Croix des Bouquets (229 127) Target population: 524 562 Regional LF Program Managers Meeting, San José, Costa Rica, 2005 10

2003 MDA Plaisance (69 853) Le Borgne (64 087) Port Margot (36 473) Cap Haitian (186 251) Dondon Saint Suzanne (24 110) Estere (37 974) Cabaret (76 731) Camp Perin (46 942) Target population: 1 010 744 Regional LF Program Managers Meeting, San José, Costa Rica, 2005 11

2004 MDA Limbe Acul du Nord Target population: 1 575 823 Regional LF Program Managers Meeting, San José, Costa Rica, 2005 12

Transmission Epidemiology Number of Communes 16 (12%) 0 84 (63%) 0. 1 – 4. 9 13 (10%) 5. 0 – 9. 9 20 (15%) 10 – 45 Regional LF Program Managers Meeting, San José, Costa Rica, 2005

Treatment 2004 Commune Leogane Plaine du Nord Quartier Morin Limonade Milot Verrettes Saut d’Eau Caracol Port-de-Paix Population # of Persons Treated 134, 190 36, 924 19, 769 45, 119 28, 802 90, 226 42, 180 6, 236 121, 116 152, 574 33, 314 15, 023 50, 089 20, 437 111, 724 37, 000 6, 149 92, 644 Regional LF Program Managers Meeting, San José, Costa Rica, 2005 14

Treatment 2004 (cont’d) Commune Population # of Persons Treated Terrier Rouge 21, 328 19, 246 La Tortue 35, 433 25, 338 Chansolme 14, 043 13, 275 Croix-des-Bouquets 229, 127 115, 082 Gonaives 206, 426 None 40, 361 42, 547 186, 251 117, 194 Cabaret 84, 796 55, 097 Acul du Nord 78, 269 51, 556 L’estere Cap-Haitien Regional LF Program Managers Meeting, San José, Costa Rica, 2005 15

Treatment 2004 (cont’d) Commune Population # of Persons Treated Limbe 69, 256 74, 346 Dondon 46, 145 27, 130 Borgne 64, 955 42, 415 Plaisance 72, 134 53, 106 Port-Margot 36, 937 36, 959 Sainte Suzanne 23, 527 20, 589 Camp Perrin 48, 699 42, 702 1, 255, 476 persons out of 1, 575, 823 treated in 2004. Regional LF Program Managers Meeting, San José, Costa Rica, 2005 16

Mass Treatment for LF Reduces Microfilaria Levels in the Blood Regional LF Program Managers Meeting, San José, Costa Rica, 2005 17

Decreases in Mosquito Infection Following Mass Treatment Regional LF Program Managers Meeting, San José, Costa Rica, 2005 18

Additional Benefits of Mass Treatment for LF 40 Prevalence (%) 35 * 30 25 Ascaris 20 Trichuris ** ** 15 10 * 5 ** 0 Pre-MDA After 1 MDA Hookworm After 2 MDA * P< 0. 05; ** P< 0. 001 Regional LF Program Managers Meeting, San José, Costa Rica, 2005 19

Progress …. l Funds from a grant to Notre Dame University from the Bill & Melinda Gates Foundation have been used to construct and equip a salt fortification plant. Regional LF Program Managers Meeting, San José, Costa Rica, 2005 20

Production of DEC and iodine-co-fortified salt is underway. Regional LF Program Managers Meeting, San José, Costa Rica, 2005 21

Plan Fortified salt l 48 000 bags of salt fortified with DEC and Iodine ready to be sold. l Launching of selling fortified salt in November. l Fortified salt to be sold at a lower price than regular salt in the market. l Availability of fortified salt starting in 4 communes: Tabarre, Gressier, Arcahaie, Leogane. l Mid-term: Expansion to other communes of the country. Regional LF Program Managers Meeting, San José, Costa Rica, 2005 22

Social Mobilization and Communication l 17 training sessions were held: – 29 community leaders – 15 local trainers l More than 4000 local distributors. l. A four-minute documentary is playing on national television and radio stations. Regional LF Program Managers Meeting, San José, Costa Rica, 2005 23

MORBIDITY l Hydrocele repair – Surgery ongoing at Hôpital Ste. -Croix – Training of additional surgeons Regional LF Program Managers Meeting, San José, Costa Rica, 2005 24

Morbidity l Leogane Support groups – 15 groups l Arcahaie Support groups – 7 groups l Milot – 6 Hope Clubs Regional LF Program Managers Meeting, San José, Costa Rica, 2005 25

Treatment Objectives for 2006 l Complete the red and blue commune treatment coverage with tablets. l Start fortified salt distribution in 4 communes and gradually expand it to all the light blue communes. l Add fortified salt as treatment strategy in the communes treated with tablets. Regional LF Program Managers Meeting, San José, Costa Rica, 2005 26

Problems and Challenges l Lack l of financial resources to scale up. Achievement of transmission interruption objectives (microfilaremia level still > 1% in Leogane after 5 years of treatment). l Systematic noncompliance. l Population migration. l Civil strife. Regional LF Program Managers Meeting, San José, Costa Rica, 2005 27

Thank you for your attention. Regional LF Program Managers Meeting, San José, Costa Rica, 2005