29 January 2018

The African-led TIBA partnership: tackling neglected diseases

Image: TIBA in South Africa 

Interview with Professor Francisca Mutapi, Edinburgh University

The ambitious African-led £7 million ‘Tackling Infections to Benefit Africa’ (TIBA) partnership has just been launched, and nine different Sub-Saharan African countries are...

As one of the driving forces behind TIBA, Francisca Mutapi said a paradigm-shifting aspect of the program is that leadership comes from African countries: “We are looking at local health challenges that have been identified by local experts in the participating countries. TIBA takes into account not only the science but also on-the-ground socio-economic and technological challenges facing Ministries of Health and others involved in developing and implementing evidence-based health policies. In particular, we are going beyond hypothesis-driven work on single infections – where a lot of studies are already being conducted – and considering how diseases can be addressed in actual local health system settings.” 

Working with real-world challenges 

The impact of neglected diseases such as malaria, sleeping sickness, schistosomiasis and lymphatic filariasis is exacerbated by the wider socio-economic challenges faced by vulnerable communities. TIBA seeks to translate research into health technologies, knowledge, and policies that are known to benefit those communities, so that their health systems are better prepared to respond to epidemics such as Ebola and other health emergencies. 

Francisca Mutapi said that TIBA will be improving more than immediate intervention for a single infection but looks at the wider health system delivering that intervention: “The headline from the recent Ebola outbreak was that it killed 20,000 people, but the lasting impact it made on the healthcare system is likely to kill far more people over the next 20 years. Health personnel were taken ill or quarantined during the outbreak, and routine immunization programs and treatments for a range of diseases ceased during that period. Effective local solutions and improved resilience are needed to address this.”

Schistosomiasis and pre-schoolers

TIBA has been facilitated by Edinburgh Professors Francisca Mutapi and Mark Woolhouse, with the help of world-class scientists and health professionals across the nine participating countries. Francisca Mutapi said that work in schistosomiasis was used as a case study for the grant application: “I have been working on schistosomiasis for 20 years. Up until about 10 years ago, the established assumptions were that young children were not being exposed to schistosome infection; and that even if they were infected they wouldn’t get sick. The safety and efficacy of the drug available for treating schistosomiasis was also unknown in pre-school children (less than 5 years old). We looked at the evidence for the assumptions being made, found they were largely anecdotal, and challenged them in the lab and in the field.”

“We saw that children were indeed being exposed, infected as a result and were experiencing disease. We also showed – crucially – that the drug of choice for treating schistosomiasis, praziquantel, was safe and efficacious in the pre-school age group, although the tablet size and bitter taste remained obstacles to its use in national control programs. Based on this research, in 2012, the WHO changed its guidelines and recommended that children under five needed treatment for schistosomiasis, and that they should be treated with praziquantel. Work by the Praziquantel Consortium has since brought us closer to having the child-friendly praziquantel formulation needed to treat children effectively. This is a grounded example of how considering an intractable health issue and systematically building robust evidence can change policy.” 

Professors Mark Woolhouse (Director, TIBA) and Francisca Mutapi (Deputy Director, TIBA)

From rapid impact to capacity building

Expertise for the TIBA partnership comes from world-class facilities in the United Kingdom (Edinburgh), Botswana, Ghana, South Africa, Kenya, Sudan, Rwanda, Uganda, and Zimbabwe.  There are six work packages planned, with all activity based on priorities from Ministries of Health in the 9 African countries:

  • WP1: Rapid Impact Projects (years 1-2)
    Nine projects worth £100k, each designed to create demonstrable improvements/impact on the ground within 18 months. WP1 addresses current knowledge gaps that result in either non-deployment of diagnostics/interventions or a lack of operational knowledge. 
  • WP2: Making a Difference Projects (years 2-3)
    Five £500k projects building on WP1 and involving two or more Africa partner countries – demonstrating relevance to national health needs and clearing a pathway to impact.
  • WP3: Toolkit Projects (years 3-4)
    Strengthening health systems, looking at innovation-to-application value chains, information exchange and data sharing, and best practice for capacity building and training. Examples include working with local authorities to develop a road map for African drug and vaccine manufacturers. 
  • WP4: Capacity Building
    Establishing in-country expertise through PhD, MSc, and MPH training along with postdoctoral fellowships and technology transfer. This is important for sustainability.
  • WP5: Dissemination for Action
    Crucial for its impact on the actual health of the individuals and their communities – this is how TIBA’s findings will be communicated to end users, i.e. communities as well as the national, continental, and global stakeholders. These stakeholders have been engaged from initial application onwards, and TIBA has received support from the African Union; New Partnership for Africa's Development (NEPAD); African Academy of Science; and Ministries of Health from all 9 countries. That engagement with stakeholders and communities is continuing. 
  • WP6: Emergency Response
    Our last work package is designed to enhance local capacity to respond to health emergencies in all 9 African countries, by supporting the development of field diagnostics, data sharing, and performing real-time genomic analyses. Edinburgh is developing portable diagnostic kits for viral, bacterial and parasite infections employing biomarkers, electrochemical and bio-sensors, or sequencing technologies. Together with several of the African partners (Kenya, Botswana, South Africa), TIBA is taking an eHealth approach to improving outbreak surveillance by optimizing technologies (e.g. smart phones), surveillance system design and data communication capabilities.

Schistosomiasis projects

TIBA projects relating to schistosomiasis are taking place in Botswana, Zimbabwe, and South Africa. In Botswana, a WP1 situational analysis of schistosomiasis among communities in the Okavango Delta will look at a national control program targeting the delta. The goal is a roadmap for the Ministry of Health. 

In South Africa, an effective drug administration program is being researched in WP1 – asking which areas need treatment and how often, and also looking at the best strategy for delivering treatment to children before they reach school. Local access strategies are crucial: for example, Zimbabwe has the options of using monthly baby monitoring clinics or gatherings for the Expanded Program on Immunization (EPI) for effective pre-school access, whereas in SA the EPI program is already too crowded with other initiatives.

Francisca Mutapi said that a WP2 program in Zimbabwe is of special interest to the Praziquantel Consortium: “TIBA hopes to run a clinical trial with the new pediatric praziquantel formulation in the near future. This is an exciting prospect, and should result in eventual deployment of the drug to many millions of children.” 

TIBA in Tanzania