Integrated approaches in NTDs: practices in Brazil

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1 Integrated approaches in NTDs: practices in Brazil Uniting to Combat NTDs Paris, April 2014 Rosa Castália França Ribeiro Soares Secretariat for Health Surveillance/Ministry of Health

Combating NTDs: National Integrated Plan Proposes integrated strategies based on: -Active search for cases and timely treatment / Integrated approach -Implementing Preventive Chemoprophylactic

2 Combating NTDs: National Integrated Plan Proposes integrated strategies based on: -Active search for cases and timely treatment / Integrated approach -Implementing Preventive Chemoprophylactic interventions when indicated. (PAHO/WHO Resolution CD 49/9 of 02/10/2009 Eradication of Neglected Diseases and other infections related to poverty ). -Contribute to pverty reduction ( Brazil Without Poverty Plan)

3 Brazil Without Poverty Plan Income security for the immediate reduction of extreme poverty, Improving access to public services, to improve education, health and living conditions of families, Productive inclusion, in order to increase capacity and employment opportunities and income generation for the poorest families.

4 Municípios Prioritários para Doenças em Eliminação Brasil Priority municipalities for the NTDs and BWP area Note: The 720 municipalities located mainly in the BWP Plan area received around US$13 million (SVS Ordinance 2556/2011) for surveillance actions in which the campaign is included.

5 Previous use of MDA strategy: Lymphatic Filariasis Lymphatic Filariasis: Number of people treated with DEC and positivity rate per year of MDA. Recife Metropolitan Region, * No. tratados 250, , , ,000 50, * Ano 1. Dietilcarbamazina 2. Percentual de infectados com microfilária de W. bancrofti pelo teste de gota espessa * dados parciais taxa de filarêmicos

6 Previous use of MDA strategy: Onchocerciasis Pre-elimination No records of new cases in Brazil from the period Low densities of parasitemia detected in sentinel areas (average of 20% in 2003, 15% in 2007 and 4% in 2012). 18, % 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 Meta/elegíveis Tratamentos realizados % Cobertura 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% s s s s s s s s s s s s s s s s s s s s s s s s s s s s s s s s s2 0.0%

7 2013: Combined Campaign Leprosy and STH pilot of trachoma Target population: - 70% of school children 5 to 14 years old studing in public schools located in municipalities with a high burden of NTDs and included in the Brazil Without Poverty Plan Objectives: - Active search for new cases of Leprosy in chidlren under 15 years of age - Offer PCT for STH - Pilot of third combined disease (trachoma) Methodology: LEPROSY - Using "self-image" form (mirror method) to identify potential suspected cases of leprosy - Perform clinical exam and treatment when confirmed the diagnose in the local health network (basic health care) - Epidemiological surveillance actions (household contact exam). STH - Treat with Albendazol in a single 400mg dosis TRACHOMA: Search and treatment of cases and contacts

8 Campaign Self-image Sheet Brazil 2013

9 Campaign Promotions Material Brazil 2013 Material de Divulgação

11 Results: Combined Campaign Leprosy and STH (under 15) Total % Participating States 25/ Total municipalities involved 649 from 706 priority (92%) 194 plus TOTAL: (priorities) Total schools 21,300 - Total school children (5-14 years, Education Sector) 4,342, School children who received a self-image sheet (leprosy) 3,625, School children treated with Albendazol 2,808, School children who completed the self-image sheet (leprosy) 5. School children referred for exam by health network (leprosy) 6. School children with a confirmed diagnosis (leprosy) 2,381, , Source: SUS Form SVS/CGHDE

Combined Campaign Leprosy and STH Distribution of new cases of leprosy by municipality Brazil, 2013 103 municipalities reported new cases, some

12 Combined Campaign Leprosy and STH Distribution of new cases of leprosy by municipality Brazil, municipalities reported new cases, some silent before 293 new cases (under 15 years old) 120 new cases (family contacts) TOTAL: 413 new cases Source: SUS Form/Datasus online at 01/09/2013

13 Combined Campaign Leprosy and STH Municipalities where campaign is carried out Brazil from 706 priority (92%) 194 non priority joined spontaneously TOTAL: 843 municipalities Source: SUS Form /Datasus online at 01/09/2013

14 Case: Outline Municipality of Alta Floresta - Mato Grosso State 49,761 inhabitants High endemic area New cases under 15 from 2009 to 2013 (campaign): Year NCD Det. Rate/100,000 inh 2009 = 09 NC 6, = 07 NC 6, = 06 NC 4, = 06 NC 6, = 17 NC 10, contacts examined by medical doctor with experience in leprosy diagnostic 94 new cases confirmed 38,37% of the examined contacts, 82 (87%) multibacilary and 12 (12,8%) paucibacilary

15 Pilot with the third disease (trachoma) TRACOMA Number of students examined for Trachoma, positive cases and treatments administered in the Campaign by UF Brazil UF (No. municip.) No. Examined (*) No. Positive cases % of positives No. of treatments RN (4) 5, RO (3) 7, RR (1) 1, SP (6) 5, TO (12) 14,845 1, ( Total (26) 35,500 1, ,957 *) Examined in the 5-14 yr age Source: SUS Form/Datasus/MS

16 2014: Outline Next steps 2013/2014 Catch up activities with innovative approach in 40 municipalities with higher burden of leprosy and remaining focus of schistosomiasis (investment: around 8 million dollars) ongoing activities including exams and drugs delivery in non-administrative hours, weekends, house by house, etc; 2014 Leprosy Campaign targeting the population and health professionals January 2014 (done) Combined Campaign May 2014 Preparation etage -03 diseases (Leprosy, STH and Trachoma) -At least 1,200 municipalities selected as priority (increased 30%) and support available for non-priority wishing to join -Strategy for children under 5 to treat STH

17 2014 Outline Advocay material includes: Leprosy, STH and Trachoma

18 2013: Health and education sectors and community together

19 2013: wide acceptance of the target population International Leprosy Summit: Overcoming the Remaining Challenges Bangkok, Thailand, July 2013

20 2013: Improving health at school can be great fun! *Censo Ibge 2010

21 Acknowledge Outline - Partners Municipal and State level Health Secretariats Municipal and State level Eduacation Secretariats National Council of Municipal Health Secretaries World Health Organization (WHO)/ NTDs Department Pan American Health Organization (PAHO) Sabin Institute Novartis Foundation Vale Foundation (Vale do Rio Doce) Brazilian Society of Dermatology Brazilian Society of Leprosy Pastoral da Criança ILEP & others...

Policy and technical topics: Selected neglected tropical diseases targeted for elimination: kala-azar, leprosy, yaws, filariasis and schistosomiasis

REGIONAL COMMITTEE Provisional Agenda item 8.3 Sixty-eighth Session SEA/RC68/12 Dili, Timor-Leste 7 11 September 2015 21 July 2015 Policy and technical topics: Selected neglected tropical diseases targeted