2022 Africa highlights
Before, sleeping sickness was a frightening disease. But now that new treatments exist, we just see it as another disease - like malaria. I am very happy that my son can take his treatment at home. It is much simpler.
Hélène, a nurse from Masi Manimba, Democratic Republic of the Congo, sits at home with her 12-year-old son, Brinol, as he takes his sleeping sickness treatment, fexinidazole, during their lunch.
En route to sleeping sickness elimination
The number of reported cases of sleeping sickness has fallen sharply over the last two decades, from almost 40,000 reported cases in 1998 to less than 1,000 per year over the past five years. This remarkable progress has been driven by both the fierce commitment of frontline health staff and the availability of safer, more effective treatments. But as cases decline, awareness of the disease can wane as well – making the sustained elimination of sleeping sickness a real challenge.
In parallel with our sleeping sickness R&D programmes in the DRC and Guinea, DNDi teams and partners are also squarely focused on supporting interventions to boost and maintain access to screening and treatment. Fexinidazole, the first simple, oral treatment for both stages of T.b. gambiense sleeping sickness, delivered by DNDi and partners in 2018, is now authorized for use in all endemic countries. A majority of eligible patients received the treatment in 2022 – provided free of charge.
To safeguard progress against sleeping sickness, we continued supporting patient screening and clinical training programmes for healthcare staff in 2022 together with our partners in the HAT Platform – and published an ethnographic study to inform and tailor interventions to ensure rapid case detection and treatment and increase community awareness of the disease. Our teams and partners also began work to improve routine pharmacovigilance reporting in the Democratic Republic of the Congo, Central African Republic, Guinea, Angola, and South Sudan.
LeishAccess: Supporting policy change for better treatments
2022 was a momentous year for our teams and partners working to improve treatments for people affected by leishmaniasis in Africa. In September, DNDi and our research partners published evidence of a shorter, safer new treatment for visceral leishmaniasis (VL) combining miltefosine and paramomycin (MF+PM). In June, the World Health Organization also recommended the combination of liposomal amphotericin B and miltefosine (LAmB+MF) as an improved treatment for people living with both VL and HIV, giving hope to thousands of patients who face poor outcomes with standard VL treatment.
Together with our consortium of partners in the LeishAccess Project, DNDi continued work in 2022 to drive policy change and bolster uptake of these and other improved tools for the diagnosis and treatment of leishmaniasis in Ethiopia, Kenya, Sudan, South Sudan, and Uganda. Our teams’ efforts focused on facilitating adoption of MF+PM and LAmB+MF, as well as thermotherapy for uncomplicated cutaneous leishmaniasis and optimal treatments for post-kala-azar dermal leishmaniasis. Together with our partners, we designed country-specific work plans to support the implementation of new guidelines and best practices, disseminated the latest clinical trial results, and supported the establishment of new treatment sites at Moroto Referral Hospital in Uganda and Sigor Hospital in Kenya.
Assistant bioanalyst Neo Moqhekoana demonstrates the process of analyte extraction to NIMR and UNC Project partners at FARMOVS in Bloemfontein, South Africa. The laboratory is lit with yellow light from sodium vapour lamps to prevent light contamination of samples.
Strengthening capacity to conduct early clinical trials in Africa
Phase I clinical trials for a sustained-release formulation of flucytosine, a drug critical in the treatment of cryptococcal meningitis, were conducted at DNDi research partner FARMOVS in Bloemfontein, South Africa in 2022. In January 2023, the FARMOVS team were joined in Bloemfontein by partners from the National Institute for Medical Research (NIMR), Tanzania, and the University of North Carolina (UNC) Project Lilongwe, Malawi, to share best practices in the collection of pharmacokinetic samples ahead of a Phase II trial of the new formulation, set to begin at sites in Malawi and Tanzania in the second half of 2023. The week-long training covered patient enrolment and registration; sample collection, storage, and transport; sample analysis; and data collection.
Photo credits: Scholars-DNDi; FARMOVS/Vicky Simpson-DNDi
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