Innovation for health. Research that makes a difference

Transcription

1 Innovation for health Research that makes a difference TDR annual report 2009

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3 Innovation for health Research that makes a difference TDR annual report 2009

4 WHO Library Cataloguing-in-Publication Data Innovation for health: research that makes a difference: TDR annual report Tropical medicine. 2.Research. 3.Program evaluation. 4.Strategic planning. 5.Annual reports. I.UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases. ISBN (NLM classification: WC 680) Copyright World Health Organization on behalf of the Special Programme for Research and Training in Tropical Diseases 2010 All rights reserved. The use of content from this health information product for all non-commercial education, training and information purposes is encouraged, including translation, quotation and reproduction, in any medium, but the content must not be changed and full acknowledgement of the source must be clearly stated. A copy of any resulting product with such content should be sent to TDR, World Health Organization, Avenue Appia, 1211 Geneva 27, Switzerland. TDR is a World Health Organization (WHO) executed UNICEF/UNDP/World Bank/World Health Organization Special Programme for Research and Training in Tropical Diseases. This information product is not for sale. The use of any information or content whatsoever from it for publicity or advertising, or for any commercial or income-generating purpose, is strictly prohibited. No elements of this information product, in part or in whole, may be used to promote any specific individual, entity or product, in any manner whatsoever. The designations employed and the presentation of material in this health information product, including maps and other illustrative materials, do not imply the expression of any opinion whatsoever on the part of WHO, including TDR, the authors or any parties cooperating in the production, concerning the legal status of any country, territory, city or area, or of its authorities, or concerning the delineation of frontiers and borders. Mention or depiction of any specific product or commercial enterprise does not imply endorsement or recommendation by WHO, including TDR, the authors or any parties cooperating in the production, in preference to others of a similar nature not mentioned or depicted. Printed in Switzerland. Compiled and edited by Julie N Reza Design and layout: Lisa Schwarb Bruno Duret Cover Photo: WHO/TDR/Craggs This report represents the combined efforts of many TDR staff, all of whom are thanked for their invaluable input, comments and support.

5 Contents PART I Foreword by Dr Tim Evans, TDR Special Programme Coordinator and Assistant Director-General Information, Evidence and Research, World Health Organization... 7 Message from Dr Jorge Motta, Chair of the TDR Joint Coordinating Board... 9 About TDR Key achievements during PART II Introduction by Dr Robert Ridley, TDR Director Research for delivery, policy and access Research for discovery and development of tools and products for neglected diseases Empowerment Promoting equity and fostering ownership and research leadership Stewardship Knowledge for decision-making and advocacy for research for health References PART III Key publications and resources TDR governance and management STAC membership Leadership at TDR TDR partnerships TDR financial review for the biennium TDR annual report

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7 PART I TDR annual report

8 6 Health for all remains a basic condition of human development and the TDR partnership remains crucial in helping to achieve this goal.

9 PART I PART I Foreword by Dr Tim Evans TDR Special Programme Coordinator and Assistant Director-General Information, Evidence and Research, World Health Organization TDR, the Special Programme for Research and Training in Tropical Diseases, provides critical tools and evidence for scaling-up health interventions to improve global health and to achieve the Millennium Development Goals. It focuses on infectious diseases of the most vulnerable, poorest and marginalized populations who have limited access to health care, with the goal of developing sustainable solutions to meet their critical needs. The health conditions of poor and marginalized communities tend to be hidden below the radar screens of health service providers and politicians. Yet these communities form the group that needs the most help. This annual report pays testimony to the determination with which TDR and its many partners are directing their attention to this important group. It outlines progress to advocate for these needs, to develop leadership and research capability in the countries where these diseases occur, and to provide critical new evidence that will contribute towards eliminating diseases such as visceral leishmaniasis. each other s strengths to do what we could not do alone. TDR staff many of them highly experienced scientists in their own right bring this all together. Although they do not conduct the research, they help make it happen through management support under the guidance of global experts always with the goal in mind to have people and affected communities in disease endemic countries play a pivotal role in the choice, design and subsequent development of effective and affordable health solutions. WHO s engagement with TDR stems from our conviction that TDR helps to bring about more efficient approaches in the combat against diseases of poverty. As a major TDR co-sponsor, WHO is pleased to pledge its continued support to the Special Programme and wish TDR ongoing success. Health for all remains a basic condition of human development and the TDR partnership remains crucial in helping to achieve this goal. WHO is the executing organization of TDR and is one of the four co-sponsoring organizations the others are the United Nations Children s Fund (UNICEF), the United Nations Development Programme (UNDP) and the World Bank. Our agencies work together, leveraging TDR annual report

10 8 TDR s emphasis on equity and access for all, ownership and sustainability, and decision-making at the local level, all provide the groundwork for its many achievements.

11 PART I Message from Dr Jorge Motta Chair of the TDR Joint Coordinating Board (JCB) * It is my privilege and pleasure to be serving as the Chair of the TDR Joint Coordinating Board (JCB) for TDR has successfully advanced into a new strategy that places emphasis on facilitation and coordination to achieve high-level impact. The JCB remains strongly committed to supporting TDR s work and applauds TDR s ability to identify new and innovative solutions in the combat of diseases of poverty. Health and development are closely linked, and research for health is essential to achieve sustainable development. TDR s emphasis on equity and access for all, ownership and sustainability, and decision-making at the local level, all provide the groundwork for its many achievements. This model is shared by many new organizations that have arisen since TDR s establishment in Over its history, the Programme has contributed evidence to significantly improve communicable disease control and protect vulnerable populations. The list of achievements includes: leprosy multidrug therapy, which has formed the basis of leprosy elimination strategies; drugs and strategies for onchocerciasis control; interruption of Chagas disease vectorial transmission in South and Central America; strategies to improve malaria treatment access and effectiveness through home-management approaches, special drug packaging, evaluation of drug combination therapy; and the validation of several marketed diagnostic tests. TDR has strengthened the ability of institutions and researchers in countries where infectious diseases create the highest burden to carry out research to international standards. It has also helped build local, national and international research networks and partnerships. Since 2008, TDR has strengthened and reshaped its empowerment and stewardship role in order to better meet the needs of policy-makers, researchers and research institutions in developing countries, and to enable them to play a pivotal role in tackling the diseases that affect them and to contribute to shaping the health research agenda. For example, TDR is helping to initiate an African Network for Drugs and Diagnostics Innovation (ANDI) to increase research partnerships and networks in Africa. As we all look ahead to 2015, the target date for achievement of the Millennium Development Goals, we see that many challenges remain. Advances in global health are inexorably linked to poverty. The current global economic environment shows signs of its devastating effects on the lives and livelihoods of the poor. Countries where resources are already stretched are finding it harder to meet the challenges of providing health care, and research is often considered an unaffordable luxury. History has shown this view to be a mistake. When challenged by difficult problems, investment in appropriately-directed research becomes even more important. Another challenge is to better understand, anticipate and counter the effect that climate and environmental change may have on the emergence, resurgence and spread of infectious diseases, especially vector-borne diseases. TDR is positioning itself to effectively address this challenge. For example, a new thematic reference group on environment, agriculture and infectious diseases will help improve research into how climate change may affect health. In reviewing and approving TDR s strategies and activities at its 32nd session in June 2009, the JCB was keen to ensure a harmonious balance between all aspects of the Special Programme. It also examined how TDR governance could be further enhanced, notably by including representatives of nongovernmental institutions that are collaborating with TDR. The JCB also considered the key role that TDR is planning to play in the implementation of some elements of the Global Strategy and Plan of Action for Public Health, Innovation and Intellectual Property. Because of TDR s focused agenda and diversified partnerships and networks, the JCB is confident that the Special Programme is well positioned to continue to harness the power of health research in ways that help alleviate the suffering of poor and disadvantaged communities. *TDR s top level governing body. For more details, see section on TDR governance and management in part III. TDR annual report

12 TDR the Special Programme for Research and Training in Tropical Diseases is the leading UN-based organization dedicated to research on infectious diseases of poverty. 10

13 PART I About TDR TDR the Special Programme for Research and Training in Tropical Diseases is the leading United Nations (UN)-based organization dedicated to research on infectious diseases of poverty. It operates within a broad framework of intergovernmental and interagency cooperation and participation. Since being established at the World Health Organization (WHO) in 1975, TDR has helped stimulate research and development (R&D) into new drugs, diagnostics and implementation strategies. In 2008 TDR began a new 10-year strategy that places greater emphasis on ensuring that disease endemic countries (DECs) play a pivotal role in research and priority setting. Through its three strategic arms (research on neglected priority needs, empowerment and stewardship) TDR continues to identify research gaps and, by working together with a huge network of collaborating organizations and individuals throughout the world, facilitate ways to address these. TDR has identified several core principals that influence its work; these are currently being fed into a monitoring and evaluation system that will help assess the performance of the programme. Our core values include: Ensuring that disease endemic countries play a pivotal role in shaping the research agenda and carrying out research. Promoting equity, including gender balance, in research. Promoting partnership. Promoting sustainability of research and its impact where the diseases occur, with the fruits of research and capacity building taken forward under local ownership. TDR focuses on how new products and strategies can best be developed and applied for the communities where they are most needed. For example, for malaria, this has meant the generation of evidence on how bednets and pre-packaged artemisinin-based combination therapies (ACTs) can be used at the community level. TDR has contributed to the tools and strategies being utilized for global disease elimination campaigns for Chagas disease, leprosy, lymphatic filariasis, and onchocerciasis; current research is helping the regional elimination campaign against visceral leishmaniasis (VL) in the Indian subcontinent. TDR has also helped develop many networks and partnerships that have advanced R&D on infectious disease, and TDR has continued to foster the training of thousands of developing-country researchers and to strengthen hundreds of developing-country research institutions. TDR has an annual budget of approximately US$ 50 million and a staff of around 100; its unique position derives from the breadth of consensus through which it operates in partnership with hundreds of scientists, institutions and networks all over the world, and by the manner in which it is governed by its four co-sponsoring organizations as well as an independent governing board comprising equal representation of developed and developing countries. TDR annual report

14 Key achievements during 2009 TDR achievements fall into four broad categories: Research for delivery, policy and access Research for discovery and development of tools and products for neglected diseases Empowerment promoting equity and fostering ownership and research leadership Stewardship knowledge for decision-making and advocacy for research for health Among the highlights in 2009 for research for delivery, policy and access were the following: Dengue: A TDR European Union jointly funded and coordinated multicentre study in seven countries has led to the development of a revised model for the clinical classification of dengue. This was shown to be user-friendly and practical for case management in a subsequent study in 18 countries. TDR-supported research has also shaped the new edition of the WHO Global Dengue Guidelines (published with TDR input in December 2009). The new dengue case classification system and guidelines should greatly enhance case management in dengue-endemic regions. Onchocerciasis: TDR-coordinated clinical trials in Mali and Senegal have provided evidence that annual treatment with the drug ivermectin, continuously applied over 15 years with widespread coverage in regions at community level, can eliminate the disease in those regions. This could lead to more concerted regional elimination campaigns. Malaria: A paper describing a TDR-coordinated clinical trial on the use of artesunate suppositories (rectal artesunate) for the treatment of malaria, which was mentioned in the TDR programme report, won the prestigious British Medical Journal (BMJ) award of 2009 clinical research paper of the year. The paper provided the first evidence of how rectal artesunate can be used to manage severe malaria and save the lives of young children in remote community settings. This evidence is feeding into other community-based initiatives. Within research for discovery and development of tools and products for neglected diseases there have also been three major breakthroughs during 2009: Malaria: For the first time, there is a guide profiling which rapid diagnostic tests work best under different field conditions. The accuracy and efficacy of 41 rapid diagnostic tests for malaria have been evaluated in a study co-funded and coordinated by TDR with several partners; a publication based on the study points out the weaknesses of several tests and identifies those that are most suitable for field use. Findings should help inform diagnostics procurement processes and will be of particular value in resource-poor settings. The report has become one of TDR s most popular publications of Tuberculosis: A TDR-commissioned trial evaluating the performance of light-emitting diode (LED) adaptors for the microscopic analysis of tuberculosis 12

15 PART I (TB) samples has shown that these low-cost adaptors simplify diagnosis. This work should enhance the diagnosis of TB, particularly in resource-poor settings, and has been incorporated into WHO s Stop TB policy guidelines. Chagas disease: Thanks to a TDR-coordinated collaboration, diagnosis of Chagas disease can be improved through a standardized protocol using a technique called the polymerase chain reaction (PCR). Such a commonly accepted standardized diagnostic protocol has the potential to help interpretation for both research and case management. During the past year, as part of its objective to enhance empowerment to foster ownership and research leadership in developing countries, TDR has supported the following: The 5 th Multilateral Initiative on Malaria (MIM) Pan-African Malaria Conference in Kenya. The MIM conference is held every three years in Africa; this year the conference brought together over 1200 scientists and major stakeholders in malaria research and control to discuss current and future issues pertinent to their work. TDR played a significant role in supporting the organization of the conference, which was overseen by a secretariat hosted at the African Malaria Network Trust (AMANET) in the United Republic of Tanzania. The largest global malaria conference of its kind, it generated new collaborations and has played a major role in helping inform malaria research. Grants, networks and training activities that will help ensure that disease endemic country scientists play a pivotal role in leading research and shaping the research agenda. The creation of several TDRsponsored research training centres was initiated, which will better allow disease endemic countries to lead research capacity-building efforts in their regions, with a train-the-trainer approach ensuring sustainability. Development of an Action Framework for Research Partnerships on Neglected Diseases of Poverty through a large stakeholders meeting in Berlin, jointly co-sponsored by TDR with the German government. The framework recommends ways in which governments, research institutions, funders and others can help to ensure more equitable research partnerships on neglected diseases of poverty. In taking forward its role of Stewardship to harmonize, identify and align research needs to country needs, TDR has undertaken three key activities over the year: The creation of a think-tank of 100 international experts organized into 10 disease-specific and thematic reference groups that will help to identify the top priorities for research on infectious diseases of poverty. Their work will feed into the production of the first global report on research into infectious diseases of poverty, which will be published in Establishment of a new initiative, Enhancing Support for Strengthening the Effectiveness of National Capacity Efforts (ESSENCE), to help increase coordination among donors in aligning their support of research in developing countries with country needs. The further development of the web-based global knowledge platform on tropical disease research, TropIKA.net, which has seen a significant increase in overall use, including the successful creation of web-based discussion spaces for a number of stakeholder-driven, partnered initiatives. The support of WHO s Department of Control of Neglected Tropical Diseases in the publication of guidelines on the diagnosis, treatment, prevention and control of dengue (see page 12). TDR annual report

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17 PART II TDR annual report

18 16 Over the last 30 years, TDR has been at the forefront of research, capacity building and global institutional development.

19 PART II Introduction by Dr Robert Ridley TDR Director TDR s work and achievements reflected in this annual report are closely linked with several important long-term and medium-term developments that occupy the thoughts of policy-makers and stakeholders in health research. These include: (i) the Millennium Development Goals; (ii) the Paris Declaration on Aid Effectiveness; (iii) climate change and the environment; (iv) the promotion of science, technology and innovation for development; (v) health systems strengthening. Millennium Development Goals: In September 2010 the UN General Assembly will take stock of where the world stands in relation to the Millennium Development Goals (MDGs) targeted for achievement in Three of these goals (MDGs 4 to 6) relate directly to health, namely to child mortality; maternal health; and HIV/AIDS, malaria and other diseases. Ultimately, the work of TDR relates to all the MDGs, including the eradication of extreme poverty and hunger (MDG 1) which can only be achieved by breaking the vicious cycle of disease and poverty. Over the last 30 years, TDR has been at the forefront of research, capacity building and global institutional development, such as through the creation of product development partnerships, to address these issues. The manner in which TDR supports research is founded in principles of equity that underlie the MDG concept. In this report there are specific examples of recently concluded and ongoing research, notably in the fields of onchocerciasis and visceral leishmaniasis (VL), that continue to support the goals of eliminating diseases of poverty. The big three diseases of HIV/AIDS, TB and malaria remain a global problem of major proportions, but due to sustained global efforts the scale of their burden is stabilizing and, in the case of malaria, may even be declining. One disease that is on the rise, however, is dengue. TDR has long played a role in stimulating innovative malaria research initiatives and has applied itself to dengue research over the last 10 years. This report highlights TDR malaria research on the development and application of rectal artesunate for the community-based management of severe malaria in children, which in March 2010 lead to an award by the prestigious British Medical Journal award of best clinical research paper of the year. The citation noted the paper s significant contribution to improvements in health and health care. The report highlights innovative diagnostics research to support malaria and TB control. It also highlights recent TDR-sponsored research that has led to new guidelines for the classification of dengue that is leading to improved case management of this increasingly important disease. Paris Declaration on Aid Effectiveness: The principles of the Paris Declaration can be summarized as promoting leadership, ownership of, and responsibility for, development within developing countries and ensuring coherence and harmonization of donor support. TDR has long supported research capacity building that has helped develop leaders who can take an evidence-based approach to decision making. This has been further strategically developed through TDR s new Stewardship and Empowerment functions, as highlighted in this report. Many of the ideals of the Paris Declaration require the development of equitable partnerships between northern and southern partners, through which true leadership and ownership can be exercised by developing country institutions. A framework for action for the development of equitable partnerships was developed at a meeting of international stakeholders in Berlin 2009 that was convened by TDR. Donor coherence is also being explored through an initiative (ESSENCE*), based at TDR, that brings together major development agencies and research funders. Climate change and environment: Climate and environmental change is increasingly recognized as one of the major challenges of our age. Its impact on health, especially through vector-borne diseases such as those * Enhancing Support for Strengthening the Effectiveness of National Capacity Effort. TDR annual report

20 Introduction covered by TDR, could be immense. TDR is working with others in WHO to incorporate environmental issues into its research and into its strategic view of poverty-associated disease. Results from recent innovative research linking ecology and community response to mosquito control for dengue are being analysed and will be covered in future reports. TDR is also preparing its first ever global report on the status and priority needs of research on infectious diseases of poverty. Based on expert analysis, review and stakeholder consultation, this report will focus on three major elements driving health research in the future. The first and foremost of these will be climate and environmental change. The other two foci of the report will be on science, technology and innovation, and on health systems. Science, technology and innovation: The impact of technology on human development and on health can be seen everywhere in our daily lives. However, it is only recently, that developing countries have collectively started to explicitly espouse and develop science, technology and innovation strategies as a prerequisite for their own development. The African Union (AU) target that 1% of gross domestic product (GDP) should be spent in this area is testament to the significance of science, technology and innovation strategies and it is anticipated that a significant proportion of this expenditure will be on health research. WHO member states have recently agreed on a Global Strategy and Plan of Action for Public Health, Innovation and Intellectual Property to address diseases that disproportionately affect developing countries. TDR plays an integral part in the WHO effort. Historically, it has supported research capacity development in scientific disciplines central to technical innovation. It is currently devoting a major effort to promoting regional networks for innovation, the most advanced of which is the African Network for Drugs and Diagnostics Innovation (ANDI). Health systems: Appropriate tools to treat and prevent disease, and policies that address development, inequity, environment and health, are of little use if there is not a functioning system in countries through which to implement policies and deliver on health care. Increasingly, research needs to be taken from discovery through to delivery within the systems context, and with the leadership and ownership of countries and communities. TDR s collective work aims at adding value and sustainability to the entirety of national health and research systems. For this to happen research towards the delivery of specific interventions must be undertaken by keeping in mind the needs of the entirety of health systems and not just the needs of any one specific intervention or disease. These and related issues increasingly underpin TDR s research and form the basis of TDR s support, under the leadership of WHO, for the first ever symposium on health systems research planned for November As you read this report we hope that you find interest and value in the work that has been undertaken and that you find it fits with the broader strategic issues and imperatives alluded to above. 18

21 PART II In this report there are specific examples of recently concluded and ongoing research, notably in the fields of onchocerciasis and visceral leishmaniasis, that continue to support the goals of eliminating diseases of poverty. TDR annual report

22 Research for delivery, policy and access TDR s delivery and access research focuses on how to improve the uptake and use of new or improved tools and products in low- and middle-income countries that have high infectious disease burdens, particularly in remote, rural areas where they are needed most. Where possible, TDR research is embedded within national control programmes so that evidence-based interventions are integrated into existing systems. Outcomes of TDR research often contribute to shaping local, national and international public health policies. 20

23 PART II Key delivery and access highlights A revised classification model has been developed for dengue following a TDR European Union co-funded and coordinated multicentre study in seven countries. The new model is simpler for clinicians to use in primary healthcare settings, and will help ensure that patients get appropriate treatment. This, together with other TDR research, has shaped the new global WHO dengue guidelines. A paper describing a TDR-coordinated clinical trial on the use of rectal artesunate for the treatment of malaria (mentioned in the TDR programme report) was awarded the 2009 British Medical Journal (BMJ) clinical paper of the year award. The study highlighted the life-saving potential of rectal artesunate, given as a suppository to malaria patients in rural areas of Bangladesh, Ghana and the United Republic of Tanzania. TDR-coordinated studies from Mali and Senegal have provided the first evidence that in certain regions the drug ivermectin, when continuously applied over 15 years with widespread coverage, could help eliminate the debilitating disease onchocerciasis (also known as river blindness because of the loss of sight it can cause in some patients). TDR annual report

24 Research for delivery, policy and access At TDR we focus on low- and middle-income countries that bear the highest burden of infectious disease. Most people living in these countries have limited access to electricity, running water and professional healthcare workers. Because access to treatment is often limited, diagnostic tools that work in these difficult conditions are critical. They can help identify the best treatment sooner, resulting in fewer complications and lowering the overall cost of care. Early treatment also reduces the chances of disease transmission. Our work includes research to improve case diagnosis and classification and studies on how to scale up delivery of drugs, diagnosis and other services. We are also investigating the best ways to control diseases and possibly eliminate them. Improvements in classification and control methods often have socioeconomic and ethical implications, so TDR frequently works with partners to develop best practice guidelines for the use of these methods. criteria and a change in country guidelines. The new classification into levels of severity has been complemented by clear treatment instructions for the three groups of patients and has been shown to be of great assistance in case management and for disease surveillance in a subsequent study in 18 countries. It is currently incorporated into a new edition of global guidelines for the diagnosis, treatment, prevention and control of dengue 3 (described in more detail on page 41), which is expected to improve case management and disease surveillance. Onchocerciasis evidence for the feasibility of elimination Achievement details Dengue revised case classification Dengue is the world s most rapidly spreading vector-borne disease, with an estimated 50 million infections occurring annually. Its spread beyond Latin America and South-East Asia is of great concern; the identification of dengue viruses in West Africa is causing particular alarm. A 2006 TDR review 1 of 37 published papers suggested that the previous WHO classification scheme was impractical, particularly in primary healthcare settings, with around 40% of dengue cases being unclassifiable. Case classification is important as it determines case management and onward referral. A new system dividing patients into those with dengue, with or without warning signs, and those with severe dengue follows the largest ever prospective study on dengue carried out in Brazil, Malaysia, Nicaragua, Philippines, Thailand, Venezuela and Viet Nam 2. Termed the DENCO study, it was co-funded with the European Union. Studies using this new classification system have so far been overwhelmingly positive. The revised classification has been used in dengue outbreak situations in Argentina, Bolivia, Cape Verde and Paraguay, where it led to changes in hospital admission A TDR multicountry study 4 co-funded with the Bill & Melinda Gates Foundation* has provided the first evidence that onchocerciasis can be eliminated. About half a million people in 30 African countries are blind or visually impaired due to onchocerciasis. The drug ivermectin has been incredibly successful in stopping disease progression by attacking the parasitic worms that cause the debilitating itching and blindness. But this control has required annual mass drug treatments, and it was unknown how long the drug would have to be given to entire communities before disease transmission was broken and the disease died out. Studies carried out in 126 villages in three regions of Mali and Senegal where ivermectin treatment had been given for over 15 years, as part of mass treatment in order to control onchocerciasis, showed that few infections remained in humans and transmission levels were below the threshold for elimination. Treatment was then stopped in test areas in each region, and follow-up evaluations carried out after months. These showed no signs of infection or transmission, which led to the conclusion that elimination * The Foundation also supported research on community-directed interventions and supports our clinical research capacity building fellowships. 22

25 PART II of onchocerciasis is possible in some endemic regions in Africa. Further studies are needed to find out if the findings can be extrapolated to other endemic areas in Africa. Malaria British Medical Journal clinical paper of the year A TDR-coordinated study was identified by the British Medical Journal (BMJ) as the best clinical research paper in 2009 that contributed significantly to improvements in health and healthcare. The Lancet article 5 was originally reported in the TDR Programme Report. It covered a large randomized clinical trial of over malaria patients in Bangladesh, Ghana and the United Republic of Tanzania and led to the conclusion that one rectal artesunate suppository, administered before referral to the hospital, substantially reduced the risk of death or disability in patients in rural villages, who could not be given oral treatment and who were unable to get to a facility for further treatment for several hours. An expert panel of judges announced their decision to award the prize in March, Dengue targeting productive breeding places for vector control A series of 2009 publications have further demonstrated the value of targeted vector control for dengue. A TDRcoordinated trial 6 carried out in Kenya, Mexico, Myanmar, Peru, Philippines, Thailand, Venezuela and Viet Nam, showed that targeting only the most productive water container types (i.e. those that led to most mosquito pupae roughly half of all water-holding container types) was as effective (and had lower implementation costs) than targeting all water-holding containers. Dengue is transmitted by mosquitoes, so the study has implications for control policies/strategies that address breeding habits of the vector. Systematic reviews are also helping to guide dengue control measures. One review indicates that spraying peridomestic areas (areas near the household) with insecticides to kill mosquitoes is ineffective against dengue transmission if used on its own. 7 TDR-funded studies also show that due to limited capacity, vector control services in many countries are not adapting to new interventions, suggesting a need for monitoring and evaluation to follow the uptake of such interventions. 8 Ongoing activities Dengue control an environmental approach The International Development Research Centre (IDRC) in Canada is in part funding eco-bio-social research in relation to dengue in Asia. The aim is to improve the understanding of ecological, biological and social variables that interact to affect the vectors that carry disease. The IDRC has also funded research to improve dengue and Chagas disease control through innovative ecosystem management. Malaria and other fevers home-based management could save lives Home-based management of malaria (HMM) has the potential to save many millions of lives, because it helps patients get access to healthcare and treatment they would not have otherwise. TDR research has already shown that artemisinin-combination therapies (ACTs) can be used successfully for HMM. 9,10 TDR studies have continued to focus on the integrated management of fevers (due to malaria, pneumonia and diarrhoea); these studies, which will be conducted in Burkina Faso, Malawi, Nigeria and Uganda, should be completed by Malaria making rectal artesunate available to severely ill children in real-life conditions through community health workers TDR studies have demonstrated that rectal artesunate suppositories buy much-needed time to stabilize seriously ill infants and young children so they can be taken to hospital for care. The next step has been a multicountry study in Ghana, Guinea Bissau, Uganda, and the United TDR annual report

26 Research for delivery, policy and access Republic of Tanzania to assess whether mother-coordinators can make rectal artesunate available in community settings. The trial was set up to answer questions such as: What is the coverage achieved by different dispensers providing near-home rectal artesunate treatment in the real-life setting? How should community personnel be trained and supported to make the drug available and to ensure that available drugs are used appropriately? Will patients and guardians feel that hospital referral can be deferred after their child has received a suppository or will they adhere to the recommendation to go immediately to the hospital? The trial has concluded and data are currently being analysed. A publication with the results from this study is planned for Malaria understanding vector resistance to insecticides to help control efforts the cotton-growing regions is resistant to all four classes of insecticide currently available for vector control. The study highlights the urgent need to monitor the impact of resistance, and should be of great interest to control efforts. Malaria and dengue MosqGuide, providing guidance for the use of genetic vector control MosqGuide 12 is a TDR-funded project bringing laboratorybased researchers to work together with field experts to develop guidance on the assessment and potential deployment of different types of genetically modified mosquitoes to tackle malaria and dengue. Commissioned in 2008, the project will be responsible for the development of best practice documents on a variety of issues, including arthropod biology, vector control and environmental risk assessment. These will be of value to those making decisions on a national, regional and international level about the safety, ethics and sociocultural aspects of using genetically modified vectors for disease control. A number of modules are in development and these will be published on the MosqGuide website: TB/HIV providing antiretrovirals earlier to patients The use of insecticides to control malaria is growing in Africa. However, control specialists are increasingly concerned by insecticide resistance seen in mosquitoes such as Anopheles gambiae. This is particularly alarming because few insecticides are available for control efforts. A TDR-funded multicentre study 11 is being carried out over 3 years in Burkina Faso, Benin, Chad, Sudan, and South Africa to establish the magnitude of vector resistance to insecticides, characterize resistance mechanisms and assess the implications for control interventions. The first year involved Burkina Faso, Chad and Sudan, and has shown how resistance is very heterogeneous, with large differences in mosquito mortality rates being observed even in the same study sites during the course of the malaria transmission season. All Burkina Faso and Chad mosquito populations, and some Sudan populations, were classed as permethrin and/or deltamethrin resistant. Some areas of all three countries also showed high frequency of DDT* resistance. A source of major concern is the finding that, in Burkina Faso, the vector population in one of With one in three people a carrier, TB is one of the world s most widespread infections. Moreover, increasing drug resistance and problems associated with TB in HIV-positive individuals make TB a growing public health concern. A TDR-supported trial** aims at providing evidence for the treatment of HIV-infected TB patients utilizing concomitant anti-tb chemotherapy and highly active retroviral therapy (HAART) through a CD4 T cell range of cells/mm 3. It is expected that the information generated from this study will complement the current global guidelines for management of these categories of patients. When completed, the trial will be the largest of its kind, with 1800 patients spread over four countries (South Africa, the United Republic of Tanzania, Uganda and Zambia). * Dichlorodiphenyltrichloroethane. ** During 2009 Merck and GlaxoSmithKline (GSK) have jointly provided in-kind support worth about US$ 2.8 million of their antiretroviral drugs, Stocrin (Efavirenz) and Combivir (AZT and 3TC), for clinical trials on the treatment of HIV/AIDS in TB patients in the United Republic of Tanzania, Uganda, Zambia and South Africa (the TB-HAART studies). GSK, in addition to its contribution of AZT (US$ 1.3 million) towards the end of 2009, added Combivir placebo, estimated at about US$ , to the study. 24

27 PART II Syphilis rapid diagnostic tests studied for introduction into control programmes programme co-funded with the German development agency GTZ has been implemented. The effect of the standardized training and application of the M&E Toolkit on programme performance is now being assessed. Visceral leishmaniasis an improved way of managing case detection Six effective rapid syphilis tests previously evaluated by TDR are currently available through WHO s Bulk Procurement Scheme. TDR is now working with seven countries in Africa, Asia and the Americas (Brazil, China, Haiti, Peru, the United Republic of Tanzania, Uganda and Zambia) on how to introduce validated rapid syphilis tests into national control programmes, and how to ensure the quality of tests and testing when used in remote settings. Visceral leishmaniasis - vector control critical to elimination Visceral leishmaniasis (VL) can cause fever, anaemia, enlargement of the spleen and severe wasting. It is potentially fatal if untreated, and has an estimated incidence of cases per year; 60% of cases occur in three countries of the Indian subcontinent Bangladesh, India and Nepal. But an elimination campaign is underway to stop this disease, in part because of the tools developed through TDR research. A TDR-supported study 13 has shown that control of the sandfly vector (that carries the VL parasite) could make an important contribution to efforts to eliminate VL. Such control is most effectively done by indoor residual spraying (IRS) with insecticides and, to a lesser extent, by the use of long-lasting insecticide treated bednets (LLIN) and through the traditional practice of plastering walls of homes with lime. The authors concluded that IRS should be strengthened in India and Nepal, and initiated in Bangladesh, for the best potential to rapidly reduce disease transmission. However, analysis of national IRS programmes in India and Nepal has identified severe performance and outcome issues (paper under revision). Based on these findings a Monitoring and Evaluation (M&E) Toolkit for IRS has been developed, and a training Results from TDR-funded studies show that although the incidence of VL has decreased since 2008 in endemic districts of India, Nepal and Bangladesh, levels are still 19 times higher than the elimination target for Interim data on case detection suggest that a three-tiered approach could reduce the incidence of the disease. In highly endemic areas, a camp approach where mobile teams visit endemic villages is most cost-effective and feasible. In districts with lower endemicity levels an index case approach is appropriate, where mobile teams do house-to-house screening around index cases reported through passive surveillance. Passive surveillance should be used in middle-low endemicity areas that already have a well established surveillance system. These findings are currently being made available to the national health services through documents and training activities. 14 We are also investigating the best ways to control diseases and possibly eliminate them. TDR annual report

28 Research for discovery and development of tools and products for neglected diseases WHO s Global Strategy and Plan of Action (GSPOA) on Public Health, Innovation and Intellectual Property calls for building and improving innovative capacity for research in developing countries and for improving, promoting and accelerating transfer of technology between developed and developing countries, as well as among developing countries. TDR s role and contribution to this is to build networks and foster southsouth collaborations in which scientists from developing countries play a leading role. This section focuses on some of the tools and products that have resulted from these partnerships. 26

29 PART II Key tools and products highlights Evaluation of 41 rapid diagnostic tests for malaria has been carried out in a study co-funded and coordinated by TDR with several partners. Much variability in the performance of tests was found, with several tests identified that are suitable for field use. The report of this study should help countries decide which tests to purchase, and also spur manufacturers into further improving the quality of their products. A TDR-commissioned trial evaluating the performance of light emitting diode (LED) adaptors for the microscopic examination of TB samples has shown that these low-cost adaptors make the examination process faster and easier. Such a simplified method for diagnosis is likely to have a positive impact in the field and has been included in WHO Stop TB guidelines. A TDR-coordinated collaboration has helped develop a standardized protocol for diagnostic testing of Chagas disease by a technique called the polymerase chain reaction (PCR). It is anticipated that such standardization will help both clinical diagnosis and research. TDR annual report

30 Discovery and development of tools and products New tools and products such as diagnostics and treatments are desperately needed to tackle infectious diseases of poverty. Treatment for many diseases still relies on drugs developed decades ago, so it is crucial to get more drugs into the R&D* pipeline. In the absence of commercial incentives, R&D companies remain reluctant to invest in developing drugs that predominantly affect the poor. At TDR we complement the work of other organizations such as product development partnerships working in this field, seeking to fill gaps in research and better engage and support developing country institutions in these endeavours. We focus on producing results as fast as possible and on a larger scale than research that can be carried out by individuals or institutions alone. We work collaboratively, using the convening power of our WHO co-sponsor to bring together multiple partners and develop new approaches to R&D. Two G-Finder reports also highlight some of the issues relating to research into new tools and products for infectious diseases of poverty. The first 15 shows that while tuberculosis, HIV/ AIDS and malaria are now receiving attention globally, neglected tropical diseases are inadequately covered. The second 16 highlights the fact that developing countries have the capacity for innovation for research and that this should be better utilized. Both papers support TDR s strategic approach to promote and build capacity for innovation on a range of infectious diseases of poverty, seeking to strengthen leadership and improve ownership of health research by developing countries. * R&D: Research and development. ** The evaluation was co-sponsored by TDR, the WHO Regional Office for the Western Pacific (WPRO) and the Foundation for Innovative New Diagnostics (FIND). Testing was performed at the US Centers for Disease Control and Prevention (CDC) and was done on samples from patients that had been quality assured and validated at numerous institutions in malaria endemic countries. Achievement details Malaria evaluation of rapid diagnostic tests to improve detection In April 2009, the day before World Malaria Day, the results from the largest ever independent, laboratorybased blinded evaluation of 41 currently available rapid diagnostic tests (RDTs) for malaria were published. 17 The study, funded by TDR and other partners,** found that there was great variability in the performance of tests at tropical temperatures, at which many tests are likely to be carried out, with some tests showing much greater sensitivity than others. It also found that testing varied between lots, suggesting that each lot should be tested post purchase and prior to use in the field. Several RDTs were found with high detection and low false-positive rates that are stable at room temperature and easy to use, so suitable for field use. RDTs are an invaluable way of quickly diagnosing disease in countries with high disease burdens, and the findings should help countries make informed choices about the RDTs they purchase this is particularly important when public health resources are limited. To ensure transparency, the reports are published openly, thereby providing an impetus for manufacturers to ensure and improve upon the quality of the tests that they produce. The publication on malaria RDTs has been highly popular, largely because it points out the weaknesses of several tests and identifies tests that are suitable for field use. This latest evaluation is part of a growing series of diagnostics evaluations that TDR has undertaken including evaluation of tests for syphilis, 18 leishmaniasis, 19 tuberculosis 20 and dengue. 21 A further evaluation of rapid tests for visceral leishmaniasis is currently under way, as is a second round of dengue tests. Results from a second round of evaluations on a further 29 malaria diagnostic products will be published in

31 PART II Tuberculosis a better way of analysing samples by microscopy been used for the diagnosis and assessment of T. cruzi infection for several years, but up until this collaboration the protocols used varied widely, making data comparison between research groups difficult. T. cruzi causes Chagas disease, and a standard operating procedure for the use of PCR to detect T. cruzi DNA will greatly aid Chagas disease diagnosis and research. The results of a TDR-sponsored multicountry process of validating the use of PCR for Chagas disease studies were presented in October 2009 at the XXI Congresso Brasileriro de Parasitologia and II Encontro de Parasitologia do Mercosul in Foz do Iguazú, Brazil, and will be published in TB is notoriously difficult to diagnose by microscopy, but it is often the only feasible method in resource-poor settings. Based on trials commissioned by TDR 22 and others, the Scientific and Technical Advisory Group of WHO s STOP TB Department recommended that conventional high-cost fluorescence microscopy could be replaced by low-cost light emitting diode (LED) microscopy in all settings where fluorescence microscopy is now used, and that fluorescence LED microscopy be phased in as an alternative for conventional Ziehl-Neelsen microscopy in both high- and low volume laboratories. 23 The LEDs make bacteria glow in specially stained smears; results so far indicate that LED fluorescence microscopy makes diagnosis faster and easier, and therefore more suitable for the field. The potential for a rapid TB blood test is also being investigated by TDR such a test could replace TB smear tests, which are costly and time consuming to carry out. A diagnostics test based on a new combination of TB antigens for use in such tests will be evaluated by TDR during Chagas disease a standardized protocol for the polymerase chain reaction A TDR-coordinated collaboration has led to the assessment of, and agreement on, a standardized protocol for polymerase chain reaction (PCR)-based detection of DNA from Trypanosoma cruzi, the parasitic organisms that cause Chagas disease. Biomedical researchers and medical practitioners from 14 countries (mainly Latin America, where Chagas disease remains endemic) participated in a workshop and symposium (sponsored by TDR, INGEBI-Conicet UBA and the United Nations University s BIOLAC programme) that led to the agreement. PCR has Ongoing activities Tuberculosis clinical trials improving treatment options A TDR-funded study focuses on a novel gatifloxacincontaining drug combination to assess if this can cut TB treatment time from six to four months. Shorter treatment times are more convenient for the patient, require fewer resources, and are more likely to ensure patients complete the course of medicines particularly important in reducing the rise of drug resistance. A multicentre phase 3 trial conducted in five African countries with national TB control programmes (in Benin and Senegal) and local institutions (in Guinea, Kenya and South Africa) has completed the enrollment and treatment phases (approximately 1840 patients) and is now following patients for relapses. If the shortened regimen proves effective and safe, this will be the pivotal trial in a regulatory submission. Toxicology and phase 1 and 2 clinical studies have already been completed. Safety and efficacy trials are also being carried out on a single-dose pill for TB that combines multiple drugs that would otherwise have to be taken as a loose combination. A single-blinded randomized trial of 1000 patients in Ethiopia and Nigeria should be completed in 2011 to assess the safety and efficacy of fixed-dose combinations over single formulation of the same drug, among a mixed group of HIV-infected and uninfected TB patients. The study was designed by TDR not just to provide the evidence base for the use of fixed-dose combinations in improving treatment adherence among TB patients, but also to develop the capacity within national programmes and associated national research institutions to conduct TDR annual report

32 Discovery and development of tools and products such studies. The tremendous contribution of this study, to research capacity development and institutional strengthening, has just been highlighted at the recently held 40th anniversary (17 19 March 2010) of the Armauer Hansen Research institute, Addis Ababa, Ethiopia, one of the collaborating sites. Onchocerciasis start of phase 3 clinical trials for moxidectin Over 100 million people are at risk of infection with onchocerciasis in Africa alone, with others at risk in some regions of the Americas and Yemen. Moxidectin could dramatically speed up elimination of disease across Africa if it can be shown that, unlike ivermectin which is currently used to control the disease, it sterilizes or kills the adult worms responsible for the long-lived nature of the infection, as well as kills the larvae. The TDR-supported clinical trial* is currently investigating moxidectin s potential for tackling this devastating illness. To be carried out over two and a half years, the trial will take place in three African countries where onchocerciasis is endemic 1500 people at four sites in the Democratic Republic of the Congo (DRC), Ghana and Liberia will be enrolled. A clinical research centre was built in Liberia, and in DRC; these centres have been fully equipped while the research teams have received training on how to conduct the trial according to international standards. Such activities highlight TDR s efforts to strengthen the research capacity of fragile states such as Liberia and DRC. Visceral leishmaniasis a new drug combination may help elimination efforts The oral drug milfetosine (brought to registration by TDR and its partners in India) has changed the face of visceral leishmaniasis (VL) treatment in recent years. For nearly a century the standard treatment for VL (or kala azar) has been a painful 30-day course of intramuscular injections with sodium stibogluconate. A further innovation may soon be available. Preliminary results from a recent clinical trial sponsored by TDR and led by Banaras Hindu University and Rajendra Memorial Research Institute of Medical Sciences in India suggest that a single injection of AmBisome (a drug also developed with TDR support) followed by 14 days of oral miltefosine, shows promise as an alternative VL treatment. AmBisome was obtained at low cost following negotiation with WHO s Department of Control of Neglected Tropical Diseases (NTD) department, which has allowed this combination to be considered in the future as a cost-effective alternative. The shorter treatment should increase compliance which will be beneficial to patients and healthcare providers. The combination will also decrease the likelihood of drug resistance, making it acceptable for a region-wide elimination programme. Preliminary results showed a cure rate efficacy of the combination regimen above 97%. Final results are due to be published in Visceral leishmaniasis improved treatment for post-kala azar dermal leishmaniasis A TDR-supported clinical trial is addressing the value of a 12-week course of the oral drug miltefosine compared to an 8-week course for treating post-kala azar dermal leishmaniasis (PKDL), a sequel of visceral leishmaniasis and a reservoir of the parasite for continued transmission of the disease. In Bangladesh where there are almost as many PKDL patients as VL patients, this is particularly important. The current PKDL treatment standard is a six-month course of treatment with pentavalent antimony, making treatment compliance difficult. Prior to this study, evidence on the efficacy of PKDL treatment with drugs other than with antimony has been scarce. * Pfizer (formerly Wyeth) has agreed to provide over US$ 6 million over three years to support the development of the drug moxidectin for onchocerciasis treatment. Pfizer and African Programme on Onchocerciasis Control (APOC) have also contributed operationally to the trial, which is being carried out in collaboration with Pfizer and African investigators and institutions. 30

33 PART II Human African trypanosomiasis treatment investigating new treatment regimens Human African trypanosomiasis (HAT) is a devastating disease that threatens millions of people in sub-saharan Africa. An ongoing TDR-funded study on stage 1 HAT is comparing the safety and efficacy of a three-day pentamidine regimen against the standard seven-day regimen. Shortened treatment should reduce side effects and costs of case management and improve the operational feasibility of HAT control. Partnering with other organizations is being actively pursued to speed up and finalize patient recruitment for clinical trials by the end of Meanwhile, the combination of nifurtimox and eflornithine (NECT) is being studied in Uganda in a clinical trial of stage 2 HAT (a stage of the disease which is fatal if untreated). This study was jointly designed with the Drugs for Neglected Diseases initiative (DNDi) to feed into a strategy for inclusion of the combination in the WHO Essential Medicines List. The data from the study will complement the information provided by DNDi which supported the inclusion of the NECT in the WHO Essential Medicines List in Republic of Tanzania. Focusing on factors that enhance tsetse fly trap performance should lead to best traps for six vector species that play a significant role in HAT transmission. Results from studies such as this will help develop an algorithm to help support decision-making and greatly improve HAT vector control. Chagas disease factors hindering elimination TDR is funding a multicountry study on prevention of triatomine bug re-infestation in Argentina, Bolivia, Brazil and Paraguay including characterization and improvement of knowledge about the status of resistance to insecticides of Chagas disease vectors (triatomine bugs). Preliminary results highlight two problems that could hinder vector elimination: (i) inadequate spraying with insecticides and development of resistance; and (ii) triatome insects that travel from areas outside those that have been sprayed. Final results should be in by the end of Human African trypanosomiasis completing the gene sequence for the tsetse fly By March 2010 a TDR-supported international genomics effort (the International Glossina Genomics Initiative, IGGI) should achieve complete sequencing of Glossina morsitans morsitans, the species of tsetse fly that acts as a vector of HAT. Understanding more about the tsetse fly may help researchers to develop ways to control disease transmission by this vector. Human African trypanosomiasis research on tsetse fly trap efficacy Preliminary findings from a TDR-funded study on the optimization of tsetse fly traps and baits have identified key physical and chemical features that limit their efficiency. As tsetse fly traps are an important element in the control of tsetse flies, the identification of features that affect trap efficiency may help to improve their design. Phase 1 field trials using a range of fabrics procured from Africa, Europe, USA and Asia started in April 2009 in Burkina Faso, Côte d Ivoire, Malawi and The United Drug discovery During 2009 two new lead compounds deserving further medicinal chemistry have been declared for malaria through work with Pfizer and Merck Serono. As part of a collaboration between TDR, NovoNordisk and the National Center for Drug Screening (NCDS) Shanghai, the first high throughput screening (i.e. rapid screening) for a TB drug target has been completed at the NCDS. Meanwhile there is continued progress with TDR compounds in medicinal chemistry centres at the University of Cape Town (South Africa), and the University of Sao Paulo (Brazil). TDR s targets database (www. tdrtargets.org), which is a global open-source resource for drug targets, continues to improve and be used by increasing numbers of scientists worldwide. TDR annual report

34 Empowerment promoting equity and fostering ownership and research leadership Over the years, TDR has played a central role in building research capacity for infectious diseases of poverty, an activity that comes under TDR s new Empowerment strategic function. In line with the 2005 Paris Declaration, our vision is to ensure that researchers from countries bearing the highest burden of infectious diseases are able to fully participate in research and its governance. Specific empowerment support activities in TDR are coordinated by an Empowerment team, but empowerment principles and activities are carried out across the entire spectrum of TDR s programmes. 32

35 PART II Empowerment highlights The 5th Multilateral Initiative on Malaria Pan-African Malaria Conference in Kenya this year, coordinated by a secretariat at the AMANET trust in Tanzania and co-sponsored by TDR, was a highly dynamic and well attended meeting that brought together a range of stakeholders in malaria research and control to discuss scientifically technical topics such as insecticide and drug resistance and genetic modification of vectors for disease control, and strategic issues relating to the potential to eliminate malaria from countries where the disease is currently endemic. Bridging these themes into a common research approach to address malaria is likely to have growing importance over the coming years. Grants, networks and training activities have continued to be provided through TDR in These build on TDR s traditional research capacity-building role, and will evolve over the coming years to ensure that developing country scientists and institutions play a greater role in leading research and shaping national and international research agendas. The creation of several TDR-sponsored research training centres was initiated, which will better allow disease endemic countries to lead research capacity-building efforts in their regions, with a train-the-trainer approach ensuring sustainability. An Action Framework for Research Partnerships on Neglected Diseases of Poverty was developed following a TDR-backed meeting of stakeholders from Africa, the Middle East, Asia, Latin America, North America and Europe. Participants discussed south south and north south partnerships, outlining the ways in which governments, research institutions, funders and others can help ensure equitable partnerships on neglected diseases of poverty. TDR annual report

36 Empowerment fostering ownership and research leadership Low- and middle-income countries can only play a pivotal role in research if their research is strengthened at institutional and national levels, which means moving beyond the traditional capacity-building model of building individual research excellence. TDR, through its Empowerment function and other empowerment activities, takes a concerted and systematic approach to addressing inequities in health research that exist between countries, within countries and in the content and conduct of research. We aim to build a more equitable environment, by developing the range and breadth of researchers and allied health professionals, nurturing research careers and helping to develop new leaders, promoting networks and strengthening national systems. Our activities have different effects at different levels National level systems: strengthened through network/partnership development and technical support. Institutions: improved access to research grants. Individuals: improved access to research grants, training courses and scholarships, mentorship and leadership/career development fellowships. Box 1 highlights the research excellence of some of our former grantees. BOX 1 Research excellence of former TDR grantees In 2009 several former TDR grantees received recognition for their research excellence. In 2009, in Addis Ababa, Ethiopia, Ethiopia last year, Sanaa Botros, Professor of Pharmacology at Egypt s Ministry of Higher Education and Scientific Research and one of the world s leading researchers studying the treatment of schistosomiasis and other tropical diseases, received an African Union Women Scientists Regional Award Earth and Life Sciences Prize in recognition of her scientific achievements. Gaining her PhD in the 1980s Botros went on to win a number of awards and honoraries, including the Arab Women Organization Award for Science and Technology in Biological Sciences in 2008 and the Country State Award in Medical Sciences from the Egyptian Academy of Scientific Research and Technology in Early in her career Botros showed that locally produced drugs for schistosomiasis were as effective as imported drugs which had, at that time, been the only available drug for schistosomiasis. The local drug went on to be used widely, saving Egypt much unnecessary expenditure. She has also shown the ineffectiveness of other drugs which, as a result, are no longer distributed in Egypt. She currently sits on the Task Force for the African Network for Drugs and Diagnostics Innovation (ANDI). Abdoulaye Djimdé, Head of the Molecular Epidemiology and Drug Resistance Unit of the Malaria Research and Training Center at Mali s University of Bamako, was named Best Pharmacist in the Francophone World by the National Academy of Pharmacy of France. Presented during the 62nd World Health Assembly in Geneva in May 2009, the award recognized Djimdé s outstanding contributions to antimalarial therapeutics development. Djimdé began his career by researching the herbal medicines that traditional healers used to treat jaundice in his native Mali. Several years later, he served as principal investigator on a Multilateral Initiative on Malaria (MIM)/TDR Antimalarial Drug Resistance Network in Mali. Now one of the world s leading experts on the molecular characterization of malaria parasite resistance to antimalarial drugs, Djimdé has published 45 peer-reviewed articles and oversees a team of 19 scientists at the University of Bamako. He works closely with the National Malaria Control Programme of Mali and currently serves as chairperson of the MIM/TDR Task Force on Malaria Research Capability Strengthening in Africa. He is also an Associate Professor of Microbiology and Immunology at the Faculty of Medicine, Pharmacy and Odonto-Stomatology, University of Bamako. 34

37 PART II Tunisian scientist Ikram Guizani, also a former TDR grantee, was awarded a prize for Best Female Scientific Researcher by the President of the Republic of Tunisia in recognition of her contributions to leishmaniasis control. As head of the Laboratory of Epidemiology and Ecology of Parasitic Disease at the Pasteur Institute of Tunisia, Guizani has made significant contributions to the understanding of the pathogenesis and population genetics of leishmaniasis at the molecular level. Taking a gene-to-patient approach, her research has resulted in several milestones: the development of a bioinformatic tool kit for in silico characterization of potential targets; validation of an antigenic leishmania target, LeIF protein; and development of a prototype diagnosis kit based on DNA chips using targets identified by comparative genomics. Over her 20-year career, Guizani has received several TDR grants, served on TDR s Research Strengthening Committee and published more than 30 peer-reviewed articles. She is a founding member of the Tunisian Women and Science Association and a founder and African coordinator of the TDR-sponsored South South Initiative for Tropical Disease Research. Lizette Koekemoer, currently Head of the Vector Control Reference Unit at the National Institute for Communicable Diseases of the National Health Laboratory Service in Johannesburg, was awarded the Southern African Association for the Advancement of Science (S2A3) British Association Medal (Silver) for 2009, one of the highest awards for original scientific research in South Africa. Koekemoer was recognized for her high-quality science, with a sound background and straightforward analytical methodology. Over the course of her career Koekemoer was involved in the discovery of two species of Anopheles mosquito and introduced new technology to vector research, including a multiplex PCR assay to identify five members of the An. funestus group of mosquitoes in Africa. The assay is now the standard method for identification of this group of mosquitoes worldwide. Another major research focus for Koekemoer has been the molecular basis of insecticide resistance in mosquitoes, which she and her colleagues have shown has a metabolic mechanism. She has published 40 peer-reviewed articles, almost all in international journals. On several occasions she has served as temporary adviser to WHO/TDR in the area of research capability strengthening, and is currently a member of the TDR Research Strengthening Group (RSG) committee. Achievement details The Multilateral Initiative on Malaria in Africa (MIM) This initiative was created to strengthen the capacity of malaria-endemic countries in Africa to carry out research to improve malaria control. Together with a number of other bodies led by a secretariat hosted by The African Malaria Network Trust (AMANET) TDR co-sponsored the 5th Multilateral Initiative on Malaria (MIM) Pan-African Malaria Conference, held in Nairobi, Kenya between 2 6 November. TDR had a significant role in organizing the event. Over 2000 people registered for the conference, making it one of the largest malaria meetings in the world. Various disciplines were represented by researchers, control experts, science administrators, healthcare workers, members of the media and representatives of private foundations, governments and international organizations from across the world. Key themes addressed at the conference included: the need to combat resistance to antimalarial drugs; mosquito resistance to insecticides; genetic modification for vector control; and strengthening African research. One of the challenges that TDR will try to address, building on its experience of community-based care, is improving access to artemisinin combination therapies to treat malaria. Discussions led by the malera initiative to address research issues identified with malaria elimination were of strategic interest. Bridging the technical research agenda to broader political and strategic control objectives is likely to grow in importance over the coming years. The MIM meeting was supported by the TropIKA.net team, which provided online background and updates about discussions, allowing participation in debates by scientists unable to attend in person. Research grants TDR continues to fund research strengthening grants and re-entry grants for a range of infectious diseases of poverty. Most of TDR s resources go to the two poorest regions of the world Africa and South- East Asia, although we fund activities throughout the world. Total ongoing activities included 33 collaborative research grants on malaria in Africa, 36 re-entry grants and 5 institutional strengthening TDR annual report

38 Empowerment fostering ownership and research leadership grants globally. Small grants have been funded through almost all of the WHO regional offices and more than 25 networks are engaged by and supported by TDR, mostly operated by health researchers in low- and middleincome countries. TDR has also helped train hundreds of scientists through a number of capacity strengthening professional development short courses (see Fig. 1). We have increased the number of short training courses and are increasing the number of candidates receiving Leadership Training Grants (LTGs) and Leadership Development Fellowships (LDFs). LTGs adopt an innovative approach to providing training grants at the PhD level. While focused mainly on the training and development of the individual grantee, they also help support the grantee s home institution to improve research practices, which has an impact regionwide. LDFs are three-year postdoctoral fellowships for experienced DECs researchers to become health research leaders by pursuing their professional development in a multidisciplinary and partnership manner. In addition, Figure 1. Relative numbers of investigators and staff undergoing capacity strengthening supported by TDR from different WHO regions Figure 2. Relative numbers of ongoing MSc/PhD grants going to different WHO regions Participating WHO regions AFR: AMR: EMR: SEAR: WPR: Africa Americas Eastern Mediterranean South-East Asia Western Pacific PhD and Masters students were funded in 24 countries (mainly in Africa see Fig. 2), a third of which were female researchers. Over the next four years 30 scientists will receive Career Development Fellowships in the area of clinical research (amounting to a total of around US$ 3 million) in partnership with the pharmaceutical industry and the Bill & Melinda Gates Foundation. Berlin stakeholders meeting - strengthening research partnerships for neglected diseases of poverty An Action Framework for Research Partnerships on Neglected Diseases of Poverty was formulated in Berlin in March following a meeting of stakeholders (including representatives from ministries of health, ministries of science and technology, development agencies, research funding agencies and leaders from technical research institutions).this was a follow-up to recommendations coming out of the Bamako Global Ministerial Forum on Research for Health in November 2008 which called for, among other things, the development of more equitable partnerships. The participants discussed south south and south-north partnerships and developed the framework, which includes recommendations for: Governments to adopt national policies for health and encourage collaboration across government to support research for health. National research institutions to develop research partnerships consistent with the national public health priorities established by governments and support the development of local scientific leadership and up-todate research and development skills; to establish, at the start of projects, equitable agreements between partners to cover issues of ownership, management and dissemination of data, research tools and publications, and where appropriate intellectual property and benefit sharing. Health research funders/donors to align their support with national and research agendas and provide adequate core support to cover the true cost of research in low-income settings. Private sector and civil society to be open to working with governments and research institutions and, for civil society, to follow up on a call for civil society engagement in research that was provided as input to the Bamako forum on research for health. 36

39 PART II Some 120 participants from Africa, the Middle East, Asia, Latin America, North America and Europe came together for the meeting, convened by TDR and the German Federal Ministry for Economic Cooperation and Development. The framework should lead to more equitable partnerships where the agenda is driven increasingly by institutions in developing countries. Ongoing activities ANDI and regional networks for innovation The concept of regional innovation networks was created to promote new thinking on innovation and access to medicines. The African Network for Drugs and Diagnostics Innovation (ANDI) is one such initiative that TDR is fostering towards this goal. Recently boosted with a grant of 5 million euros from the European Union, ANDI is being set up to partner, fund and coordinate research through collaborative project networks and partnerships, and is seeking to establish support platforms to help manage pharmaceutical research throughout Africa. ANDI held its second stakeholder meeting in A sustainable fund is being sought that can yield around US$ 30 million a year. This will fund a portfolio of innovative products within Africa and provide knowledge management and database/ technical support for the projects. ANDI will operate under an African-led governance and management structure through a central office with subregional hubs. Further information can be obtained from: partnerships/initiatives/andi The concept behind the initiative has proved so popular that it has already spurred on the development of other regional networks. A Chinese network held its first meeting in 2009 and is under further development to link into a broader Asian network. It is anticipated that, once established, these networks will more broadly support south south collaboration for innovation. Other networks working together to enhance health research and its impact TDR currently hosts the secretariat for ISHReCA (the Initiative to Strengthen Health Research Capacity in Africa). Created in response to needs expressed by African researchers, ISHReCA is working to secure donor support to run medium-term programmes that will attract young minds to health research and raise the profile of health researchers on the continent ( ISHReCA is set up to provide the much needed forum to express researchers needs more powerfully vis-à-vis funders and African governments. Efforts are underway to establish the secretariat at a host institution in Africa and develop its future strategy. TDR has also helped develop and host the secretariat for ESSENCE (Enhancing Support for Strengthening the Effectiveness of National Capacity Efforts) a new initiative set up by funding agencies to harmonize the activities of funders and so improve the way that funders work together to increase research capacity in Africa. TDR continues to support other networks by providing advice and guidance. This includes the Partnership for Social Sciences in Infectious Diseases of Poverty (PSSiDP) and the Forum for African Medical Editors (FAME). TDR supported a meeting in Geneva to assist PSSiDP to develop a new five-year business plan, including a revision of its strategic approach and a resource mobilization plan. TDR will continue to part-fund this network over the next two years. TDR also helped initiate the South-South Initiative (SSI) for tropical disease research ( which has successfully promoted research partnerships between scientific groups across Africa, Latin America and Asia. SSI s mission is to foster scientific leadership in disease endemic countries promoting high quality collaborative research and increased competitiveness in the field of diseases of poverty. Training activities TDR continues to develop health research leadership in low- and middle-income countries at all levels. As well as increasing knowledge, skills and competencies through funding PhDs and MScs, TDR is developing short courses in research methodology and project management, and providing guidance on writing research proposals. TDR also funds and facilitates research strengthening, professional development and career development. A new mentorship initiative will provide incentives to support the link between young and established researchers. The creation of four new regional training centres in 2010 in Indonesia, Kazakhstan, Columbia and Rwanda will further allow the transfer of ownership of these courses to disease endemic countries. Several specific training activities have been handed over to institutional or regional training centres to help build self-sustainability. Regional training centres in biosafety for human health and the environment have already been set up in Colombia (for Latin America), India (for Asia) and Mali (for Africa). TDR annual report

40 Stewardship knowledge for decision making and advocacy for research for health TDR s Stewardship function forms the third arm of TDR s new strategy. It focuses on collating knowledge to make informed decisions on research policies and priorities, and on advocacy for research needed to decrease the burden of diseases of poverty. TDR s Stewardship team is specifically dedicated to neglected diseases knowledge management, knowledge sharing and priority setting in the global health arena. However, stewardship activities are carried out across the entire spectrum of TDR s programmes as an element integral to disease-related research, capacity-building and other activities. 38

41 PART II Stewardship highlights A think-tank of 100 international experts has been created to develop and analyse reports from 10 disease-specific and thematic reference groups and so identify the top priorities for research on infectious diseases of poverty. Their findings will help shape a global report on research into infectious diseases of poverty, to come out in The web-based global knowledge platform on tropical disease research, TropIKA.net, has seen a significant increase in use in Four developing countries were among the top ten users of the platform. The first TropIKA.net Career Development Fellowship, which provides post-doctoral scientists with hands-on experience translating research outputs and outcomes to reach a wider audience, has also been awarded. Development of dengue guidelines (in collaboration with WHO s Department of Control of Neglected Tropical Diseases), which will help improve the diagnosis, treatment, prevention and control of dengue. TDR annual report

42 Stewardship knowledge for decision making and advocacy... Infectious diseases of poverty are a formidable stumbling block to human development and realization of the MDGs in most low-income countries. Despite increased funding globally for health and health research, the impact on human health has been less than optimal partly because research efforts have been uncoordinated, fragmented and sometimes not well focused, with inequitable input from the developing world. At TDR we are trying to redress this situation. Through its Stewardship function, TDR will work with experts and a broad array of stakeholders to: Help identify priority research needs and major research gaps Provide a strategic overview of infectious disease research Provide a global knowledge platform on health research Provide a neutral discussion platform for stakeholders Advocate for support of health research and the use of its results tive research initiatives Achievements Creation of a think-tank identifying the top priorities for research on infectious diseases of poverty In 2011 TDR will publish the first in a periodic set of global reports on research into infectious diseases of poverty. This is intended to be a major international reference that will accelerate research efforts to meet the public health challenges of infectious diseases of poverty (see ongoing activities in this section). Primarily aimed at research funders, policymakers and the research community, especially in developing countries, the report will highlight major issues and priorities for action on research for infectious diseases of poverty that could create a real shift in the health research landscape. It will promote effective use of research results for policies and agendas on infectious diseases of poverty in the coming decade and beyond. Through providing a common resource, the report should result in greater health impact from the collective global health research effort, with those countries most afflicted by infectious diseases of poverty playing an integral and pivotal role. Top priorities for research on infectious diseases of poverty to feed into this report are being developed by a major think-tank of 100 international experts. These experts are organized into 10 disease-specific and thematic reference groups (DRGs and TRGs respectively, see Box 2). Each of these reference groups will produce a report that will develop the top priorities to be discussed in the global report. Infectious diseases of poverty remain a formidable stumbling block to human development and the attainment of the healthrelated Millennium Development Goals in most low-income countries TropIKA.net reaching an increased audience with latest news and information on research for health When TropIKA.net was launched in 2007 as a web-based, global knowledge management platform ( the goal was that it would eventually become a one-stop-shop for research on infectious diseases of poverty. Since then, TropIKA.net s reach has increased substantially and the content has been greatly enhanced. The platform is gaining recognition as a place for stakeholders in infectious disease research to improve knowledge of the area and enhance dialogue with others. Knowledge hubs have been implemented 40

43 PART II at five key scientific forums, including the second ANDI stakeholder meeting and the 5th MIM Pan-African Malaria Conference. The first TropIKA.net Career Development Fellowship has also been awarded to a scientist from China the goal of these fellowships being to provide postdoctoral, hands-on experience in translating research output and outcomes so that these can be accessed by a greater audience. Other highlights from TropIKA.net are provided in Box 3. BOX 2 Disease-specific and thematic reference groups Dengue - new guidelines for diagnosis, treatment, prevention and control Dengue is the world s most rapidly spreading vector-borne disease and is of growing concern to those involved in the field of public health. Over the years, the epidemiology of dengue has changed, and the 1997 WHO guidelines on diagnosis, treatment, prevention and control of dengue are out of date. In late 2009, TDR supported WHO s Department of Control of Neglected Tropical Diseases to publish new guidelines for diagnosis, treatment, prevention and control of dengue. 25 These guidelines, which are the culmination of several years collaborative work that started with the report from the Dengue Scientific Working Group in 2006 and subsequent systematic literature reviews, 26 as well as multicentre studies covering all dengue endemic regions, have already been taken up and put into action by dengue-endemic countries such as Argentina, Bolivia, Nicaragua, and Paraguay. Ongoing activities Preparation of a global report on research for infectious diseases of poverty Publication is planned for the second quarter of 2011, with subsequent reports published every 3 4 years. The first stage is the completion of the disease-specific and thematic reference group reports, which will then be synthesized into a global report that will have key chapters on: (i) the environment and health; (ii) health systems and universal coverage; and (iii) innovation and biotechnology. Distribution of host countries & co-chairs of disease specific and thematic reference groups Disease-specific reference groups (DRGs) DRG 1 Malaria DRG 2 Tuberculosis DRG 3 Chagas disease, human African trypanosomiasis and leishmaniasis DRG 4 Helminth diseases (including onchocerciasis, filariasis, schistosomiasis and soil-transmitted helminths) DRG 5 Dengue and other emerging viral diseases of public health importance DRG 6 Other infectious diseases, including zoonoses Thematic reference groups (TRGs) TRG 1 Social science research and gender TRG 2 Innovation and biotechnology platforms for health interventions TRG 3 Implementation research and health systems research TRG 4 Environment, agriculture and human health Examples of critical issues identified by the DRGs: DRG 3 Accurate estimates of the diseases burden, prevalence and incidence, and strategies for sustainable and integrated surveillance systems. DRG 5 Processes of case management at all levels, including training and identification of essential components of a dengue ward and how to respond to a sudden surge in case load. TRG 1 Processes leading to marginalization of people and linkages with infectious diseases of poverty. TRG 4 Trends and forecasts in environmental conditions and agricultural systems, and implications for infectious diseases of poverty. TDR annual report

44 Stewardship knowledge for decision making and advocacy... BOX 3 TropIKA.net highlights During 2009 TropIKA.net has had: a substantial increase in the number of visitors from developing countries. Four developing countries (Brazil, India, Philippines and South Africa) were among the top ten users of the platform. The platform has received over 7500 visits per month from users in 175 countries (September 2009) over 640 new items added to the website, including interviews with leading figures involved in action against infectious diseases. Knowledge hubs have been implemented at five key scientific forums including: ESSENCE (Enhancing Support for Strengthening the Effectiveness of National Capacity Effort) Workshop on Capacity Development in Health Research (United Republic of Tanzania, March 2009) Second meeting of the African Network for Drugs and Diagnostics Innovation (ANDI; South Africa, October 2009) 5th MIM Pan-African Malaria Conference (Kenya, November 2009) Annual meeting of the Global Forum for Health Research (Cuba, November 2009) American Society of Tropical Medicine & Hygiene 58th Annual Meeting (USA, November 2009) Collaborative workspaces have also been used by the following major global health initiatives: ESSENCE ( ANDI ( malera (Malaria Eradication Research Agenda) ( ISHReCA (Initiative to Strengthen Health Research Capacity in Africa) ( Research Partnerships for Neglected Diseases ( TDR s disease and thematic reference groups First Global Symposium on Health Systems Research Awareness is growing among politicians, policy-makers, health service providers and researchers that the evidence base to improve the performance of health systems is not strong enough. Under WHO leadership and with other partners, TDR, through its Stewardship function, is hosting a secretariat responsible for organizing the first Global Symposium on Health Systems Research Science to Accelerate Universal Health Coverage, which will be held in Montreux, Switzerland (16 19 November 2010). The aim of the symposium is to share evidence, identify significant knowledge gaps and set a research agenda to help to accelerate universal health coverage, especially in low- and middle income countries. The four-day event will focus on two main streams. The first stream state of the art research will include themes: political economy of universal health coverage, health system financing, scaling-up of health services, monitoring and evaluation, and knowledge translation. The second stream state of the science will address foundational issues in health systems research (HSR) such as the need for a common terminologies and frameworks; an inventory of methodologies and their strengths; and capacity-building opportunities for HSR. In both of these streams of the Symposium, TDR operations research related to scaling up proven interventions as well its guidelines for operations research will be part of the programme. More generally, expected outputs of the symposium include the publication of background papers on the above-mentioned themes and development of a global agenda for health systems research. More importantly, this initiative is expected to build and strengthen the scientific community of HSR and improve the use of this research for health policy development. Genetically modified mosquitoes building a framework for testing disease control Together with WHO and the USA Foundation for the National Institutes of Health (FNIH), TDR convened a group of scientists and specialists from 13 countries for brainstorming about the current status and future development of genetically-modified mosquitoes (GMM) for malaria and dengue control. The participants recommended developing a framework that would help guide the testing of GMM as a method of controlling disease through reduced transmission. This work will include recommendations for assessing efficacy and safety, and include regulatory, ethical, legal and social issues around the development and release of these mosquitoes helping countries prepare for GMM testing. The first consultative meeting was held earlier this year and a report is now available online

45 PART II References 1 Bandyopadhyay S, Lum LC, Kroeger A. Classifying dengue: a review of the difficulties in using the WHO case classification for dengue haemorrhagic fever. Tropical Medicine & International Health, 2006, 11: Manuscript submitted for publication. 3 4 Dengue - Guidelines for diagnosis, treatment, prevention and control. Geneva, WHO/ TDR, 2009 ( dengue-diagnosis-treatment/pdf/dengue-diagnosis.pdf, accessed 18 May 2010). Diawara L et al. Feasibility of onchocerciasis elimination with ivermectin treatment in endemic foci in Africa: first evidence from studies in Mali and Senegal. PLoS Neglected Tropical Diseases, 2009, 3: e497. doi: /journal.pntd Gomes MF et al. Pre-referral rectal artesunate to prevent death and disability in severe malaria: a placebo-controlled trial. Lancet, 2009, 373: Tun-Lin W et al. Reducing costs and operational constraints of dengue vector control by targeting productive breeding places: a multi-country non-inferiority cluster randomized trail. Tropical Medicine & International Health, 2009, 14: Esu E et al. Effectiveness of peridomestic spraying with insecticide on dengue transmission; systematic review. Tropical Medicine & International Health, 2010, 15: Horstick O et al; Dengue vector-control services: How do they work? A systematic literature review and country case studies. Transactions of the Royal Society of Tropical Medicine, 2010, 104: Tiono AB et al. Implementation of home based management of malaria in children reduces the work load for peripheral health facilities in a rural district of Burkina Faso. Malaria Journal, 2008, 7: Pagnoni F. Home management of malaria. the Lancet, 2009, 374: Ranson H et al. Insecticide resistance in Anopheles gambiae: data from the first year of a multi-country study. Malaria Journal, 2009, 8: Mumford J et al. MosqGuide: A project to develop best practice guidance for the deployment of innovative genetic vector control strategies for malaria and dengue. Asia Pacific Journal of Molecular Biology and Biotechnology, 2009, 17: Joshi AB et al. Chemical and environmental vector control as a contribution to the elimination of visceral leishmaniasis on the Indian subcontinent: cluster randomized controlled trials in Bangladesh, India and Nepal. BMC Medicine, 2009, 7: Siddhivinayak Hirve, SP et al. Effectiveness and feasibility of active and passive case detection in the Visceral Leishmaniasis elimination initiative in India, Bangladesh and Nepal. The American Journal of Tropical Medicine and Hygiene, 2009 (in press). 15 Moran M et al. Neglected disease research and development: New times, new trends, USA, The George Institute for International Health, Moran M et al. Neglected disease research and development: how much are we really spending? USA, The George Institute for International Health, TDR annual report Malaria Rapid Diagnostic Test Performance - results of WHO product testing of malaria RDTs: Round 1, Geneva, WHO/TDR, 2008 ( tdr-research-publications/rdt-performance/pdf/full-report-malaria-rdts.pdf, accessed 18 May 2010). 18 Diagnostics evaluation series no.1 - Laboratory-based evaluation of rapid syphilis diagnostics. Geneva, WHO/TDR, 2003 ( tdr-research-publications/sdi, accessed 18 May 2010). 19 The use of visceral leishmaniasis rapid diagnostic tests, Geneva, WHO/TDR, 2008 ( RDTs.pdf, accessed 18 May 2010). 20 Diagnostics evaluation series no. 2 - Laboratory-based evaluation of 19 commercially available rapid diagnostic tests for tuberculosis, Geneva, WHO/TDR, 2008 ( May 2010). 21 Diagnostics evaluation series no. 3 - Evaluation of commercially available anti-dengue virus immunoglobulin M tests, Geneva, WHO/TDR, 2009 ( publications/tdr-research-publications/diagnostics-evaluation-3, 18 May 2010). 22 Cuevas et al. Publication in preparation. 23 Report of the ninth meeting of the strategic and technical advisory group for tuberculosis, Geneva, WHO, 2009, ( report_2009.pdf, accessed 18 May 2010). 24 Stakeholders meeting: on strengthening research partnerships for neglected diseases of poverty. Geneva, WHO/TDR, 2009 ( stewardship/pdf/berlin_mtg_report_final.pdf, accessed 18 May 2009). 25 Dengue - guidelines for diagnosis, treatment, prevention and control. Geneva, WHO/TDR, 2009 ( accessed 18 May 2010). 26 Santamaria R et al. Comparison and critical appraisal of dengue clinical guidelines and their use in Asia and Latin America. International Health, 2009, 1: Progress and prospects for the use of genetically modified mosquitoes to inhibit disease transmission. Geneva, WHO/TDR, 2010 ( training-guideline-publications/gmm-report/pdf/gmm-report.pdf, accessed 12 May 2010) 43

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47 PART III TDR annual report

48 TDR is a partnership programme, bringing people and groups together to identify research gaps, advocate for 46 TDR s unique position derives...from the breadth of the consensus through which it operates in partnership with hundreds of scientists, institutions and networks all over the world, and by the manner in which it is governed.

49 PART III Key publications and resources TDR-funded research led to 169 articles being published in peerreviewed scientific journals during The percentage of first authors from disease endemic countries was 71.5%. We also published 11 TDR scientific publications (see below), which are available free of charge in print or via the TDR website (www. who.int/tdr). Over the year we have also published three issues of TDRnews, which provides deep, journalistic coverage of key research projects, as well as news of TDR-funded researchers, meetings and initiatives. These are all available in the publications and resources section of the TDR website. Our redesigned website has experienced steady growth of about 5% a year, with over content pages accessed by over 1 million visits from government, academia and the health care sector. Key features include news about TDR-funded work and researchers, and a vast publications and resources section with free downloads of all research and guideline publications, accessible at or in print. During 2009 alone our handbook on good laboratory practice, for example, had nearly downloads. Published in 2009 A human rights-based approach to neglected tropical diseases A WHO information sheet, developed jointly with TDR and WHO s Department of Health, Ethics and Trade, that aims to improve understanding about neglected tropical diseases. This document is also available in French and Spanish. Dengue Guidelines for diagnosis, treatment, prevention and control A new edition of guidelines that provide updated practical information on diagnosis, treatment, prevention and control of dengue. Evaluation of commercially available anti-dengue virus immunoglobulin M tests. Diagnostics evaluation series No. 3 A report describing the results of a WHO/TDR/PDVI (Pediatric Dengue Vaccine Initiative) evaluation of nine commercially available anti-dengue virus IgM tests. TDR annual report

50 Key publications and resources Good clinical laboratory practice (GCLP) A guide on how to carry out good clinical laboratory practice. Web only. Good laboratory practice training manual: Trainer (2nd edition) A manual on good laboratory practice (GLP) aimed at trainers of GLP. Good laboratory practice training manual: Trainee (2nd edition) A manual on good laboratory practice (GLP) aimed at trainees of GLP. Handbook: Good laboratory practice (2nd edition) A handbook that provides laboratories and trainers in disease endemic countries with technical information needed to implement GLP programmes. Malaria rapid diagnostic test performance results of WHO product testing of malaria RDTs: Round 1 (2008) A report outlining the results of a WHO/TDR/FIND (Foundation for Innovative New Diagnostics) sponsored evaluation of laboratory-based rapid diagnostic tests (RDTs) for malaria. Operational research in support of antiretroviral therapy scale-up A meeting report summarizing the findings from country operational research projects following a lessons learnt workshop and product development team meeting in Pathways to better diagnostics for tuberculosis A blueprint for the development of tuberculosis diagnostics, developed by the New Diagnostics Working Group of the Stop TB Partnership, which intends to help tuberculosis diagnostics researchers work more effectively with academics, officials and industry professionals. Strategic and business plan for the African Network for Drugs and Diagnostics Innovation (ANDI) A publication (developed in collaboration with several stakeholders, notably African research institutions, the African Development Bank and the European Union) outlining how ANDI will lead to the creation of a sustainable platform for R&D innovation in Africa. 48