Recognizing the value of ongoing operational research to support The World Health Organization’s Global Programme to Eliminate Lymphatic Filariasis (GPELF), the Bill and Melinda Gates Foundation in November 2006 agreed to fund a proposal from the Global Alliance (GAELF) addressing these needs. The proposal, entitled “Resolving the critical challenges now facing the GPELF,” focuses on specific targets identified as essential to the Programme by the GPELF and agreed to by the Foundation. The total award, $11.7 million over 4 years, will be managed on behalf of the GAELF by the LF Support Center at the Task Force for Global Health in Atlanta.

Goals and Objectives

The goal of the grant is to ensure the ultimate success of the GPELF by finding solutions to the challenges and potential barriers facing it today. These challenges – identified and articulated by scientists, public health leaders and program managers through a series of international meetings and publications – have translated as the specific goals of the project; namely,

1. To facilitate programmatic decision-making by identifying epidemiological and operational criteria that distinguish programs able to succeed in LF elimination using Mass Drug Administration (MDA) alone from those requiring MDAs + other supplemental measures;
2. To identify supplemental interventions that would be most effective and cost-effective in facilitating interruption of LF transmission where current MDA strategies might not be sufficient or rapid enough;
3. To develop innovative financing strategies for countries particularly in Africa) to build financially sustainable programs to achieve LF elimination.

To achieve these 3 goals, the grant targets 8 specific Objectives (4 relating to the 1st goal, 2 relating to the 2nd goal, and 2 relating to the 3rd goal).

Since the 1st goal requires precise technical definitions and means to assess program success, the objectives of this goal focus principally on tools – standardizing those now available, comparing their effectiveness in demonstrating the absence of LF transmission, and selecting the most effective approaches for defining program end-points, conducting surveillance and assessing the impact of population compliance. Click here for more information about our work with Northrop Grumman toward achieving this goal.

The 2nd goal addresses the challenge of identifying effective and cost-effective supplementary measures (specifically, vector control or modified drug treatment regimens) for programs requiring more than the current MDA approaches. Since vector control strategies for malaria (targeting Anopheles) and for source reduction of Culex are already well established, studies will define just how effective these are against LF and in what situations they could be utilized cost-effectively; results could have a major impact on how LF programs are implemented, especially where LF and malaria co-exist. Because ivermectin and albendazole are used for the 2-drug MDA regimens at dosages below those optimal for each drug used alone, regimens employing twice the current dosages of these drugs and/or double the frequency of administration (i.e., twice-yearly) will be evaluated in clinical trials for possible use where interventions beyond once-yearly MDA may be required to interrupt transmission.

The 3rd goal recognizes the significant financial challenges faced by the GPELF and seeks to develop innovative strategies to achieve long-term, sustainable funding. Its first objective is to create a ‘financial situation analysis’ that includes a thorough review of the current national allocations for LF (and other NTDs [Neglected Tropical Diseases]) in selected countries and identification of factors important for gaining decision-makers’ support for LF programs. The second objective builds on this information and utilizes the World Bank to establish linkages among national LF programs, ministries of health and finance, and international development organizations and agencies both to promote recognition by these organizations of the value that programs targeting LF and other NTDs have for development and to increase access of LF programs to available international funding.

Organization and Management

To carry out the specific research required to meet the grant’s 8 objectives will require the collaboration of at least 25 different investigators in more than 20 different countries. The idea is to define the specific research elements of each objective, identify the best places and investigators to address the questions efficiently and economically, and then to solicit the cooperation of these groups to participate in multi-center studies.

A Technical Group has been established to oversee and advise on each of these 8 Objectives of the grant. Members of the Group are individuals selected not only because of their LF and technical expertise but also because of their independence from receiving any research funds from the grant itself. Though each member of the Technical Group will generally coordinate activities for one Objective, they will all share in advising on all aspects of the grant activities. The members of the Technical Group and their principal responsibilities are:

Objective 1	Assessment Tools: Refinement & Operationalization	Mark Bradley
Objective 2	Epidemiological Determinants of Outcome	Rafe Henderson & Gautam Biswas
Objective 3	Post-MDA Surveillance Strategies	Gautam Biswas & Rafe Henderson
Objective 4	Impact of MDA on Morbidity	C.P. Ramachandran
Objective 5	Supplementary Vector Control	Graham White
Objective 6	Alternative Chemotherapy Schedules	John Horton
Objective 7	Financial 'Situation Analysis'	Bernhard Liese
Objective 8	Bridging Gaps between Needs and Funds	Bernhard Liese

Representatives from WHO-TDR (Research and Training in Tropical Diseases) also work with the Technical Group members to provide expertise on several of the grant's objectives.

The Secretariat located at the Task Force for Global Health in Atlanta supports this Technical Group and is ultimately responsible to the GAELF’s Executive Group for all of the grant’s activities and initiatives.

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