The Coalition for Operational Research on Neglected Tropical Diseases

Since 1987, The Task Force for Global Health and its partners have been on the frontlines of the global Neglected Tropical Disease (NTD) control and elimination effort. The Task Force manages large-scale donations of medicines from Pfizer and Merck that are used to eliminate three NTDs – trachoma, lymphatic filariasis (LF) and river blindness. In support of NTD programs, The Task Force drives a robust operational research portfolio to answer critical scientific questions about how to overcome barriers to NTD control and elimination.

In recent years, increased attention has been focused on NTDs that can be addressed by preventive chemotherapy. In 2013, The Task Force for Global Health was asked to help bridge the gap among NTD scientists, donors, and implementing partners by serving as the secretariat or hub for the Coalition for Operational Research on Neglected Tropical Diseases (COR-NTD). The coalition provides a valuable mechanism for collaboration and the sharing of resources and expertise, and has become a leading scientific body focused on NTD control, elimination, and eradication.

 

The Challenge

With the 2012 London Declaration, the global health community pledged to control, eliminate, or eradicate 10 NTDs by 2020. This ambitious initiative required NTD programs to rethink their approaches to overcoming the operational barriers to reaching NTD control, elimination, and eradication goals. The “last mile” of NTD programs can often be the most challenging. Many of the unanswered operational research questions involved the “last mile” and created urgency for greater collaboration among researchers, funders, and program implementers. The operational research questions varied in scope from how to establish baselines for NTD prevalence to determining when to stop mass drug administration. Gaps also existed in the availability of diagnostic tools to support these activities. A new flexible mechanism was needed to support the research agenda of NTD programs. This research also needed to be endorsed by the World Health Organization (WHO), which sets guidelines for mass treatment programs.

 

The “last mile” of disease elimination programs can often be the most challenging and requires greater collaboration among researchers, funders, and program implementers.

 

In Laos PDR, an operational research project supported by COR-NTD is looking at new diagnostic tools for determining the prevalence of schistosomiasis, an NTD caused by parasites that live in snails along the Mekong River.

The Opportunity

In 2013, the Bill & Melinda Gates Foundation funded the creation of the NTD Support Center (NTD-SC) at The Task Force to address operational research needs related to the control and elimination of five NTDs – lymphatic filariasis (LF), onchocerciasis (river blindness), schistosomiasis, soil-transmitted helminthiasis, and trachoma. The center evolved from the earlier LF Support Center that began in 2001 and had also been funded by the Gates Foundation. The Task Force’s deep scientific expertise in NTDs was a key factor in the creation of NTD-SC. One of NTD-SC’s core objectives was to align its research agenda more closely with program needs. It became quickly apparent that the best way to do that was to create a space where NTD stakeholders could identify operational needs and undertake research together in support of programmatic goals. NTD-SC helped lay the foundation for COR-NTD through its own collaborative approach to conducting operational research. This expertise also helped ensure the coalition’s successful launch. At first, COR-NTD included only Gates grantees working on NTDs. However, as the value of the coalition was realized, the community was opened to the entire NTD community.

 

The Strategy

COR-NTD uses a number of means to foster collaboration in support of NTD control and elimination goals. Each year, COR-NTD holds a two-day meeting in conjunction with the American Society of Tropical Medicine & Hygiene where research findings are shared. The meeting also provides an opportunity for the community to identify knowledge gaps and set the research agenda for the coming year. Since the meeting began in 2013, attendance has increased every year. In 2017, COR-NTD hosted more than 450 stakeholders, including 30 new partners, and had a long waiting list of others who applied to attend. In addition to the annual meeting, COR-NTD helps facilitate communication among partners through an online dashboard of the operational research being conducted around the world on NTDs. This system, which currently tracks 209 studies in 61 countries, helps the community monitor progress and identifies opportunities for strengthening NTD research.

President Jimmy Carter at Coalition for Operational Research on NTDs (COR-NTD). Photo by Michael A. Schwarz

A major area of focus is on the development of new tools for improving decision-making. In Ethiopia and Tanzania, COR-NTD members recently created and tested a new confirmatory mapping tool for assessing levels of LF infection in low-prevalence settings. In a study in 55 districts, the new tool determined that 52 districts did not require continued treatment, saving both countries an estimated $9.2 million in treatment costs. With NTDs being highly endemic in many African countries, COR-NTD recently partnered with the African Research Network for Neglected Tropical Diseases to strengthen the capacity of local scientists to conduct operational research. Supported by USAID, the program provides funds to African researchers whose work is related to the control and elimination of NTDs. Nearly 100 researchers applied for grants in the program’s first year.

 

“Providing WHO with the evidence base it needs to facilitate NTD guidelines is an important outcome of COR-NTD’s work.”

– Eric Ottesen, MD, NTD-SC Director, The Task Force for Global Health

 

The Impact

Until COR-NTD was launched, there was no mechanism for NTD scientists, funders, program implementers, and policy makers to share knowledge and guide research based on what they were learning on the ground. COR-NTD helped strengthen programmatic impact by accelerating collective actions to answer critical operational research questions. In just four years, COR-NTD has grown into the largest scientific body conducting operational research focused on NTD control, elimination, and eradication. The coalition continues to build and nurture partnerships. In addition, USAID and the first non-U.S. donor, the United Kingdom’s Department for International Development, recently provided significant new support to the work of the coalition. COR-NTD began with an emphasis on a limited set of NTDs. In the coming years, it hopes to diversify its NTD portfolio and enable operational research that addresses the public health issues that are a cause and consequence of these diseases. As the community continues to grow, it is anticipated that the coalition’s impact will continue to increase.

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