Public notice and comments on the Guideline Development Group for WHO human African trypanosomiasis therapeutic guideline

Deadline: 22 December 2023

6 December 2023
Call for consultation

Human African trypanosomiasis (HAT), or sleeping sickness, is a parasitic infection that almost invariably progresses to death unless treated. It caused devastating epidemics during the 20th century, but thanks to sustained and coordinated efforts over the past 20 years, the number of reported cases has fallen to historically low levels. HAT is a neglected tropical disease that occurs in sub-Saharan Africa, within the distributional limits of its vector, the tsetse fly.

The choice of treatment depends on the trypanosome sub-species (gambiense or rhodesiense) and the disease stage. Drugs for the treatment of first-stage disease will generally not cure second-stage disease. Conversely, the use of second-stage drugs is not justified in first-stage disease because they tend to be more toxic and complex to administer. This has changed to some extent after the introduction of fexinidazole in gambiense HAT.

WHO is convening a Guideline Development Group to develop the update of the WHO interim guidelines for the treatment of gambiense human African trypanosomiasis, released in 2019 with the addition of fexinidazole for rhodesiense HAT, and a specific framework for pentamidine also in rhodesiense HAT.

To form the Guideline Development Group, 14 experts were identified, with recognized work in the field of treatment of HAT and other pathologies, but also in public health related issues, from different institutions. This group includes experts from endemic countries working in the national control programmes and with experience in case management, as well as clinicians from non-endemic countries who manage exported cases.

The names and brief biographies of individuals being considered for participation in the Guideline Development Group are hereby provided for public notice and comment.

Comments and perceptions brought to the attention of WHO through this process are an integral component of WHO’s Conflicts of Interest assessment policy, so as to strengthen public trust and transparency in connection with WHO meetings involving the provision of technical/normative advice. Comments and perceptions will be carefully reviewed and treated confidentially. The comments will not be published and will be kept on record.

WHO reserves the right to discuss information received through this process with the relevant expert with no attribution to the provider of such information. Upon review and assessment of the information received through this process, WHO, in its sole discretion, may take appropriate management action in accordance with its policies.

The participation of an expert in a WHO meeting does not imply that the individual is endorsed or recommended by the Organization, nor does it create a binding relationship between the expert and WHO.

Comments should be provided by email, and the receipt of these will be acknowledged through generic email notification to the sender.

Please send your comment to neglected.diseases@who.int with the subject, “Comments on the Guideline Development Group – HAT therapeutic guideline”, indicating the name, nature and contact details of the sender.

The deadline for public comments is 22 December 2023.

 

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    Guideline Development Group members biographies

    M. Barrett, M

    Country of primary residence: United Kingdom of Great Britain and Northern Ireland

    Biography

    Professor Mike Barrett is Professor of Biochemical Parasitology at the University of Glasgow in Scotland. He has worked in the field of understanding drug modes of action and resistance mechanisms for 35 years, with a particular interest in HAT. His PhD work focused on dissecting biochemical targets for drugs; since then, he has carried out further research into understanding how drugs used against trypanosomes exert their mode of action and how drug resistance emerges. Eflornithine, for example, was shown to inhibit ornithine decarboxylase and no other target, while resistance to this drug was shown to relate to loss of a transporter that carries it into trypanosomes. Most recently he has shown that the oxaborole class, including acoziborole, inhibits the protein TbCPSF3.

    He developed a field-useable microscopy-based test for resistance to melarsoprol in the early 2000s and was involved in the development of furamidine, a compound that ultimately failed in phase II/III clinical trials. He is currently part of the DNDi Scientific Advisory Committee and has followed the development of fexinidazole and acoziborole in recent years particularly closely. Professor Barrett has worked with WHO for more than 20 years and is part of the Expert Committee on HAT.

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    L. Blumberg, F

    Country of primary residence: South Africa

    Biography

    Professor Lucille Blumberg is a medical graduate of the University of the Witwatersrand in South Africa, an Associate Professor in the Department of Medical Microbiology at the University of Stellenbosch, and a lecturer in the Faculty of Veterinary Medicine at the University of Pretoria. She has specialist qualifications in clinical microbiology, travel medicine and infectious diseases. Until 2021, she was the Deputy Director at the National Institute for Communicable Diseases of the National Health Laboratory Service and the founding head of the Division of Public Health Surveillance and Response. She is currently medical consultant to the Division for Outbreak Preparedness and Response (which includes the travel medicine unit) and also medical consultant to the Centre for Emerging, Zoonotic and Parasitic Diseases where her major focus is on malaria, rabies, viral haemorrhagic fevers, pandemics, epidemics, One Health and zoonotic diseases, and travel-related infections.

    She is currently a consultant at Right to Care where she focuses on creating a One Health programme especially for rabies and on responding to health emergencies in South Africa and the region. She has worked on a number of outbreaks including rabies, avian influenza, cholera, typhoid and the Lujo virus. She is Chair of the WHO-IH STAG (Strategic & Technical Advisory Group on Infectious Hazards with Pandemic and Epidemic Potential), a member of the Strategic and Technical Advisory Group for Neglected Tropical Diseases and of the Task Force for the WHO R&D Blueprint for Crimean-Congo haemorrhagic fever. Professor Blumberg has been the Editor-in-Chief of the International Journal of Infectious Diseases’ One Health journal since 2023.

    Show less L. Blumberg, F

    S. Bukachi, F

    Country of primary residence: Kenya

    Biography

    Professor Salome Bukachi is an Associate Professor at the University of Nairobi’s Institute of Anthropology, Gender and African Studies. Previously she worked for 6 years at the former Kenya Trypanosomiasis Research Institute as a research officer in the socioeconomics department. She holds a PhD in anthropology, specializing in medical anthropology. The author of more than 45 publications and supervisor of over 50 graduate students, she has carried out extensive research on the social and behavioural aspects of African trypanosomiasis besides research in other infectious diseases. Her research has focused on community participation, gender, health systems, and the socioeconomic and cultural/behavioural aspects of mainly zoonotic infectious diseases.

    She also undertakes research on water security, agriculture and general development issues. She works with various local and international stakeholders in research and development on anthropological issues. Her main disease focus has been on infectious zoonotic diseases (African trypanosomiasis, Rift Valley fever and brucellosis, among others). She is a member of several regional and global initiatives including the Africa One Health Network, the One Health High-Level Expert Panel and the LANCET–PPATS Commission on Prevention of Viral Spillover. Professor Bukachi has mentored many African anthropologists and continues to contribute to the emerging field of anthropology of infectious diseases and nutritional anthropology.

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    R. Chancey, F

    Country of primary residence: United States of America

    Biography

    Dr Rebecca Chancey is a paediatrician, epidemiologist and subject matter expert in the Parasitic Diseases Branch at the United States Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia. She received her medical degree from Washington University School of Medicine in St Louis and completed her paediatrics residency at Duke University. She obtained a diploma in tropical medicine and hygiene from the Gorgas Memorial Institute of Tropical Medicine in Lima, Peru, and has worked in multiple African countries.

    She currently conducts domestic and international epidemiology research at CDC where she is chief of the Parasitic Diseases Drug Service. She coordinates with drug companies, the United States Food and Drug Administration and WHO to ensure treatment guidelines are up to date and drug supply is available for HAT. Dr Chancey consults with physicians from around the United States who seek diagnostic assistance and treatment recommendations for a variety of parasitic diseases, including HAT.

    Show less R. Chancey, F

    A. Edielu, M

    Country of primary residence: Uganda

    Biography

    Dr Andrew Edielu is a medical doctor and tropical disease researcher with special interest in neglected tropical diseases. He is a scientist at the MRC/UVRI & LSHTM Uganda Research Unit, and a study coordinator at Makerere University–Johns Hopkins Research Collaboration.

    He was a member of the HAT Platform and a clinician at Lwala Hospital, a general hospital that serves as a treatment centre and sentinel surveillance site for Trypanosoma brucei rhodesiense. Dr Edielu was the local investigator for IMPAMEL III, a clinical trial that led to shortening of the treatment schedule for T.b. rhodesiense, and chaired the Data Safety Monitoring Board for the clinical trial of fexinidazole for treatment of T.b. rhodesiense.

    Show less A. Edielu, M

    V. Lejon, F

    Country of primary residence: France

    Biography

    Since 2013, Dr Veerle Lejon has been research director at the Intertryp Joint Research Unit of the French National Research Institute for Sustainable Development in Montpellier, France. She obtained her PhD in 2002 at the University of Antwerp (Belgium) and a “Habilitation à Diriger des Recherches at the University of Montpellier in France, where she now lives. Her research mainly focuses on HAT. Veerle Lejon started her research career in 1994 at the Institute of Tropical Medicine in Antwerp, Belgium (ITM) investigating diagnostic markers for the neurological disease stage in HAT.

    In 2005, she did postdoctoral studies at McGill University in Montreal. Until 2013, she continued to work at the ITM on staging of HAT, shortened post-treatment follow-up, diagnostic accuracy of parasitological tests, and development and evaluation of antibody detection tests. At the IRD, Dr Lejon continues to work on development and evaluation of diagnostic tests, including organization of diagnostic trials. She coordinated a Horizon 2020 EDCTP2 project (DiTECT-HAT) and participates in several EU Horizon projects (HAT-r-ACC, STROGHAT, COMBAT) on diagnosis, control and treatment of animal and human African trypanosomiasis.

    Dr Lejon works in close collaboration with partners from HAT-endemic countries, and is also involved in training both at academic and health facility levels.

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    A. Lindner, M

    Country of primary residence: Germany

    Biography

    Dr Andreas Lindner is a senior physician at the Institute of International Health at the Charité University in Berlin, Germany, where he has worked since 2017. He is head of the Tropical and Travel Medicine Outpatient Clinic and head of the research group on neglected diseases and vulnerable populations. He is a specialist in infectious diseases and tropical medicine. He holds a Masters in Tropical Medicine and International Health and a Diploma from the London School of Hygiene & Tropical Medicine. He lives in Berlin, Germany.

    He has worked for Médecins Sans Frontières on HAT projects in the Central African Republic, Chad, the Congo and South Sudan. Since 2018, Dr Lindner has participated regularly in WHO expert panels on HAT, and was part of the WHO Guideline Development Group for the treatment of HAT in 2019; he was also part of the European Medicines Agency expert meeting on fexinidazole in 2018.

    Show less A. Lindner, M

    L. Matemba, M

    Country of primary residence: United Republic of Tanzania

    Biography

    Dr Lucas Matemba is a medical doctor and epidemiologist who is currently a principal research scientist at the National Institute for Medical Research, United Republic of Tanzania. He received his medical degree from Volgograd State Medical Academy of the Russian Federation, a Master’s degree in public health from the Muhimbili University of Health and Allied Sciences, United Republic of Tanzania, a PhD in epidemiology from the University of Edinburgh, United Kingdom, and a postdoctoral fellowship in epidemiology and One Health from the Sokoine University of Agriculture, United Republic of Tanzania.

    His research experience includes designing and managing several field-oriented research projects. A large part of his research is directed towards the control of neglected zoonoses with particular focus on rhodesiense HAT (rHAT). His work has significantly contributed to designing strategies for rHAT elimination. Dr Matemba now works very closely with the National Neglected Tropical Disease Control Program and most of his recent work has been engaged in operational research and policy focusing on other neglected zoonoses.

    Show less L. Matemba, M

    V. Mwanakasale, M

    Country of primary residence: Zambia

    Biography

    Professor Victor Mwanakasale has worked for the Copperbelt University Michael Chilufya Sata School of Medicine in Ndola city, Zambia, since 2012. He holds BSc, MBChB, MSc, Dip and PhD degrees. A medical doctor and a medical parasitologist, he teaches medical parasitology and laboratory diagnostics to medical students at the Copperbelt University. He has been involved in research and clinical care of HAT cases in Zambia.

    He is the national coordinator for the Trypanosomiasis control program of the Ministry of Health of Zambia. Professor Mwanakasale is also the Chairperson of the Copperbelt University Biomedical Research Ethics Committee.

    Show less V. Mwanakasale, M

    C. Pasi, M

    Country of primary residence: Zimbabwe

    Biography

    Dr Christopher Pamhidza Pasi has been directly responsible for the clinical management of nearly all rhodesiense HAT patients in Zimbabwe for the past two decades. His has held internal medicine positions from the district to central levels for the past 40 years. He is currently Chief Executive Officer at the Harare Central Hospital after being its Director of Clinical Services. His main research interests are tropical infectious diseases and respiratory medicine. He has been the Secretary-General and President of the National Physicians Association of Zimbabwe, a member of the Medical and Dental Practitioners Council of Zimbabwe of the European Respiratory Society, the chairman of Zimbabwe’s National Malaria Case Management subcommittee and a board member of the National Pharmaceutical Company Pvt Ltd Zimbabwe.

    He has chaired the Pharmacovigilance and Clinical Trials committee and is a member of the Registration committee of the Medicines Control Authority of Zimbabwe. He is an honorary lecturer at the Faculty of Medicine of the University of Zimbabwe and a Training Supervisor at the East Central and Southern African College of Physicians. Dr Pasi authored the Guidelines for Management of Malaria in Zimbabwe (2015).

    Show less C. Pasi, M

    T. Phiri, F

    Country of primary residence: Malawi

    Biography

    Dr Tapunda Phiri is a medical doctor who has worked at the Rumphi district hospital in Malawi for 3 years. She obtained her medical degree (MBBS) from Kamuzu University of Health Sciences, formerly known as the University of Malawi College of Medicine, in 2017, and completed her internship at Mzuzu central hospital in mid-2020. At Rumphi hospital, Dr Phiri is involved in the clinical management of patients suffering from rhodesiense HAT, within the team prescribing and administering suramin, melarsoprol and fexinidazole to these patients, and witnessing first-hand the side-effects and efficacy of each drug.

    Show less T. Phiri, F

    J. Seixas, M

    Country of primary residence: Portugal

    Biography

    Professor Jorge B.A. Seixas is a professor at the Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon in Portugal. After graduating in medicine (1984) and specializing in tropical medicine (MSc and PhD), he acquired clinical experience in Angola, Brazil, Guinea-Bissau and Portugal. Since 1991, he has taught tropical medicine subjects at the Institute of Hygiene and Tropical Medicine in Angola, Brazil and the Democratic Republic of the Congo. His main research interests are malaria, Chagas disease, neglected tropical diseases, travel medicine, bioethics and clinical research in developing countries.

    For the past 20 years Professor Seixas has participated in several clinical studies and clinical trials on HAT in collaboration with the Swiss Tropical and Public Health Institute and the Drugs for Neglected Diseases initiative, as well as with WHO for the implementation of new treatment tools for HAT elimination.

    Show less J. Seixas, M

    P. Simarro, M

    Country of primary residence: Spain

    Biography

    Dr Pere P. Simarro is a medical doctor with a PhD in preventive medicine and public health. In 2001, he was based at the WHO Office in Cameroon providing first-line support to countries endemic for HAT, and in 2005 in WHO Geneva as head of the HAT control and surveillance programme. Before engaging with WHO, he lived for 25 years in several African countries managing large control programmes including those for HAT, tuberculosis, leprosy and schistosomiasis as well as postgraduate training programmes for medical doctors and nurses. In 1985, he founded and was the director of the HAT control centre in Bata (Equatorial Guinea), the technical support body for the HAT national control programme.

    He has been the technical adviser for several nongovernmental organizations involved in HAT control programmes. Since retiring from WHO in 2014, he has served as a senior adviser in the HAT programme of the Drugs for Neglected Diseases initiative in Geneva in charge of access and external relationships and as a consultant in several WHO meetings for the development of diagnostics and treatment as well as strategies for HAT elimination. Dr Simarro is based in Geneva, Switzerland.

    Show less P. Simarro, M

    M. Tihitina, M

    Country of primary residence: Ethiopia

    Biography

    Dr Mamecha Tihitina is among the physicians who actively participate in the diagnosis and treatment of HAT patients in Ethiopia. “Reemergence of Human African Trypanosomiasis Caused by Trypanosoma brucei rhodesiense, Ethiopia” is the title of a case series report that he co-authored. He also co-wrote the official guidelines for usage at the national level, “Interim Guidance for Human African Trypanosomiasis (HAT Rhodesiense) Surveillance and Response”, which are being published in association with the Ethiopian Public Health Institute. He obtained his medical doctorate from Haramaya University in January 2020 and has been practicing medicine for 3.5 years with a keen interest in infectious diseases.

    He currently resides in Selam ber town in Gamo zone, Ethiopia, and works at Selam ber primary hospital, where he diagnoses and treats patients with HAT. Alongside his clinical duties, Dr Tihitina also manages Selam ber primary hospital, where his organization was acknowledged as one of the top-performing primary health-care facilities under his leadership.

    Show less M. Tihitina, M

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