Advancing NTD Roadmap through the 2022 Gap Assessment Tool (GAT) Introduction
Introducing the Gap Assessment Tool (GAT) for the NTD roadmap, focusing on disease-specific assessments like Schistosomiasis. The 2022 GAT aims for greater standardization and objectivity in assessment criteria across diseases with specific rubrics defined for each dimension.
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Gap Assessment Tool (GAT) for the NTD road map: AN INTRODUCTION
Elimination (transmission) Elimination Control Eradication (public health problem) Schistosomiasis Onchocerciasis Dracunculiasis Buruli ulcer Lymphatic Mycetoma Trachoma Filariasis CRITICAL ACTION REQUIRED Leprosy Dengue NO HINDRANCES Yaws Scientific understanding Diagnostics Technical Effective interventions Operational and normative guidance Planning, governance and programme management Strategy and service delivery Monitoring and evaluation Access and logistics Health infrastructure and workforce Advocacy and funding Collaboration and multisectoral action Enablers Capacity and awareness building
Disease-specific assessment Example: Schistosomiasis Colour ranking Dimension Current status Actions required Diagnostics Kato Katz and urine filtration used to measure prevalence and intensity but suboptimal in low prevalence areas More sensitive and specific rapid diagnostic tests are being used and others are under development Develop and introduce standardized, sensitive, point-of- care diagnostics for different prevalence settings and all schistosome species; use for mapping and transmission assessment Create biorepository of sera, urine and stool for diagnostic development, validation and evaluation Develop test for resistance to praziquantel Develop molecular test for xenomonitoring and surveillance ( ) Monitoring and Evaluation Epidemiology of the disease currently not well understood Working group established to provide new guidance for M&E, granular mapping and impact assessment Improve data quality and mapping to support target and track progress. Collect M&E data from pre-SAC, SAC and adults to inform optimal treatment strategy Implement impact assessments for potential strategy adjustment Use endemicity data to target WASH investment ( ) Female genital schistosomiasis atlas published to help in diagnostics (2015) Manual on morbidity management under development Manual on malacology, web training platform and App under development Manual on field use of molluscicides published (2017) Support training of health staff in laboratory diagnostics, clinical management of cases and genital manifestations, malacology and snail control. Adopt strategy for long-term sustainability and greater national ownership Raise awareness among general public of the disease and its transmission, prevention ( ) Capacity and awareness building
The 2022 GAT Greater standardisation of assessment criteria across diseases. Increased objectivity in colour ranking assessment. A specific, measurable colour rubric should be defined for each dimension. The rubric should reinforce cross-cutting approaches. The rankings should include the views of a large number of people for greater representativeness. Greater engagement with country programmes. Periodic replication Assess the four priority dimensions (Access & Logistics, Advocacy & Funding, Diagnostics, M&E)
Implementation stages and participants WHO country offices Global online survey Country online survey 1 Public Disease-specific focus group discussions WHO Regional offices WHO HQ focal points Disease experts National NTD PM 2 Dimension-specific focus group discussions Dimension experts Country rep. WHO NTD dept. lead 3 WHO Region rep. NTD Road map Team 4 GAT Steering committee WG MER Pilot team Working Group on Monitoring and Evaluation 5 WG MER
STEP 1: Online surveys GLOBAL SURVEY Open to the public Assess fulfilment of indicators at the global level. Information on follow-up actions, current status and recommended actions Descriptive statistics for global trends Thematic analysis (status and actions) Integrated survey results report COUNTRY SURVEY WHO offices where NTD are endemic. Provides country-level inputs for global level indicators (% of endemic countries that ). Information on country-level follow-up actions, current status and recommended actions Quant. trends as % of endemic countries. Thematic analysis (status and actions)
STEP 1: Progress update Questionnaire design for country and global surveys (completed). Translation of country and global surveys into French, Spanish, Arabic, and Portuguese (completed). Reviews of translations to check for technical terminology and homogenisation with the road map text (completed). Survey programming using Lime Survey software (completed). Functionality and content checks for all language versions (completed). Design of report template for survey data to feedback into the disease-specific FGD (completed).
STEP 1: Survey report template Open survey questions: Status and actions 1. Current status of diagnostic tools. (Summary descriptors). Theme 1 Theme 2 Results I. DIAGNOSTICS 2022 Global online survey results Survey questions: Ranking Results Background Information 1. Select the statement that best describes the alignment of currently available diagnostics tests with program needs (ASSURED: Affordable, Theme 3 Theme 4 Theme 5 Others Dimension attributes required: Road map consultation Sensitive, Specific, User-friendly, Robust and Rapid, Equipment-free, Deliverable) Diagnostic tools that meet the ASSURED criteria are available to support all program actions required to reach the road map targets Diagnostic tools that meet the ASSURED criteria are available to support at least one program action required to reach the Road Map targets Available diagnostic tools permit progress towards Road Map targets, but do not meet the ASSURED criteria Available diagnostic tools are not adequate to support program actions required to make progress towards the road map targets. Do not know Subject Current status Availability of effective, standardized, affordable diagnostics for timely detection, assessment of end-points, surveillance. Availability of point-of-care diagnostics (where appropriate) usable at community level and in low-resource settings. 2019 ranking Status Actions required Macroscopy and laboratory PCR currently used Develop serological field diagnostic test for humans and animals Develop field pond-side test for detecting D. medinensis DNA in copepods 2022 Color assessment criteria Overall trends Diagnostic tools for all current or future use cases meet the TPP performance characteristics, or if TPPs are not available, they meet the ASSURED criteria. Diagnostic tool(s) meet quality standards established by WHO or other competent regulatory authorities* Diagnostic tools for at least one current or future use case meet the TPP performance characteristics, or if TPPs are not available, they meet the ASSURED criteria. Diagnostic tool(s) meet quality standards established by WHO or other competent regulatory authorities* Diagnostic tool(s) support programmatic actions which permit progress toward road map targets for at least one current or future program use case. Recommended actions to reach 2030 targets General trends in opinions (consensus or divergence). Implications for the assessment (significant changes or none). Summary of relevant descriptors General trends in opinions (consensus or divergence). Implications for the assessment (significant changes or none). Summary of relevant descriptors General trends in opinions (consensus or divergence). Implications for the assessment (significant changes or none). Summary of relevant descriptors 2. Do diagnostic tools currently used by programs meet quality standards established by WHO or other competent regulatory authorities (FDA, OIE, etc)? Follow-up on 2019 actions required Available tools are not adequate to support intervention decisions. Data sources Color ranking from survey results Overall trends Global survey: Provided information on color ranking criteria, current disease status, follow-up actions on 2019 recommendations, and critical actions for 2030 road map. Trends in responses suggest a yellow ranking. Most respondents (40%) considered that diagnostic tools meet the ASSURED criteria and are available to support at least one program action. The majority (80%) likewise considered that existing diagnostic tools meet quality standards established by WHO or other competent regulatory authorities. Note, however, that there are split views on whether diagnostic tools are ASSURED (30% did not consider them as such). Such a statement would shift the color ranking to orange.
STEP 2: Progress update Design of the methodological process for disease-specific FGD (completed). Identification of experts and country representatives for disease- specific FGD (ongoing). Design of the methodological process of dimension-level FGD (completed). Briefing sessions for members of disease-specific FGD (planning). Scheduling for disease-specific FGD (planning).
STEP 2: Disease-specific focus group discussions GAT SC Integrated survey results report Review results and confirm ranking criteria Colour ranking Narrow down potential colour rankings Assess criteria fulfilment Describe current status Recommend critical actions Profile Outline justification for changes compared to previous gap assessment. Trends
STEP 2: Output from disease-specific focus group discussions NTD: [DISEASE NAME] Colour ranking Dimension Current status Actions required Trend Justification Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Maecenas porttitor congue massa. Fusce posuere, magna sed pulvinar ultricies, purus lectus malesuada libero, sit amet commodo magna eros quis urna. Nunc viverra imperdiet enim. Fusce est. Vivamus a tellus. Pellentesque habitant morbi tristique senectus et netus et malesuada fames ac turpis egestas. Proin pharetra nonummy pede. Mauris et orci. Access and logistics Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Maecenas porttitor congue massa. Fusce posuere, magna sed pulvinar ultricies, purus lectus malesuada libero, sit amet commodo magna eros quis urna. Nunc viverra imperdiet enim. Fusce est. Vivamus a tellus. Pellentesque habitant morbi tristique senectus et netus et malesuada fames ac turpis egestas. Proin pharetra nonummy pede. Mauris et orci. Advocacy and funding Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Maecenas porttitor congue massa. Fusce posuere, magna sed pulvinar ultricies, purus lectus malesuada libero, sit amet commodo magna eros quis urna. Nunc viverra imperdiet enim. Fusce est. Vivamus a tellus. Diagnostics Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Maecenas porttitor congue massa. Fusce posuere, magna sed pulvinar ultricies, purus lectus malesuada libero, sit amet commodo magna eros quis urna. Nunc viverra imperdiet enim. Fusce est. Vivamus a tellus. Monitoring and evaluation
STEP 3: Preparatory analysis: sorting colour rankings by inter-assessment trend 2022 disease-specific FGD rankings by trajectory Negative Narrative assessments Numerical difference in rankings Road map ranking NTD No change Positive 2019 status 2022 status Justification for trend Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Dracunculiasis -1 Leishmaniasis (visceral) -2 Rabies -1 Chagas 0 Yaws 0 Human African Trypanosomiasis (gambiense) Human African Trypanosomiasis (rhodesiense) 0 Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. 0 Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at ruteux velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Schistosomiasis 0 Soil transmitted helminthiasis 0 Trachoma 0 Onchocerciasis 1 Leprosy 2 ( .) ( .) ( .) ( .) ( .) ( .) ( .) Number of NTDs 20 3 7
STEP 3: Preparatory work - Thematic matrix of disease-level required actions Encompassing themes for recommended actions by the disease-specific FGD 2022 color ranking Target Disease Mapping methodologies Donec lacinia quam in vehicula laoreet. Nulla facilisi. Donec lacinia quam in vehicula laoreet. Nulla facilisi. . Surveillance systems Databases ( ) ( ) Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Eradication Draculiniasis Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Yaws Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Interruption of Transmission Onchocerciasis Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Human African Trypanosomiasis (gambiense) Leprosy Donec lacinia quam in vehicula laoreet. Nulla facilisi. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Elimination as a public health problem Chagas Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Human African Trypanosomiasis (rhodesiense) Leishmaniasis (visceral) Donec lacinia quam in vehicula laoreet. Nulla facilisi. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Donec lacinia quam in vehicula laoreet. Nulla facilisi. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Schistosomiasis Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Donec lacinia quam in vehicula laoreet. Nulla facilisi. Rabies Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Soil transmitted helminthiasis Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Quisque ultrices dolor et diam semper, at rutrum velit lobortis. Trachoma
STEP 3: Dimension-level focus group discussions Structured disease-specific assessment Ranking review Identify and vote on any inconsistencies and divergences. If agreement on need for changes, re-assess colour ranking. Outline dimension-level actions that can enable disease-level recommendations for each encompassing theme. Cross-cutting solutions Communicate any differences of opinion to disease- specific focus group participants. Communicate outcomes to GAT-SC, including any divergent views across groups. Trends
Upcoming activities (Dec-Jan) 1. Online surveys to be released the week of 12thDecember (TBC). 2. Communications push to motive responses on release and again after the New Year. 3. Data collection to be completed on 15th January. 4. Final composition of disease-specific FGD. 5. Final composition of the GAT Steering Committee. 6. Scheduling of briefing sessions for disease-specific FGD members.
Revised timeline for assessment of the first 4 dimensions (TBC) 2022 2023 Activity Dec January February March April Online surveys Survey data analysis and criteria review (GAT SC) Disease-specific FGD Dimension FGD Review and approval disease and dimension assessments M&E WG approval final report Report to STAG
