DGIS -ITG IMT A. von HUMBOLDT (IMTAvH) Lima, Peru Institutional strengthening & collaboration.

DGIS -ITG

IMT A. von HUMBOLDT

(IMTAvH)

Lima, Peru

Institutional strengthening

& collaboration

Lima & UPCH• Lima, massive rural immigration

in 1970-1980: 2 10 M

• Universidad Peruana Cayetano Heredia

National General Hospital (4th line)

Northern Lima, 3 million inhabitants

UNIVERSIDAD PERUANACAYETANO HEREDIA

Facultades

Facultad de Medicina “Alberto Hurtado”

Facultad de Ciencias y Filisofía

Facultad de Estomatología

Facultad de Veterinaria y Zootecnia

Facultad de Educación

Facultad de Enfermería

Facultad de Salud Pública y Administración “Carlos Vidal Layseca”

Facultad de Psicología

- Private University, founded 1962

- 8 Facs, 6.500 students

- Hospital: 420 beds, training in 28

medical specialities, 900 students

- 3 Research Institutes,

including IMT AvH

IMTAvH (1968)

•Clinics for Tropical and Infectious Diseases

150 consultations /day, 36 beds,

9 infectiologists, 3 dermatologists

• 7 labs

• 9 courses, pre- & post-graduate incl. Gorgas Course

Instituto de Medicina Tropical Alexander von Humboldt

Founded 1968, German Foundation von Humboldt Support PNUD / WB / WHO / TDR Link with National Institute of Health, MOH Peru for epidemiology 2 poles of excellence, clinical and biological resulting from academic

(University) and medical (Fac Med + National Hospital) environment

Constraints

80's: international cooperations pulled off by lack of confidence indemocracy of current regime

90's: Fujimori stopped governmental funding to private Universities

IMTAvH- ITG

1987 Spin-off from DGIS/IMTA cooperation with Bolivia joint research project EC-STD (INCO) Leishmaniases

1988 Collaboration for Mycobacterioses Françoise Portaels / Humberto Guerra

1987 Collaboration for Mycoses Danielle Swinne / Betty Bustamante

1989 Memorandum of Understanding (MoU)1996 Collaboration in Malnutrition (P. Kolsteren)

joint EC-INCO project Antwerp -Lima - Cochabamba1996 MoU expanded + Nutrition, Public Health, STD1998 Framework Programme DGIS-ITG-IMTAvH "International Strenthening & Collaboration"

COLLABORATION

5 topics 12 partners 4 ITMA departmentsLeishmaniases *Jorge Arevalo Parasitologycut., muco-cut. Alejandro Llanos-

Cuentas, MD*Jean-Claude Dujardin,

D Sc •Mycobacterioses Humberto Guerra, MD MicrobiologyTB, MDR-TB, Buruli Françoise Portaels, D Sc Mycoses Betty Bustamante, MD Clinical Sciences & Sporotrichosis Danielle Swinne, D Sc Institute of Public

Health Brussels •Malnutrition Iris Pecho Public Health Micronutrients, Anna Pradaco-infections Patrick Kolsteren •Clinical Research Eduardo Gotuzzo Clinical Sciences (since 2000) Tine VerdonckHIV/TB, skin ulcer* Coordination: 2 local coordinators (JA/Lima, JDC/Antwerp) + 1 promotor (DLR/Antwerp)

SYNERGY BETWEEN TOPICS

Clinical epidemiology of HIV/TB and skin ulcerMolecular tools for diagnosis and epidemiology

INSTITUTIONAL STRENGTHENING

Human Resources: tech training, M Sc, PhDCentralized equipment for cryobanking & molecular biologyComputerized management of reference collections: clinical specimens, pathogens, seraDistance Learning: CD- ROM Trop. Med. cfr Erwin Van den Ende

4,2

7,0

12,4 14,0

-

5,0

10,0

15,0

1998 1999 2000 2001

BUDGET M BEF

DGIS INPUT, BUDGETARY

BREAKDOWN 2000

BUDGET 12 M 4

19%

18%

27%

14%

13%

9%

EQUIPMENT

CONSUMABLES

PERSONNEL

TRAINING GRANTS

TRAVELS & STAYS

ADMINISTRATIONCOSTS

QUALITY CONTROL

2001 Administrative management: 2nd back-up site visit (LS + JVL)

External evaluation: 1 Lat-Am + 1 EU experts

2002 New 5-yr Master Plan to be identified by IMTAvHinstitutional prioritiesQC indicatorssustainability

DGIS PROGRAMME

Strengthens institutional sustainability reference and teaching capacity

competitivity in research fund raising: EC-INCO, WHO/TDR, NIH…

Major achievements (equipment)

• Improvement of basic laboratory facilities

• Common facilities for sample storage (-70°C)

•Bio-Safety

•Common laboratory facilities for molecular biology

Major achievements (training)

• Clinical research: 2 MDs • Leishmania: 2 PhD, 4 MSc, 2 MSc• Mycology: 1 MSc• Mycobacteriology: 5 Medical students, 1 MSc• Nutrition: 2 experts, multidisciplinary team• Common activities: management biological

samples

Major achievements (science)

Clinical research:• TB: many patients with MDR, frequent co-infection PCP-

TB

• Skin ulcer (differential diagnosis): predictive value of clinical and epidemiological information; mostly due to Leishmania, PCR without biopsy (scrap)

• Translation of CD-Rom on Tropical Medicine in spanish (+/- 75% achieved)

Major achievements (science)

Leishmania: • PCR identification of Leishmania species directly in

biopsies (first in the world): prognosis and epidemiological

surveillance • Development of methodologies for analysis of differential

gene expression (virulence, drug resistance)

• Opening of a research line on the influence of vit A on disease progress

Major achievements (science)

Mycobacteriology:• Implementation of phage-based methodology for

identification of Mycobact. infection and determination of drug-resistance

• Detection of resistance to second line drugs in the general population of TB patients and in patients with MDR-TB (16% kanamycin, 10% ofloxacin)

• Detection of autochtonous cases of Buruli ulcer

Mycology:• possibility to be regional/national reference centre

• initiation of studies on molecular epidemiology of fungi

Nutrition:• 71% anemia < 5 years: despite good quality of iron-

enriched bread, this is not provided to children; search for alternative strategies.

• Effect of nutritional supplements on parasitoses

Major achievements (science)

Output (publications)

• Leishmania: 1 PhD thesis, 1 MSc thesis, 3 papers

• Mycology: 3 papers

• Mycobacteriology: 1 manual, 1 paper, 5 abstracts in proceedings

• Nutrition: reports, papers in the pipeline

• Clinical research: 1 paper in preparation

Output (projects)• Leishmania: 2 TDR, 1 INCO-Dev (Drug

resistance), 1 QOL (epidemiological surveillance)

• Mycology: 2 clinical trials• Mycobacteriology: 1 INCO-Dev (concerted

action), 1 submission to TDR• Nutrition: 1 INCO-Dev, 1 USAID• Clinical research: 2 submissions to TDR

Synergy

Clinical research

Tropical and Infectious diseasesLeishmaniases

MycosesMycobacterioses

HIV/AIDS

Molecular diagnosisand epidemiology

Ref. Sample collection

Role of nutritionalstatus

Prospects

• Clinical trials

• Reference centre for molecular diagnosis and epidemiology of pathogens (inter-regional course)

• Immunology (starting from HTLV/Strongyloides)?

• …(Cysticercose, neuro-)

DGIS

Institutional strengthening

Stability, continuity, pilot studies for competitivity in research projects(EC-INCO, WHO-TDR, NIH..)