Expert Consultation: Elimination targets and milestones for Kala Azar Elimination Road Map from 2021 to 2030 in South East Asia

On July 30 and 31, 2019, the DNDi Drugs for Neglected Diseases initiative India Foundation organised an expert consultation in New Delhi on the elimination targets and milestones for the Kala Azar Elimination Road Map from 2021 to 2030 in Southeast Asia. This consultation was attended by around 30 national and international specialists.

The Kala-Azar Elimination Initiative (KAEP), launched in 2005, is an alliance of 5 countries, Bangladesh, Bhutan, India, Nepal and Thailand to eliminate visceral leishmaniasis or kala-azar as a public health problem from their countries. The current target is to reduce the incidence of kala-azar to below 1 per 10,000 per year in each endemic implementation unit (i.e.district or sub-district, depending on country). 

The consultation was organised to define the elimination targets and milestones for Kala-Azar elimination road map from 2021 to 2030 and to finalize the draft document reviewing the progress, gaps and needs of the elimination programme in South Asia.

Experts recommended that early detection of cases is essential in order to ensure prompt treatment. And sustained un-interrupted availability of quality-assured medicine has to be ensured.  

Accelerated drug and vaccine R&D for better, more economical, and more user-friendly treatment alternatives (e.g. short-course, oral, safe, and easy-to-administer drugs) for VL and PKDL is needed, especially for vulnerable groups such as women of child-bearing age and children. Robust evidence for vector control tools and strategy are required.

Experts agreed to fix the elimination target by 2030 for al VL (new and relapse) cases in India, Nepal and Bangladesh. The case mortality rate to be below 1% for VL (new and relapses) diagnosed cases, excluding HIV co-infected, within 6 months after treatment.

The need for better epidemiological tools to understand transmission, including modelling and data sharing was also felt. More studies should be done to deepen understanding of the vector lifecycle for more effective vector control. There is a need for tools for predicting outbreaks through risk mapping and validation (human and environmental risk factors) and predictive biomarkers for relapses and PKDL are also needed.