Projects

Employing a Feasibility Study as a tool for Establishing a Regional Biobank of High Risk Biological Agents and Emerging Dangerous Pathogens

The project seeks to improve biobanking of high risk pathogens while recognizing the right for security and health, without compromising legal, social, ethical and/or ethnic boundaries.

Implementing Organizations / Country : Philippines and Singapore

Objective:

Determine the feasibility of establishing a regional biobank facility for high risk and emerging dangerous pathogens.

The project will be implemented between August 2021 to July 2022.

Strengthening of ASEAN Preparedness and Response to Biological Threats.

In the past 20 years, the world has been scourged by emerging and reemerging infectious diseases, diseases that are public health emergencies of international concern. The Philippines has had its share of outbreaks, including SARS (2003), Ebola Reston in nonhuman primates and pigs (2008), pandemic influenza A(H1N1) in 2009, MERS (2014), Zika (2016) and vaccine preventable diseases such as measles, dengue and poliomyelitis. The key to mitigation of the devastating effects is a preparedness plan with an evidence- based program to predict possible outbreaks.

In 2014, to enhance ASEAN risk assessment capability to track and detect emerging infectious diseases and other relevant potential threats through the use of Biodiaspora, a project was launched with the Philippines as the lead country. The ASEAN Biodiaspora Program is a real-time web-based risk assessment tool, linking multiple datasets. The objective is to build regional capacity in data analytics, visualization and communication that strengthen ASEAN’s epidemic and pandemic preparedness and response capabilities to naturally occurring or man- made biological threats.

In 2 years, the ASEAN Biodiaspora project aims to reach this goal through four main strategies:

1. Establish Regional Virtual Center for Biodiaspora
2. Strengthen the network of existing national and regional (ASEAN) capacity for big data analytics and visualization
3. Continuous development and maintenance of the system
4. Establish a policy framework for project sustainability

The Cagayan Valley Center for Health Development (CVCHD) has pioneered the creation of the Cagayan Valley Collaborating Center for Disease Prevention and Control (CV CCDPC) with its vision to be the Center of Excellence in Applied Epidemiology and Surveillance that catalyzes evidence-based decision-making toward better policies and public health outcomes through the development of Committed, Competent, Compassionate and Responsive Surveillance Teams in Cagayan Valley. It is created to equip, empower and establish epidemiology and surveillance units (ESU) in every Local Health System (LHS) in Region 2 being the prime source of accurate, complete, and timely information for evidence-based decision-making.

On March 20, 2020, the first Coronavirus Disease - 2019 (COVID-19) was recorded in the region. As a new emerging infectious disease that has caused a global pandemic, COVID-19 gave us an awakening on the importance of establishing functional epidemiology units in all health facilities to strengthen their capacity for early detection and response to epidemics, thus maximizing integrated approach to outbreak detection, prevention and control from the community. Republic Act 11332 also known as the Law on Mandatory Reporting of Notifiable Diseases and Health Events of Public Concern requires all Local Government Units (LGU) to establish a functional Epidemiology and Surveillance Unit (ESU) in response to the Universal Health Care Law. In Section 8 of this RA, all ESUs shall have human resource complement and have adequate resources to effectively perform disease surveillance and response functions.

Currently in the region, the disease surveillance systems procedures for data collection and public health investigation at different levels produce inefficiencies and duplication of efforts thus, there is a need to strengthen and streamline the disease surveillance and response and ensure the functionality of every ESU. In response to this situation, the Cagayan Valley Center for Health Development (CVCHD) through the creation of Cagayan Valley Collaborating Center for Disease Prevention and Control (CV CCDPC) conceptualized FETP Intermediate Course to equip health professionals in applied epidemiology and surveillance. However, the regional office needs the expertise of Field Epidemiologists on the appropriate training course to be conducted.

In May 2021, CVCHD has contracted FETPAFI to support the Cagayan Valley Epidemiology Center (CVEC) to train and strengthen the capacity of the Regional, Provincial, and City Disease Surveillance Officers and Health Professionals in early detection and response to epidemics and to adequately address emerging, re-emerging public health problems in Cagayan Valley.

Technical Assistance to Support the Implementation of Health Resources Availability Monitoring Systems (HeRAMS) in Mindanao during COVID-19 Response

The Health Resources and Services Availability Monitoring System (HeRAMS) is an online platform that aims to provide decision-makers and health sector actors with critical and up-to-date information on the availability of essential health resources and services at the different levels of the health system. It promotes standardization across the health sector response from both a resource- and a policy- point of view, and contributes towards improving intra- and intersectoral collaboration. Dubbed as a “surveillance system of health systems”, it has been successfully deployed in developing countries such as Yemen. The overall goal of the project is to activate HeRAMS as part of the COVID-19 response in Mindanao, Philippines to support the monitoring of health resources and services and ensure their continuity throughout health emergencies such as the pandemic.

From November 2020 to August 2021, FETPAFI is tasked to build and strengthen the capacity of the rural health units (RHUs) and hospitals and infirmaries (HAIs) in the six regions comprising Mindanao in monitoring health resources and services availability through the HeRAMS platform and to establish HeRAMS baseline data from the trained RHUs and HAIs.

For more information about the HeRAMS Platform, you may visit the official website:

https://www.herams.org

Determining the Prevalence and Behavioral Factors of HIV and STI in the Philippines through the conduct of the Integrated HIV Behavioral and Serologic Surveillance (IHBSS)

The IHBSS is a study primarily conducted by the Epidemiology Bureau that aims to determine the prevalence of HIV-AIDS and STD in the country, and to better understand behavioral factors that lead to such prevalence. The 2018 IHBSS is the seventh round of the surveillance, whose implementation has been granted to the non-government organization, the Field Epidemiology Training Program Alumni Foundation, Inc. (FETPAFI).

FETPAFIis tasked to handle the administrative and field operation aspects of the project, in partnership with the Epidemiology Bureau, the STI/AIDS Cooperative Central Laboratory (SACCL), and the Philippine National AIDS Council (PNAC) of the Department of Health (DOH). The project fund is managed by the Philippine Council for Health Research and Development of the Department of Science and Technology (PCHRD-DOST) under the Advancing Health through Evidence-Assisted Decisions with Health Policy and Systems Research (AHEAD-HPSR) program.

The 2018 IHBSS (Year 1) was conducted between April 2018 to April 2019, across 13 sentinel sites, including the cities of Angeles, Baguio, Cagayan De Oro, Cebu, Davao, General Santos, Iloilo, Mandaue, Pasay, Quezon, Taguig, Talisay (Cebu) and Zamboanga covering both males who have sex with males (MSM) and transgender women (TGW) using time location sampling (TLS). The IHBSS among female sex workers (FSW) was done within the 10 of the 13 sentinel sites (excluding Taguig City, Mandaue City and Talisay City) using systematic sampling.

The 2018 IHBSS (Year 2), April 2019 – June 2021 focused on the analysis and interpretation of the 7^th IHBSS round and conduct of Formative Assessments among key population. The activities comprised of dissemination activities (i.e. CAPE, Community Engagement, Data Dissemination and Utilization), AIDS Epidemic Modeling (AEM) workshops and consultative meetings, exploratory study on the risks and barriers to service uptake among WLHIV and online survey among males and  transgender women who have sex with males.

The 2018 IHBSS also considered the need to measure emerging risk behaviors among key population groups (i.e. chemsex), changes in social and sexual networks (i.e. online/social media networks), and innovations in HIV strategies for prevention and testing (i.e. condom access points, community-based HIV screening [CBS], etc.).

The next round of the IHBSS will be in 2022.

For more details about the methodology, results, key findings and recommendation of the 2018 IHBSS, please refer the technical report found in the Resources/ Reports tab.

Pilot-testing of a Scorecard Designed to Assess the Performance of LGUs in the Elimination of NTDs in the Philippines

Neglected tropical diseases (NTDs) refer to a diverse group of communicable diseases which occur under tropical and subtropical conditions and are “intimately linked to poverty”. Of the 17 NTDs identified by the World Health Organization (WHO), six are currently endemic in the Philippines, namely: lymphatic filariasis;  schistosomiasis;  soil-transmitted helminthiases;  food-borne trematodiases;  rabies; and  leprosy.

The LGU NTD Scorecard was developed to measure LGU performance in five areas, namely: (1) program support, (2) logistics, (3) surveillance, monitoring and evaluation (M&E) and program planning, (4) advocacy and partnerships, and (5) research and innovation. The results of the performance assessment are envisioned to guide LGUs in decision-making related to retaining, improving, or changing strategies to improve or sustain current levels of performance, while the national government can use the results of the scorecard to guide the national NTD programs in developing and/or updating policies, as well as providing technical and financial assistance to LGUs as needed.

Under this project, FETPAFI pilot-tested the LGU scorecard for NTDs to promote the adoption and use of the LGU scorecard for NTDs by determining the barriers and facilitators to its implementation in the Philippine health system. Specifically, the final output is to draft an Administrative Order (AO) based on the insights gained from the pilot-testing.

FETPAFI started implementation in October 2019 covering the  provinces of Cagayan and Tarlac in Luzon, Bohol and Capiz in the Visayas and Bukidnon and South Cotabato in Mindanao as pilot sites.

Prevalence of common NCDs and their associated risk factors in the Philippines and the feasibility, validity and reliability of using mobile phone surveys to produce population level estimates

Non-Communicable Diseases (NCDs) are the leading cause of death worldwide. According to the World Health Organization country profiles in 2014, NCDs contribute to 34% of all deaths in the Philippines.

Efficient monitoring and surveillance are cornerstones to track the progress of NCD burden, related risk factors, and policy interventions. The systematic monitoring of risk factors to generate accurate and timely data is essential for Philippines’ ability to prioritize crucial resources and make sound policy decisions to address the growing NCD burden. With increasing access and use of mobile phones globally, opportunities exist to explore the feasibility of using mobile phone technology as an interim method to collect data and supplement household surveys.

In the Philippines, the goal of the NCD Mobile Phone Survey is to provide nationally representative estimates of indicators that can provide information on NCDs to help make programmatic recommendations to improve and enhance NCD prevention and response in Philippines.  The results may be used to supplement results of key behavior risk factors assessed in the WHO Stepwise survey or other national surveillance systems.

The NCD Mobile Phone Survey included 18 core questions on the following topics:

• Demographics
• Tobacco Use
• Alcohol Use
• Diet (Fruit, Vegetable, and Salt Consumption)
• Diabetes
• Hypertension

The implementation process consisted of five stages: engagement, planning and pre-test, full-scale data collection, data management and analysis, and data release and use.

Since 2018, the survey has been implemented in the Philippines in 2 phases. Phase 1 (2018) covered 3,679 individuals while Phase 2 (2020-2021) 3,087 individuals. These respondents were Globe, Smart, and Sun mobile phone networks subscribers and participated in the survey via short message service (SMS) and mobile web modes.

In July 2021, the CDC Foundation has extended the contract of FETPAFI until December 2021 to continue the work and open the opportunity for future surveys within the Department of Health.

The COVID-19 mobile phone survey was launched in August 2021.

Rabies, a horrific but preventable disease, kills over 200 people annually in the Philippines. The National Rabies Prevention and Control Program in the Philippines has catalysed control efforts with some provinces now aiming to declare freedom from rabies. However, outbreaks continue and human deaths still occur. While access to lifesaving post-exposure prophylaxis (PEP) for rabid bite victims has improved and has reduced mortality, it has proven expensive. Rising PEP use has put a strain on local and national budgets, even as rabies circulation has declined, raising the question of how these efforts can be sustained. Meanwhile, routine rabies surveillance in the Philippines has shortcomings and is not sufficiently sensitive for international agencies to recognize rabies-free areas or to rapidly respond to incursions which remain a risk while rabies circulates in other provinces in the country. As a result, surveillance needs strengthening and use of PEP needs rationalizing for the Philippines to fully benefit from rabies control measures that are currently underway. 

Integrated Bite Case Management (IBCM) has been identified as a potential strategy that can sufficiently enhance surveillance to enable verification of rabies freedom and rapid detection of incursions for effective outbreak responses to maintain rabies freedom. Operationalizing IBCM as a key component of enhanced surveillance should have immediately beneficial applications within the Philippines and could more broadly benefit the global campaign to eliminate human rabies deaths by 2030. SPEEDIER`s aim is to deliver a cost-effective, epidemiologically robust, enhanced surveillance and response package to guide and sustain the elimination of rabies from the Philippines. 

Specific objectives are to: 

1. Assess the impact of IBCM on increasing case detection of rabies and thereby enabling rapid and effective outbreak responses to maintain rabies freedom;
2. Assess the potential for IBCM to improve patient care, by identifying and treating persons bitten by suspect rabid dogs who would otherwise be overlooked by the health system; 
3. Assess the impact of judicious protocols for administration of rabies PEP and therefore the potential for generating cost savings
4. Determine whether IBCM and judicious PEP can be implemented as intended in different local contexts, identifying facilitators and barriers to successful implementation and sustainable roll out;
5. Develop best practices for delivering enhanced surveillance to support rabies elimination, bridging research to policy and implementation;
6. Develop decision support tools and guidance for risk assessment, outbreak response and maintaining rabies freedom in the Philippines.

The study design comprises a feasibility study followed by an implementation study of IBCM with the active advocacy for rationalized use of PEP in the low socio-economic class provinces of Romblon and Oriental Mindoro, that include geographically isolated and disadvantaged communities. Through this implementation research we will develop best practice for an enhanced surveillance approach using IBCM as a strategy to detect rabid animals, with risk assessment of bite patients triggering epidemiological investigations and informing PEP use.

Detection and Characterization of Novel Respiratory Viruses in Mallard Ducks (Anas luzonica) and in Environmental Samples in Central Luzon, Philippines

Globally, zoonotic avian viruses pose a threat to public health. Wild birds in aquatic habitats may serve as reservoir of the pathogens. Infection and transboundary transmission through migration of birds may carry pathogens to those in contact with domestic ducks and birds or through the contaminated water. Duck raising practice in the Philippines is through grazing from ducklings until such time that they are about to lay to minimize farm inputs. During this time they can be exposed to migratory birds and environmental water from sanctuaries where wild birds stay during the migration time (October to February) along the East Asia-Australasian Flyway.

This study aims to detect and characterize the novel respiratory viruses that may be present in mallard ducks and the water samples from where they are grazed. 

The Philippine government through the Department of Health (DOH) is ramping-up the implementation phase of the COVID-19 vaccination program. Currently, the country has received 77,410,640 doses of seven (7) different brands of vaccines with the goal of inoculating the target population of 77,139,058 at the end of 2021. As of November 2021, the coverage rate of fully vaccinated individuals in the country is at 28.51%.

The DOH-led NVOC together with the Department of Information and Communications Technology (DICT), Department of Interior and Local Government (DILG), Food and Drug Authority (FDA), Armed Forces of the Philippines (AFP), Presidential Communications Operations Office (PCOO), Philippine National Police (PNP) and the National Task Force (NTF) Against COVID-19 has started its operations since 1 February 2021 with the active support of WHO, UNICEF and private sector.

As the complexities of vaccine roll-out relies heavily on coordination of different levels of governance and reporting, it is essential that NVOC strengthen its current capacity to provide technical assistance in the field and efficient data management including end to end inventory of vaccines for timely provision of analysis to decision-makers and implementers.

In January 2022, the World Health Organization (WHO) Philippines engaged the Field Epidemiology Training Program Alumni Foundation, Inc. (FETPAFI) under an Agreement for Performance of Work (APW) contract to provide technical assistance in strengthening the operations of the National Vaccination Operations Center (NVOC) for COVID-19 vaccines in the regional and national level.

For the next 6 months, FETPAFI will gather the manpower to provide needed data management and technical support in strategic areas/offices of the DOH specifically at the Field Implementation and Coordination Teams (FICT) and Supply Chain Management Service (SCMS) to comply with the objectives of the vaccination roll-out, through the recruitment, training and supervision of field coordinators in Luzon, Visayas and Mindanao, and data managers/analysts in NVOC and SCMS.

The Philippines is considered highly endemic for hepatitis B, with an estimated 16.7% of the general population having evidence of chronic hepatitis B virus (HBV) infection. The Philippines introduced the hepatitis B vaccine for infants as part of the National Immunization Program (NIP) in a phased approach in 1991, while the birth dose of the vaccine (HepB-BD) was introduced to cntrol perinatal transmission in 2007. The World Health Organization (WHO) recommends that countries in the Western Pacific Region, including the Philippines, achieve 95% coverage of the HepB-BD and 3-dose infant series.

In May 2018, the Department of Health (DOH), in partnership with WHO, the US Centers for Disease Control and Prevention (CDC) and the Field Epidemiology Training Program Alumni Foundation Inc (FETPAFI), conducted a serosurvey among children aged 5 and 6 years old to estimate the prevalence of the hepatitis B surface antigen (HBsAg) among children born after the nationwide hepatitis B introduction. Questionnaires assessing routine vaccination coverage were administered and blood specimens collected to test for serologic evidence of infection through a rapid, point-of-care HBsAg test.

The survey covered 25 provinces/ cities, with a total of 2,686 child respondents. As of June 26, 2018, approximately 11,874 households have been visited in 244 barangays nationwide. However, out of the 2,059 households with eligible children, only 1,493 have been successfully interviewed and tested after obtaining the consent from parents/ legally-authorized guardians (LAR) (See Annex A). Around 489 parents/ LAR (or 23.7%) refused to participate in the survey, while another 77 households were unable to participate due to the unavailability of either the child or his/her parent/ LAR, or the failure to collect blood samples during the team’s first visit.

Several issues and concerns encountered have significantly hampered the implementation of the survey in the field. These include:

1. Challenges in the coordination and communication of survey information, from the national to the barangay level;
2. Unwillingness of some local government units (LGUs) to participate in a DOH-led activity;
3. Revisions and finalization of the translated informed consent forms (ICFs) to be used in the survey;
4. Start of the academic school year, leading to the unavailability of eligible children during visits;
5. Intermittent rains and inclement weather conditions and terrain in some areas; and
6. Prevailing perceptions caused by the Dengvaxia^TM controversy and circulating social media message regarding ISIS-linked individuals pretending to be DOH personnel and infecting people with AIDS.

PR for Contracting Partner for the Recruitment of Acute Flaccid Paralysis Surveillance Officers (AFPSOs) for the Department of Health.

Polio is a highly infectious disease caused by a virus. The virus is transmitted by person-to-person spread mainly through the fecal-oral route or, less frequently, by a common vehicle (for example, contaminated water or food) and multiplies in the intestine. Polio infections can lead to irreversible paralysis (usually in the legs).

On September 19, 2019, the Department of Health (DOH) confirmed that Polio re-emerged in the Philippines, nineteen years after the country was declared polio-free in 2000.

In January 2020, FETPAFI was tasked to support the Polio surveillance in the country thru a project funded by the World Health Organization Philippines. All activities were led by the DOH-Epidemiology Bureau and in coordination and technical guidance from the WHO. The project focused on strengthening the on-going Polio surveillance thru the hiring and capacitating of surveillance officers who will man and support the surveillance in all the regions of the country, either at the Regional Epidemiology and Surveillance Unit (RESU) or the Provincial DOH Office (PDOHO). With more than twenty Acute Flaccid Paralysis Surveillance Officers (AFPSO), the project was implemented from February to September in 2 Phases.

For sustainability, the project was endorsed by FETPAFI  with the recommendation of continuing the contracts of AFPSOs and capacity building of the new AFPSO hired directly by the DOH Regional Health Offices.