1. Analysis of the National Liver Disease State of the art THEBERA Theodor Bilharz into the European Research Area FP7 ERAWIDE INCO Project 2010-6-2 Sanaa Botros Theodor Bilharz Research Institute THEBERA Coordinator “Priority Needs and Future Guidelines for Liver Research in Egypt and EC role in International Cooperation” Stakeholders Meeting Cairo, 5th December, 2013

2. THEBERA Objective Strengthen the capacity of Theodor Bilharz Research Institute (TBRI) for participation in European health research initiatives by expanding cooperation with the ERA while realizing it as an International Excellence Centre for liver disease research/management. Stakeholders Meeting Cairo, 5th December, 2013 “Priority Needs and Future Guidelines for Liver Research in Egypt and EC role in International Cooperation”

3. THEBERA Partner Organizations  Theodor Bilharz Research Institute (TBRI): A medical governmental research institute focusing on management of endemic diseases  Academy of Scientific Research and Technology (ASRT): A non profit organization providing public service by ensuring independent assessment of sciences  Europe for Business Ltd (EFB): A high growth knowledge Co., providing support to PP organizations in product innovation and R&D projects  PISA University (UNIPI): A regional referral center for major hepatobiliary and liver transplant surgery with large liver transplant program Stakeholders Meeting Cairo, 5th December, 2013 “Priority Needs and Future Guidelines for Liver Research in Egypt and EC role in International Cooperation”

4. THEBERA Scientific Activities M1M1M1M1 M1M1M1M1 M 42 WP1 (lead TBRI) : Project Management WP6 (lead ASRT): Dissemination and Network Facilitation WP2 Analyze the current Sate of the Art regarding liver disease WP5: THEBERA aims to establish TBRI Excellence Centre for liver disease research/management WP3 Build capacity for International Cooperation WP4 Capacity building for liver disease Business Plan based on WP2 & similar EU experience Stakeholders Meeting Cairo, 5th December, 2013 “Priority Needs and Future Guidelines for Liver Research in Egypt and EC role in International Cooperation”

5. Analysis of National Liver Disease State of the Art Analysis of National Liver Disease State of the Artwww.thebera.eg.netObjectives  How far researchers, research work conducted, health system tackling liver disease served the national health policy.  Were plans established conducive to develop appropriate platforms to control infection, properly manage liver disease and set up plans for development and rationalization for use of vaccines, diagnostics and drugs. Analysis involved  Current policies & programs (objectives, evidence -based, action taken & outcome), funding needs & offers, cooperation patterns and actors.  Researchers, research conducted, health systems research tackling liver disease. Stakeholders Meeting Cairo, 5th December, 2013 “Priority Needs and Future Guidelines for Liver Research in Egypt and EC role in International Cooperation”

6. Analysis of National Liver Disease State of the Art www.thebera.eg.netApproach  Liver diseases: Context, Tools and Actors.  Strategies: “Egyptian National Control Strategy (NCS) for viral hepatitis”.  Socioeconomic burden of HCV in Egypt.  Publications of national institutes on liver disease published nationally &internationally. 2005-2010.  Coordinating institute “TBRI” publications & projects. Publications Analysis  National institutes’ number of publications (national & international).  Number of collaborating international organizations.  Quality of publications and details of international affiliations.  Most targeted journals, liver disease subject and research topic.  Relevancy of national institutes research to NCS on viral hepatitis. Stakeholders Meeting Cairo, 5th December, 2013 “Priority Needs and Future Guidelines for Liver Research in Egypt and EC role in International Cooperation”

7. Volume of international and national research publications on liver researchover the period 2005-2010 liver research over the period 2005-2010 Stakeholders Meeting Cairo, 5th December, 2013 “Priority Needs and Future Guidelines for Liver Research in Egypt and EC role in International Cooperation”

8. Volume of international and national publications on liver disease according to field of research over the period 2005-2010 Stakeholders Meeting Cairo, 5th December, 2013 “Priority Needs and Future Guidelines for Liver Research in Egypt and EC role in International Cooperation”

9. Volume of international and national publications according to studied liver disease over the period 2005-2010 Stakeholders Meeting Cairo, 5th December, 2013 “Priority Needs and Future Guidelines for Liver Research in Egypt and EC role in International Cooperation” N.B: The small slices are ranging from 1.7% to 0.2% and represent HEV, Hep. Tox., Fatty Liver, NAFLD, HGV and NASH respectively. N.B: The small slices (1.61% - 0.16%) represent fascioliasis, HCV combined research with other hepatitis viruses or schistosomiasis, other viral hepatitis subtypes, liver transplantation and NASH.

10. Salient Findings 56%88%  Collaborating international organizations comprised 56% with 88% of leading scientists affiliated to Egyptian universities and institutions. diagnostic/prognostic  Most of researches published internationally targeted diagnostic/prognostic aspects.  Survey assessments surveillance sentinel groups and mathematical modeling  Survey assessments research aspects were acceptable to evaluate the liver disease problem in Egypt but for surveillance sentinel groups and mathematical modeling may better timely explain the situation. HCV, HCC, HBV and CLD social medicine, health care management and blood safety.  Majority of research topics targeted HCV, HCC, HBV and CLD the least studied was social medicine, health care management and blood safety.  Community acquired risk factors hospital acquired ones  Community acquired risk factors for infection were efficiently studied contrary to hospital acquired ones. hepato-protectives.  Drug studies were mainly on natural products targeting chiefly hepato-protectives. therapeutic management and liver transplantation  Editorial on therapeutic management and liver transplantation were poorly represented. Stakeholders Meeting Cairo, 5th December, 2013 “Priority Needs and Future Guidelines for Liver Research in Egypt and EC role in International Cooperation”

11. Liver disease priority needs Governance  Oversight body to co-ordinate between entities providing health services for liver disease patients e.g. MoHP, MoSR, MoHE and HIO.Finance  Better tracing of different liver institute domestic funding to forecast future funding requirements with efforts for fund raising; national and international.Networking  Academic institutions, private, public sectors, international organizations and policy makers, blood banks and build up of integrated information system for surveillance and patient follow-up.Education/Training  Programs for training more physicians on management of liver diseases, supportive staff “nurses and technicians” and a continued medical education program for senior staff. Stakeholders Meeting Cairo, 5th December, 2013 “Priority Needs and Future Guidelines for Liver Research in Egypt and EC role in International Cooperation”

12. Policy  Strategies to increase the awareness and knowledge of the general population on modes of transmission and methods of prevention.  Expanding infection control program in public and private healthcare facilities, innovative solutions for better control of hospital acquired viral infection and a plan to control small blood banks.  Efficient notification system to audit and register private sector with respect to acute infection, chronic liver disease, application of infection control program and injection safety procedures.  Allocation of budget to narrow the time lapse between different prevalence surveys to make best benefit of surveillance system.  A program to assess the efficacy of HBV vaccination in children, sentinel groups and high risk groups.  Solving the technical and financial constraints limiting liver transplantation. Stakeholders Meeting Cairo, 5th December, 2013 “Priority Needs and Future Guidelines for Liver Research in Egypt and EC role in International Cooperation”

13. Technical/Research  Establishment of proper database system.  Operational research concerning scaling up of case detection and improving access to medical care.  Meta-data analysis studies to choose the highest ranking biomarkers for proper management of liver disease.  Mathematical modeling for estimation of future burden of HCV and HBV infections to upscale the allocated budget according to expected needs.  New tools adaptable or as modification from existing R&D, new makeovers e.g. homemade shorter course, more cost effective interferon and the availability of antiviral syrup for pediatric use.  Social rehabilitation program for patients during medical and after major surgery with interventions to improve quality of life.  Increasing the number of liver treatment centers, availability of tools for management of liver diseases at remote health facilities e.g. endoscopies, sonar and labs for PCR. Stakeholders Meeting Cairo, 5th December, 2013 “Priority Needs and Future Guidelines for Liver Research in Egypt and EC role in International Cooperation”

14. Thank You Stakeholders Meeting Cairo, 5th December, 2013 “Priority Needs and Future Guidelines for Liver Research in Egypt and EC role in International Cooperation”