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Implementation of test-and-treat with doxycycline and temephos ground larviciding as alternative strategies for accelerating onchocerciasis elimination in an area of loiasis co-endemicity: the COUNTDOWN consortium multi-disciplinary study protocol

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Wanji, Samuel, Nji, Theobald Mue, Hamill, Louise, Dean, Laura ORCID: https://orcid.org/0000-0002-4910-9707, Ozano, Kimberley, Njouendou, Abdel J., Abong, Raphael A., Obie, Elisabeth Dibando, Amuam, Andrew, Ekanya, Relindis, Ndongmo, Winston Patrick Chounna, Ndzeshang, Bertrand L., Fung, Ebua Gallus, Nnamdi, Dum-Buo, Nkimbeng, Desmond Akumtoh, Teghen, Samuel, Kah, Emmanuel, Piotrowski, Helen, Forrer, Armelle, Khan, Jahangir ORCID: https://orcid.org/0000-0002-6151-764X, Woode, Maame E., Niessen, Louis ORCID: https://orcid.org/0000-0002-8639-5191, Watson, Victoria, Njoumemi, Zakariaou, Murdoch, Michelle, Thomson, Rachael, Theobald, Sally ORCID: https://orcid.org/0000-0002-9053-211X, Enyong, Peter, Turner, Joseph D. ORCID: https://orcid.org/0000-0002-2185-5476 and Taylor, Mark J. ORCID: https://orcid.org/0000-0003-3396-9275 (2019) 'Implementation of test-and-treat with doxycycline and temephos ground larviciding as alternative strategies for accelerating onchocerciasis elimination in an area of loiasis co-endemicity: the COUNTDOWN consortium multi-disciplinary study protocol'. Parasites & Vectors, Vol 12, Issue 1, e574.

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Abstract

Background

Onchocerciasis is a priority neglected tropical disease targeted for elimination by 2025. The standard strategy to combat onchocerciasis is annual Community-Directed Treatment with ivermectin (CDTi). Yet, high prevalence rates and transmission persist following > 12 rounds in South-West Cameroon. Challenges include programme coverage, adherence to, and acceptability of ivermectin in an area of Loa loa co-endemicity. Loiasis patients harbouring heavy infections are at risk of potentially fatal serious adverse events following CDTi. Alternative strategies are therefore needed to achieve onchocerciasis elimination where CDTi effectiveness is suboptimal.
Methods/design

We designed an implementation study to evaluate integrating World Health Organisation-endorsed alternative strategies for the elimination of onchocerciasis, namely test-and-treat with the macrofilaricide, doxycycline (TTd), and ground larviciding for suppression of blackfly vectors with the organophosphate temephos. A community-based controlled before-after intervention study will be conducted among > 2000 participants in 20 intervention (Meme River Basin) and 10 control (Indian River Basin) communities. The primary outcome measure is O. volvulus prevalence at follow-up 18-months post-treatment. The study involves four inter-disciplinary components: parasitology, entomology, applied social sciences and health economics. Onchocerciasis skin infection will be diagnosed by skin biopsy and Loa loa infection will be diagnosed by parasitological examination of finger-prick blood samples. A simultaneous clinical skin disease assessment will be made. Eligible skin-snip-positive individuals will be offered directly-observed treatment for 5 weeks with 100 mg/day doxycycline. Transmission assessments of onchocerciasis in the communities will be collected post-human landing catch of the local biting blackfly vector prior to ground larviciding with temephos every week (0.3 l/m3) until biting rate falls below 5/person/day. Qualitative research, including in-depth interviews and focus-group discussions will be used to assess acceptability and feasibility of the implemented alternative strategies among intervention recipients and providers. Health economics will assess the cost-effectiveness of the implemented interventions.
Conclusions

Using a multidisciplinary approach, we aim to assess the effectiveness of TTd, alone or in combination with ground larviciding, following a single intervention round and scrutinise the acceptability and feasibility of implementing at scale in similar hotspots of onchocerciasis infection, to accelerate onchocerciasis elimination.

Item Type: Article
Subjects: QV Pharmacology > Anti-Bacterial Agents. Tissue Extracts > QV 350 Anti-bacterial agents (General or not elsewhere classified)
WA Public Health > Preventive Medicine > WA 243 Diagnositic services
WC Communicable Diseases > Tropical and Parasitic Diseases > WC 695 Parasitic diseases (General)
WC Communicable Diseases > Tropical and Parasitic Diseases > WC 850 Nematode infections (General)
WC Communicable Diseases > Tropical and Parasitic Diseases > WC 885 Onchocerciasis
WW Ophthalmology > WW 100 General works
Faculty: Department: Biological Sciences > Department of Tropical Disease Biology
Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1186/s13071-019-3826-8
Depositing User: Cathy Waldron
Date Deposited: 22 Jan 2020 15:50
Last Modified: 14 Feb 2020 12:13
URI: https://archive.lstmed.ac.uk/id/eprint/13557

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