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
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...
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| Format: | Article |
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BMC
2019-12-01
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| Series: | Parasites & Vectors |
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| Online Access: | https://doi.org/10.1186/s13071-019-3826-8 |
| _version_ | 1819075944778825728 |
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| author | Samuel Wanji Theobald Mue Nji Louise Hamill Laura Dean Kim Ozano Abdel J. Njouendou Raphael A. Abong Elisabeth Dibando Obie Andrew Amuam Relindis Ekanya Winston Patrick Chounna Ndongmo Bertrand L. Ndzeshang Ebua Gallus Fung Dum-Buo Nnamdi Desmond Akumtoh Nkimbeng Samuel Teghen Emmanuel Kah Helen Piotrowski Armelle Forrer Jahangir A. M. Khan Maame E. Woode Louis Niessen Victoria Watson Zakariaou Njoumemi Michele E. Murdoch Rachael Thomson Sally Theobald Peter Enyong Joseph D. Turner Mark J. Taylor |
| author_facet | Samuel Wanji Theobald Mue Nji Louise Hamill Laura Dean Kim Ozano Abdel J. Njouendou Raphael A. Abong Elisabeth Dibando Obie Andrew Amuam Relindis Ekanya Winston Patrick Chounna Ndongmo Bertrand L. Ndzeshang Ebua Gallus Fung Dum-Buo Nnamdi Desmond Akumtoh Nkimbeng Samuel Teghen Emmanuel Kah Helen Piotrowski Armelle Forrer Jahangir A. M. Khan Maame E. Woode Louis Niessen Victoria Watson Zakariaou Njoumemi Michele E. Murdoch Rachael Thomson Sally Theobald Peter Enyong Joseph D. Turner Mark J. Taylor |
| author_sort | Samuel Wanji |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-21T18:33:28Z |
| format | Article |
| id | doaj.art-461a69575fce44e5b20bcada9f192621 |
| institution | Directory Open Access Journal |
| issn | 1756-3305 |
| language | English |
| last_indexed | 2024-12-21T18:33:28Z |
| publishDate | 2019-12-01 |
| publisher | BMC |
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| series | Parasites & Vectors |
| spelling | doaj.art-461a69575fce44e5b20bcada9f1926212022-12-21T18:54:13ZengBMCParasites & Vectors1756-33052019-12-0112111310.1186/s13071-019-3826-8Implementation 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 protocolSamuel Wanji0Theobald Mue Nji1Louise Hamill2Laura Dean3Kim Ozano4Abdel J. Njouendou5Raphael A. Abong6Elisabeth Dibando Obie7Andrew Amuam8Relindis Ekanya9Winston Patrick Chounna Ndongmo10Bertrand L. Ndzeshang11Ebua Gallus Fung12Dum-Buo Nnamdi13Desmond Akumtoh Nkimbeng14Samuel Teghen15Emmanuel Kah16Helen Piotrowski17Armelle Forrer18Jahangir A. M. Khan19Maame E. Woode20Louis Niessen21Victoria Watson22Zakariaou Njoumemi23Michele E. Murdoch24Rachael Thomson25Sally Theobald26Peter Enyong27Joseph D. Turner28Mark J. Taylor29COUNTDOWN, Department of Microbiology and Parasitology, Faculty of Science, University of BueaCOUNTDOWN, Research Foundation for Tropical Diseases and EnvironmentSightsaversCOUNTDOWN, Department of International Public Health, Liverpool School of Tropical MedicineCOUNTDOWN, Department of International Public Health, Liverpool School of Tropical MedicineCOUNTDOWN, Research Foundation for Tropical Diseases and EnvironmentCOUNTDOWN, Department of Microbiology and Parasitology, Faculty of Science, University of BueaCOUNTDOWN, Department of Microbiology and Parasitology, Faculty of Science, University of BueaCOUNTDOWN, Department of Microbiology and Parasitology, Faculty of Science, University of BueaCOUNTDOWN, Department of Microbiology and Parasitology, Faculty of Science, University of BueaCOUNTDOWN, Department of Microbiology and Parasitology, Faculty of Science, University of BueaCOUNTDOWN, Department of Microbiology and Parasitology, Faculty of Science, University of BueaCOUNTDOWN, Research Foundation for Tropical Diseases and EnvironmentCOUNTDOWN, Research Foundation for Tropical Diseases and EnvironmentCOUNTDOWN, Department of Microbiology and Parasitology, Faculty of Science, University of BueaCOUNTDOWN, Department of Microbiology and Parasitology, Faculty of Science, University of BueaCOUNTDOWN, Department of Microbiology and Parasitology, Faculty of Science, University of BueaCOUNTDOWN, Department of International Public Health, Liverpool School of Tropical MedicineCOUNTDOWN, Department of Tropical Disease Biology, Liverpool School of Tropical MedicineCOUNTDOWN, Department of Clinical Sciences, Liverpool School of Tropical MedicineCentre for Health Economics, Monash UniversityCOUNTDOWN, Department of International Public Health, Liverpool School of Tropical MedicineCOUNTDOWN, Department of Clinical Sciences, Liverpool School of Tropical MedicineHealth Economics Unit, Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaounde ICOUNTDOWN, Department of Tropical Disease Biology, Liverpool School of Tropical MedicineCOUNTDOWN, Department of Tropical Disease Biology, Liverpool School of Tropical MedicineCOUNTDOWN, Department of International Public Health, Liverpool School of Tropical MedicineCOUNTDOWN, Department of Microbiology and Parasitology, Faculty of Science, University of BueaCOUNTDOWN, Department of Tropical Disease Biology, Liverpool School of Tropical MedicineCOUNTDOWN, Department of Tropical Disease Biology, Liverpool School of Tropical MedicineAbstract 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.https://doi.org/10.1186/s13071-019-3826-8OnchocerciasisOnchodermatitisWolbachiaDoxycyclineCameroonVector Control |
| spellingShingle | Samuel Wanji Theobald Mue Nji Louise Hamill Laura Dean Kim Ozano Abdel J. Njouendou Raphael A. Abong Elisabeth Dibando Obie Andrew Amuam Relindis Ekanya Winston Patrick Chounna Ndongmo Bertrand L. Ndzeshang Ebua Gallus Fung Dum-Buo Nnamdi Desmond Akumtoh Nkimbeng Samuel Teghen Emmanuel Kah Helen Piotrowski Armelle Forrer Jahangir A. M. Khan Maame E. Woode Louis Niessen Victoria Watson Zakariaou Njoumemi Michele E. Murdoch Rachael Thomson Sally Theobald Peter Enyong Joseph D. Turner Mark J. Taylor 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 Onchocerciasis Onchodermatitis Wolbachia Doxycycline Cameroon Vector Control |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | Onchocerciasis Onchodermatitis Wolbachia Doxycycline Cameroon Vector Control |
| url | https://doi.org/10.1186/s13071-019-3826-8 |
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