@article{93278,
  keywords = {Abate, Multi-disciplinary, NTD Elimination, Temephos, onchocerciasis, Vector control, Wolbachia, Cameroon, Doxycycline, Onchodermatitis},
  author = {Wanji S and Nji T and Hamill L and Dean L and Ozano K and Njouendou A and Abong R and Obie E and Amuam A and Ekanya R and Ndongmo W and Ndzeshang B and Fung E and Nnamdi D and Nkimbeng D and Teghen S and Kah E and Piotrowski H and Forrer A and Khan J and Woode M and Niessen L and Watson V and Njoumemi Z and Murdoch M and Thomson R and Theobald S and Enyong P and Turner J and Taylor M},
  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.},
  abstract = {<p><b>BACKGROUND: </b>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.</p><p><b>METHODS/DESIGN: </b>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/m) 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.</p><p><b>CONCLUSIONS: </b>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.</p>},
  year = {2019},
  journal = {Parasites & vectors},
  volume = {12},
  pages = {574},
  month = {12/2019},
  issn = {1756-3305},
  url = {https://parasitesandvectors.biomedcentral.com/track/pdf/10.1186/s13071-019-3826-8},
  doi = {10.1186/s13071-019-3826-8},
  language = {eng},
}