02143nas a2200241   4500000000100000008004100001653003900042653001900081653003700100653001600137653002700153653001900180653003000199100001700229700001100246700001400257245008600271856003300357300001200390490000700402520147800409022001401887       2018                            d10aNeglected tropical diseases (NTDs)10aonchocerciasis10aAlternative treatment strategies10aElimination10aMacrofilaricidal drugs10aNew treatments10aTest-and-Treat strategies1 aBoussinesq M1 aFobi G1 aKuesel AC00aAlternative treatment strategies to accelerate the elimination of onchocerciasis.  uhttps://tinyurl.com/y7rshkg4  ai40-i480 v103 a<p>The use of alternative (or complementary) treatment strategies (ATSs) i.e. differing from annual community-directed treatment with ivermectin (CDTI) is required in some African foci to eliminate onchocerciasis by 2025. ATSs include vector control, biannual or pluriannual CDTI, better timing of CDTI, community-directed treatment with combinations of currently available anthelminthics or new drugs, and 'test-and-treat' (TNT) strategies requiring diagnosis of infection and/or contraindications to treatment for decisions on who to treat with what regimen. Two TNT strategies can be considered. Loa-first TNT, designed for loiasis-endemic areas and currently being evaluated using a rapid test (LoaScope), consists of identifying individuals with levels of Loa microfilaremia associated with a risk of post-ivermectin severe adverse events to exclude them from ivermectin treatment and in treating the rest (usually &gt;97%) of the population safely. Oncho-first TNT consists of testing community members for onchocerciasis before giving treatment (currently ivermectin or doxycycline) to those who are infected. The choice of the ATS depends on the prevalences and intensities of infection with Onchocerca volvulus and Loa loa and on the relative cost-effectiveness of the strategies for the given epidemiological situation. Modelling can help select the optimal strategies, but field evaluations to determine the relative cost-effectiveness are urgently needed.</p>
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