03089nas a2200313   4500000000100000008004100001260004400042653002400086100001400110700001600124700001300140700001900153700001300172700001600185700001300201700001200214700001200226700001400238700001400252700001400266700001800280700001800298245014700316856008600463300000900549490000700558520219600565022001402761       2023                            d  bSpringer Science and Business Media LLC10aInfectious Diseases1 aOtabil KB1 aBasáñez M1 aAnkrah B1 aBart-Plange EJ1 aBabae TN1 aKudzordzi P1 aDarko VA1 aRaji AS1 aDatsa L1 aBoakye AA1 aYeboah MT1 aFodjo JNS1 aSchallig HDFH1 aColebunders R00aNon-adherence to ivermectin in onchocerciasis-endemic communities with persistent infection in the Bono Region of Ghana: a mixed-methods study  uhttps://bmcinfectdis.biomedcentral.com/counter/pdf/10.1186/s12879-023-08806-8.pdf  a1-140 v233 a<p><strong>Background:</strong> The World Health Organization has proposed that onchocerciasis elimination (interruption) of transmission be verified in 12 (approximately a third) endemic countries by 2030. The strategy to reach this goal is based on ivermectin Mass Drug Administration (MDA) with high geographical and therapeutic coverage. In addition to coverage, high levels of treatment adherence are paramount. We investigated factors associated with ivermectin intake in an area of Ghana with persistent Onchocerca volvulus infection.</p>

<p><strong>Methods:</strong> In August 2021, a cross-sectional mixed-methods study was conducted in 13 onchocerciasis-endemic communities in the Bono Region of Ghana. Individuals aged ≥ 10 years were invited to participate in a questionnaire survey. A total of 48 focus group discussions and in-depth interviews with 10 community drug distributors and 13 community leaders were conducted.</p>

<p><strong>Results:</strong> A total of 510 people participated in the study [median age: 32, interquartile range 30 (20‒50) years]; 274 (53.7%) were females. Of the total, 320 (62.7%) declared that they adhered to each treatment round and 190 (37.3%) admitted they had not taken ivermectin during at least one MDA round, since becoming eligible for treatment. Of 483 participants with complete information, 139 (28.8%) did not take ivermectin during the last round (March 2021), and 24 (5.0%) had never taken ivermectin (systematic non-adherers). Reasons for not taking ivermectin included previous experience/fear of side-effects, being absent during MDA, pregnancy, the desire to drink alcohol, and drug distribution challenges. Being male, having good knowledge and perception of the disease, and not having secondary or higher level of formal education were significantly associated with higher odds of ivermectin intake.</p>

<p><strong>Conclusions:</strong> A relatively high level of non-adherence to ivermectin treatment was documented. There is a need for targeted educational and behavioural change campaigns to reverse these trends and ensure a steady course toward meeting onchocerciasis elimination targets in Ghana.</p>
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