Abstract
Attention is increasingly focusing on how best to accelerate progress toward meeting the WHO’s 2030 goals for neglected tropical diseases (NTDs). For river blindness, a major NTD targeted for elimination, there is a long history of using vector control to suppress transmission, but traditional larvicide-based approaches are limited in their utility. One innovative and sustainable approach, “slash and clear”, involves clearing vegetation from breeding areas, and recent field trials indicate that this technique very effectively reduces the biting density of Simulium damnosum s.s. In this study, we use a Bayesian data-driven mathematical modeling approach to investigate the potential impact of this intervention on human onchocerciasis infection. We developed a novel “slash and clear” model describing the effect of the intervention on seasonal black fly biting rates and coupled this with our population dynamics model of Onchocerca volvulus transmission. Our results indicate that supplementing annual drug treatments with “slash and clear” can significantly accelerate the achievement of onchocerciasis elimination. The efficacy of the intervention is not very sensitive to the timing of implementation, and the impact is meaningful even if vegetation is cleared only once per year. As such, this community-driven technique will represent an important option for achieving and sustaining O. volvulus elimination.
Highlights
Large-scale initiatives aiming to control and eliminate neglected tropical diseases (NTDs) have made significant progress in treating at-risk populations and reducing the transmission and burden of these communicable diseases[1]
We developed a novel data-driven black fly biting rate model that considers seasonal fluctuations to account for this variation when simulating the “slash and clear” vector control intervention investigated in this study
The major result of this study that is immediately relevant for onchocerciasis elimination programmes is that supplementing annual mass drug administration (MDA) programmes with community-directed Vector control (VC) by clearing vegetation can significantly accelerate the achievement of parasite elimination in a sustainable manner
Summary
Large-scale initiatives aiming to control and eliminate neglected tropical diseases (NTDs) have made significant progress in treating at-risk populations and reducing the transmission and burden of these communicable diseases[1]. The intervention was well-accepted by community members who were motivated to reduce the biting of black flies, and it was inexpensive requiring only basic materials already available in the villages These results of the initial trials suggest that the “slash and clear” technique is highly promising for interrupting transmission in a cost-effective and sustainable manner. We developed a mathematical model of the “slash and clear” intervention to investigate the potential for this VC strategy to enhance efforts to accelerate progress toward onchocerciasis elimination. As part of this development, we introduce a new seasonal black fly biting rate model We couple this intervention model with our population dynamics model of onchocerciasis transmission[26] to evaluate the benefit of supplementing MDA with “slash and clear” VC for accelerating transmission interruption. Our forecasts suggest that “slash and clear”, when used in conjunction with IVM MDA, can significantly accelerate the achievement of onchocerciasis elimination across endemic settings
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