Abstract
Since its initiation in 1995, the African Program for Onchocerciasis Control (APOC) has had a substantial impact on the prevalence and burden of onchocerciasis through annual ivermectin mass treatment. Ivermectin is a broad-spectrum anti-parasitic agent that also has an impact on other co-endemic parasitic infections. In this study, we roughly assessed the additional impact of APOC activities on the burden of the most important off-target infections: soil-transmitted helminthiases (STH; ascariasis, trichuriasis, hookworm, and strongyloidiasis), lymphatic filariasis (LF), and scabies. Based on a literature review, we formulated assumptions about the impact of ivermectin treatment on the disease burden of these off-target infections. Using data on the number of ivermectin treatments in APOC regions and the latest estimates of the burden of disease, we then calculated the impact of APOC activities on off-target infections in terms of disability-adjusted life years (DALYs) averted. We conservatively estimated that between 1995 and 2010, annual ivermectin mass treatment has cumulatively averted about 500 thousand DALYs from co-endemic STH infections, LF, and scabies. This impact comprised approximately an additional 5.5% relative to the total burden averted from onchocerciasis (8.9 million DALYs) and indicates that the overall cost-effectiveness of APOC is even higher than previously reported.
Highlights
The African Program for Onchocerciasis Control (APOC) is an international program aimed at controlling the disease burden of human onchocerciasis in sub-Saharan Africa (SSA), and elimination of infection where possible, using mass drug treatment (MDA) [1,2]
Onchocerciasis, or river blindness, is an infectious disease caused by the worm Onchocerca volvulus, which is transmitted between humans through the bites of blackflies and causes deforming skin disease, itch, and vision loss
We estimated that without APOC, the potential disease burden of soil-transmitted helminth (STH) infections, lymphatic filariasis, and epidermal parasitic skin diseases (EPSDs) in individuals otherwise treated with ivermectin would amount to a cumulative burden of 1.7 million disability-adjusted life years (DALYs) between 1995 and 2010
Summary
The African Program for Onchocerciasis Control (APOC) is an international program aimed at controlling the disease burden of human onchocerciasis (river blindness) in sub-Saharan Africa (SSA), and elimination of infection where possible, using mass drug treatment (MDA) [1,2]. Despite the lack of comprehensive epidemiological data, it is known that EPSDs are prevalent across SSA and that the associated morbidity is significant in regions of high poverty [9,14,15]. Together, these infections are responsible for a considerable burden of disease [14,15]. Annual mass treatment with ivermectin is expected to have an additional health impact by averting part of the burden related to these off-target infections [8,16,17,18,19] These additional beneficial effects of ivermectin are being used to sensitise communities to participate in MDA, up till the off-target health impact has not been quantified and its importance remains unknown
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