Abstract
BackgroundOnchocerciasis causes a considerable disease burden in Africa, mainly through skin and eye disease. Since 1995, the African Programme for Onchocerciasis Control (APOC) has coordinated annual mass treatment with ivermectin in 16 countries. In this study, we estimate the health impact of APOC and the associated costs from a program perspective up to 2010 and provide expected trends up to 2015.Methods and FindingsWith data on pre-control prevalence of infection and population coverage of mass treatment, we simulated trends in infection, blindness, visual impairment, and severe itch using the micro-simulation model ONCHOSIM, and estimated disability-adjusted life years (DALYs) lost due to onchocerciasis. We assessed financial costs for APOC, beneficiary governments, and non-governmental development organizations, excluding cost of donated drugs. We estimated that between 1995 and 2010, mass treatment with ivermectin averted 8.2 million DALYs due to onchocerciasis in APOC areas, at a nominal cost of about US$257 million. We expect that APOC will avert another 9.2 million DALYs between 2011 and 2015, at a nominal cost of US$221 million.ConclusionsOur simulations suggest that APOC has had a remarkable impact on population health in Africa between 1995 and 2010. This health impact is predicted to double during the subsequent five years of the program, through to 2015. APOC is a highly cost-effective public health program. Given the anticipated elimination of onchocerciasis from some APOC areas, we expect even more health gains and a more favorable cost-effectiveness of mass treatment with ivermectin in the near future.
Highlights
Onchocerciasis is caused by Onchocerca volvulus, a filarial nematode restricted to human hosts
Before the inception of African Programme for Onchocerciasis Control (APOC) in 1995, about 32 million people (45%) in APOC areas were infected with onchocerciasis, with 404,000 people (0.6%) blind because of onchocerciasis, another 889,000 (1.2%) suffering from visual impairment, and 10 million people (14%) suffering from troublesome itch
By 2010, about 65% of the population lived in areas subjected to 10–13 rounds of mass treatment, 17% in areas subjected to 6–9 rounds of mass treatment, 18% in areas subjected to 3–5 rounds of mass treatment, and less than 1% in areas subjected to only 1–2 rounds of mass treatment (Table 1)
Summary
Onchocerciasis is caused by Onchocerca volvulus, a filarial nematode restricted to human hosts. The microfilariae are found predominantly migrating through the skin and eyes and are transmitted by biting flies of the genus Simulium (the vector), an obligatory part of the parasite’s life cycle. Onchocerciasis is responsible for a considerable burden of disease, mainly because of visual impairment, blindness, disfiguring skin lesions, and severe itching, which are the results of continuous exposure to microfilariae. Onchocerciasis has been largely eliminated from West Africa by the Onchocerciasis Control Programme (1974–2002), which relied on intense vector control and mass treatment with the drug ivermectin [2]. Onchocerciasis causes a considerable disease burden in Africa, mainly through skin and eye disease. Since 1995, the African Programme for Onchocerciasis Control (APOC) has coordinated annual mass treatment with ivermectin in 16 countries. We estimate the health impact of APOC and the associated costs from a program perspective up to 2010 and provide expected trends up to 2015
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