Community-directed delivery of doxycycline for the treatment of onchocerciasis in areas of co-endemicity with loiasis in Cameroon

Samuel Wanji,Peter A Enyong,Julious N Che,Mathias Esum,David W Taylor,Theolbald Nji,Fifen Alassa,Armand Nkwescheu,Mark J Taylor,Achim Hoerauf,Geremy Kamnang,Nicholas Tendongfor

doi:10.1186/1756-3305-2-39

Abstract

BackgroundSevere side effects following ivermectin treatment of onchocerciasis in areas of co-endemicity with loaisis have been an impediment for the work of the African Programme for Onchocerciasis Control (APOC) in forested regions of several countries. Doxycycline has been shown to be effective in the treatment of onchocerciasis and has the added advantages of killing adult Onchocerca volvulus but neither adult Loa loa nor their microfilariae. This drug therefore offers great potential for the treatment of onchocerciasis in areas of co-endemicity with loiasis. The limitation of use of this drug is the duration of treatment that may pose a potential problem with therapeutic coverage and compliance with treatment. To benefit from the advantages that doxycycline offers in the treatment of onchocerciasis, it will be necessary to establish an effective distribution system that can access remote communities. This study assessed the feasibility of a large-scale distribution of doxycycline for the treatment of onchocerciasis in areas of co-endemicity with loiasis using a community-directed approach.MethodsThe study was carried out in 5 health areas co-endemic for Onchocerca volvulus and Loa loa which had no prior experience of the Community Directed Treatment with Ivermectin (CDTI). The community-directed delivery process was introduced using a cascade mechanism from the central health system that passed through the regional health delegation, health district and the health areas. Community health implementers (CHIs) were trained to deliver doxycycline to community members and, under the supervision of the health system, to monitor and document drug intake and side effects.ResultsThe community members adhered massively to the process. Of the 21355 individuals counted, 17519 were eligible for treatment and 12936 were treated with doxycycline; giving a therapeutic coverage of eligible population of 73.8%. Of the 12936 who started the treatment, 97.5% complied by the end of six weeks. No serious side effect was registered during the six week treatment.ConclusionThis study indicates that when empowered the community health implementers can successfully deliver doxycycline for six weeks for the treatment of onchocerciasis in areas of co-endemicity with loiasis. The therapeutic coverage and the compliance treatment rate achieved in this study coupled to the known efficacy of doxycycline on O. volvulus, are indicators that the strategy involving the mass administration of doxycycline can be used to control onchocerciasis in those areas of co-endemicity with loiasis where ivermectin may be contraindicated.

Highlights

Introduction of the community directed interventionAdvocacy meetings on the community-directed treatment with doxycycline were held with the health system at the central, regional, district levels and front-line health facilities
The therapeutic coverage and the compliance treatment rate achieved in this study coupled to the known efficacy of doxycycline on O. volvulus, are indicators that the strategy involving the mass administration of doxycycline can be used to control onchocerciasis in those areas of co-endemicity with loiasis where ivermectin may be contraindicated
Endemicity of onchocerciasis and loiasis in the study site The five health areas selected for the study were endemic for onchocerciasis and loiasis

Summary

Introduction

Advocacy meetings on the community-directed treatment with doxycycline were held with the health system at the central, regional, district levels and front-line health facilities These meetings brought together representatives of the Ministry of Health, National Onchocerciasis Task Force (NOTF), Non-governmental organisations (NGO) involved in the control of onchocerciasis and the health personnel. A new strategy involving a large-scale mass distribution of ivermectin to endemic communities [3] was rapidly put in place by APOC with an objective to eradicate onchocerciasis as a public health problem, and a barrier to socio-economic development through a community-directed treatment approach Using this approach, over 60 million people were receiving regular treatment for onchocerciasis by the end of 2008, close to one million disability-adjusted life years have been averted, the prevalence of infection has reduced by about 73% compared with pre-APOC levels. Over 60 million people were receiving regular treatment for onchocerciasis by the end of 2008, close to one million disability-adjusted life years have been averted, the prevalence of infection has reduced by about 73% compared with pre-APOC levels. [4]

Methods

Results

Discussion

Conclusion