Abstract
River blindness (onchocerciasis) causes severe itching, skin lesions, and vision impairment including blindness. More than 99% of all current cases are found in sub-Saharan Africa. Fortunately, vector control and community-directed treatment with ivermectin have significantly reduced morbidity. Studies in Mali and Senegal proved the feasibility of elimination with ivermectin administration. The treatment goal is shifting from control to elimination in endemic African regions. Given limited resources, national and global policymakers need a rigorous analysis comparing investment options. For this, we developed scenarios for alternative treatment goals and compared treatment timelines and drug needs between the scenarios. Control, elimination, and eradication scenarios were developed with reference to current standard practices, large-scale studies, and historical data. For each scenario, the timeline when treatment is expected to stop at country level was predicted using a dynamical transmission model, and ivermectin treatment needs were predicted based on population in endemic areas, treatment coverage data, and the frequency of community-directed treatment. The control scenario requires community-directed treatment with ivermectin beyond 2045 with around 2.63 billion treatments over 2013–2045; the elimination scenario, until 2028 in areas where feasible, but beyond 2045 in countries with operational challenges, around 1.15 billion treatments; and the eradication scenario, lasting until 2040, around 1.30 billion treatments. The eradication scenario is the most favorable in terms of the timeline of the intervention phase and treatment needs. For its realization, strong health systems and political will are required to overcome epidemiological and political challenges.
Highlights
Elimination of neglected tropical diseases (NTDs) has recently emerged on the global health agenda and gained prominence with the release of the global plan to combat NTDs by the World Health Organization (WHO) [1]
More than 99% of all current cases are found in sub-Saharan Africa where the disease has historically hindered socioeconomic
The treatment goal is shifting from control to elimination in Africa as morbidity has significantly decreased through vector control and communitydirected treatment with ivermectin
Summary
Elimination of neglected tropical diseases (NTDs) has recently emerged on the global health agenda and gained prominence with the release of the global plan to combat NTDs by the World Health Organization (WHO) [1]. One of the NTDs targeted for elimination is onchocerciasis (river blindness). This is a parasitic disease caused by filariae that are transmitted by blackflies. Onchocerciasis is endemic in parts of Africa, Latin America, and Yemen, but over 99% of all current cases are found in sub-Saharan Africa [6] where onchocerciasis has historically been a serious public health problem and hindered socioeconomic development in endemic areas [7]. The Onchocerciasis Control Program (OCP), which was implemented in West Africa from1975 to 2002, and the African Programme for Onchocerciasis Control (APOC), which has supported onchocerciasis control activities in sub-Saharan countries since 1995 and continued the OCP’s activities where needed, have decreased the burden of disease to such an extent that it is no longer a public health problem in most endemic areas [8]. Political instability and security concerns that limit access to endemic areas hamper its implementation [4]
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