Whitworth J A, Alexander N D, Seed P, Thomas W, Abiose A, Jones B R
London School of Hygiene and Tropical Medicine, UK.
Health Policy Plan. 1996 Sep;11(3):299-307. doi: 10.1093/heapol/11.3.299.
We have investigated various aspects related to managing wide-scale ivermectin distribution schemes within randomized controlled trials in communities where onchocerciasis is endemic. Multiple logistic regression analysis of determinants of compliance to five doses of ivermectin in 589 people in Sierra Leone showed independent significant associations with leopard skin depigmentation, the severity of side effects of treatment, fulfilling the exclusion criteria for treatment, and long-term residence in the community. These results are useful for tailoring health promotion messages in Sierra Leone, but the associations may differ in other West African societies. In Nigeria 1847 people were interviewed about various subjective responses, including itching. None of these showed clear improvement after three years of ivermectin treatment. Positive comments about treatment were generally non-specific and similar in the placebo and ivermectin groups. Negative comments were usually related to adverse reactions, especially itching and rash, and were more common after ivermectin. The lack of any benefit attributable to ivermectin that is discernible to its recipients may make it difficult to maintain the high compliance rates needed for long periods if mass dosing programmes are to have a lasting impact on onchocerciasis. In addition, no consistent effects of ivermectin were found by measuring visual acuity, height, weight or haematocrit in comparison with placebo. This may indicate that evidence of clinical impact is very slow to develop and is hard to measure using simple objective methods after only three doses of treatment. At present it seems that parasitological, entomological and detailed ophthalmological or dermatological methods are required to demonstrate the impact of ivermectin treatment in the medium-term.
我们在盘尾丝虫病流行的社区中，对随机对照试验中大规模伊维菌素分发计划管理的各个方面进行了调查。对塞拉利昂589人接受五剂伊维菌素治疗依从性的决定因素进行的多因素逻辑回归分析显示，与豹皮样色素脱失、治疗副作用的严重程度、符合治疗排除标准以及在社区长期居住存在独立显著关联。这些结果有助于调整塞拉利昂的健康促进信息，但在其他西非社会，这些关联可能有所不同。在尼日利亚，对1847人进行了关于各种主观反应（包括瘙痒）的访谈。在伊维菌素治疗三年后，这些反应均未显示出明显改善。对治疗的积极评价通常不具体，在安慰剂组和伊维菌素组中相似。负面评价通常与不良反应有关，尤其是瘙痒和皮疹，在使用伊维菌素后更为常见。如果大规模给药计划要对盘尾丝虫病产生持久影响，而接受者却无法察觉到伊维菌素有任何益处，这可能会使难以长期维持所需的高依从率。此外，与安慰剂相比，通过测量视力、身高、体重或血细胞比容未发现伊维菌素有一致的效果。这可能表明临床影响的证据发展非常缓慢，在仅接受三剂治疗后，很难用简单的客观方法进行测量。目前看来，需要采用寄生虫学、昆虫学以及详细的眼科或皮肤病学方法来证明伊维菌素治疗在中期的影响。
