Molecular and Biochemical Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK.
Parasit Vectors. 2012 Mar 20;5:53. doi: 10.1186/1756-3305-5-53.
Anti-Wolbachia treatment with doxycycline is effective in sterilising and killing adult Onchocerca volvulus nematodes, proving superior to ivermectin and of great potential as an alternative approach for the treatment and control of onchocerciasis, particularly in areas of Loa loa co-endemicity. Nevertheless, the length of the required treatment poses potential logistical problems and risk of poor compliance, raising a barrier to the use of doxycycline in Mass Drug Administration (MDA) strategies. In 2007 and 2008 a feasibility trial of community-directed treatment with doxycycline was carried out in two health districts in Cameroon, co-endemic for O. volvulus and L. loa. With 17,519 eligible subjects, the therapeutic coverage was 73.8% with 97.5% compliance, encouraging the feasibility of using doxycycline community-directed delivery in restricted populations of this size. The current study evaluated the effectiveness of this community-directed delivery of doxycycline four years after delivery.
Infection with O. volvulus was evaluated by skin biopsy and nodule palpation. Of the 507 subjects recruited, 375 had completed the treatment with doxycycline followed by one or two rounds of annual ivermectin MDA and 132 received one or two rounds of annual ivermectin MDA alone. Statistically significant lower microfilarial prevalence (17.0% [doxycycline plus ivermectin group], 27.0% [ivermectin only group], p = 0.014) and load (p = 0.012) were found in people that had received doxycycline followed by ivermectin compared to those who received ivermectin only.
This study demonstrates the long-term effectiveness of doxycycline treatment delivered with a community-directed strategy even when evaluated four years after delivery in an area of ongoing transmission. This finding shows that a multi-week course of treatment is not a barrier to community-delivery of MDA in restricted populations of this size and supports its implementation to compliment existing control strategies for onchocerciasis, where needed.
多西环素抗沃尔巴克氏体治疗对成年盘尾丝虫具有绝育和杀灭作用，优于伊维菌素，作为治疗和控制盘尾丝虫病的替代方法具有巨大潜力，尤其是在罗阿罗阿共疫区。然而，所需治疗的持续时间带来了潜在的后勤问题和低依从性风险，这对多西环素在大规模药物治疗（MDA）策略中的使用构成了障碍。2007 年和 2008 年，在喀麦隆两个奥氏丝虫和罗阿罗阿共疫区的卫生区进行了社区定向多西环素治疗可行性试验。共有 17519 名合格受试者，治疗覆盖率为 73.8%，依从率为 97.5%，这令人鼓舞地证明了在这种规模的受限人群中使用社区定向多西环素输送的可行性。本研究评估了在治疗结束四年后，这种社区定向多西环素输送的有效性。
通过皮肤活检和结节触诊评估奥氏丝虫感染情况。在招募的 507 名受试者中，375 名完成了多西环素治疗，随后进行了一轮或两轮年度伊维菌素 MDA，132 名仅接受了一轮或两轮年度伊维菌素 MDA。接受多西环素联合伊维菌素治疗的人群的微丝蚴患病率（17.0%[多西环素+伊维菌素组]，27.0%[伊维菌素组]，p=0.014）和负荷（p=0.012）明显低于仅接受伊维菌素治疗的人群。
即使在治疗结束四年后，在持续传播的地区，采用社区定向策略进行多西环素治疗也能长期有效。这一发现表明，多西环素治疗的多周疗程并不是在这种规模的受限人群中进行 MDA 社区治疗的障碍，并支持在需要时将其纳入现有的盘尾丝虫病控制策略。
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