Turner Hugo C, Walker Martin, Churcher Thomas S, Osei-Atweneboana Mike Y, Biritwum Nana-Kwadwo, Hopkins Adrian, Prichard Roger K, Basáñez María-Gloria
Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary's Campus), Imperial College London, United Kingdom.
Council for Scientific and Industrial Research, Water Research Institute.
Clin Infect Dis. 2014 Oct;59(7):923-32. doi: 10.1093/cid/ciu467. Epub 2014 Jun 18.
Recently, there has been a shift in onchocerciasis control policy, changing from prevention of morbidity toward elimination of infection. Switching from annual to biannual ivermectin distribution may accelerate progress toward the elimination goals. However, the settings where this strategy would be cost effective in Africa have not been described.
An onchocerciasis transmission framework (EpiOncho) was coupled to a disease model in order to explore the impact on disability-adjusted life years averted, program cost, and program duration of biannual ivermectin treatment in different epidemiological and programmatic scenarios in African savannah.
While biannual treatment yields only small additional health gains, its benefit is pronounced in the context of the elimination goals, shortening the time frames for and increasing the feasibility of reaching the proposed operational thresholds for stopping treatment. In settings with high precontrol endemicity (and/or poor coverage and compliance), it may not be possible to reach such thresholds even within 50 years of annual ivermectin, requiring adoption of biannual treatment. Our projections highlight the crucial role played by coverage and compliance in achieving the elimination goals.
Biannual ivermectin treatment improves the chances of reaching the 2020/2025 elimination goals, potentially generating programmatic cost savings in settings with high precontrol endemicity. However, its benefit and cost are highly sensitive to levels of systematic noncompliance and, in many settings, it will lead to an increase in costs. Furthermore, it may not always be feasible to implement biannual treatment, particularly in hard-to-reach populations. This highlights the continued need for a macrofilaricide.
最近，盘尾丝虫病控制政策发生了转变，从预防发病转向消除感染。从每年分发伊维菌素改为每两年分发一次可能会加快实现消除目标的进程。然而，尚未描述该策略在非洲具有成本效益的实施环境。
将盘尾丝虫病传播框架（EpiOncho）与疾病模型相结合，以探讨在非洲大草原不同的流行病学和规划情景下，每两年进行一次伊维菌素治疗对避免残疾调整生命年、项目成本和项目持续时间的影响。
虽然每两年进行一次治疗仅能带来少量额外的健康收益，但其在消除目标背景下的益处显著，缩短了达到提议的停止治疗操作阈值的时间框架并增加了可行性。在控制前流行率高（和/或覆盖率及依从性差）的环境中，即使每年使用伊维菌素治疗50年也可能无法达到这些阈值，需要采用每两年治疗一次的方案。我们的预测突出了覆盖率和依从性在实现消除目标中所起的关键作用。
每两年进行一次伊维菌素治疗提高了实现2020/2025年消除目标的机会，在控制前流行率高的环境中可能节省项目成本。然而，其益处和成本对系统性不依从水平高度敏感，在许多环境中，这将导致成本增加。此外，每两年进行一次治疗可能并不总是可行的，特别是在难以到达的人群中。这凸显了对一种杀成虫剂的持续需求。
