Ministry of Public Health and Population, Port-au-Prince, Haiti.
IMA World Health, Port-au-Prince, Haiti.
PLoS Negl Trop Dis. 2016 Oct 5;10(10):e0004954. doi: 10.1371/journal.pntd.0004954. eCollection 2016 Oct.
Lymphatic filariasis (LF) and soil-transmitted helminths (STH) have been targeted since 2000 in Haiti, with a strong mass drug administration (MDA) program led by the Ministry of Public Health and Population and its collaborating international partners. By 2012, Haiti's neglected tropical disease (NTD) program had reached full national scale, and with such consistently good epidemiological coverage that it is now able to stop treatment for LF throughout almost all of the country. Essential to this success have been in the detail of how MDAs were implemented. These key programmatic elements included ensuring strong community awareness through an evidence-based, multi-channel communication and education campaign facilitated by voluntary drug distributors; strengthening community trust of the drug distributors by ensuring that respected community members were recruited and received appropriate training, supervision, identification, and motivation; enforcing a "directly observed treatment" strategy; providing easy access to treatment though numerous distribution posts and a strong drug supply chain; and ensuring quality data collection that was used to guide and inform MDA strategies. The evidence that these strategies were effective lies in both the high treatment coverage obtained- 100% geographical coverage reached in 2012, with almost all districts consistently achieving well above the epidemiological coverage targets of 65% for LF and 75% for STH-and the significant reduction in burden of infection- 45 communes having reached the target threshold for stopping treatment for LF. By taking advantage of sustained international financial and technical support, especially during the past eight years, Haiti's very successful MDA campaign resulted in steady progress toward LF elimination and development of a strong foundation for ongoing STH control. These efforts, as described, have not only helped establish the global portfolio of "best practices" for NTD control but also are poised to help solve two of the most important future NTD challenges-how to maintain control of STH infections after the community-based LF "treatment platform" ceases and how to ensure appropriate morbidity management for patients currently suffering from lymphatic filarial disease.
淋巴丝虫病 (LF) 和土壤传播性蠕虫 (STH) 自 2000 年以来一直是海地的目标，由公共卫生和人口部及其合作的国际伙伴领导的大规模药物管理 (MDA) 计划一直在进行。到 2012 年，海地的被忽视热带病 (NTD) 计划已全面覆盖全国，由于流行病学覆盖率一直很好，现在几乎可以在全国范围内停止 LF 的治疗。这一成功的关键在于 MDA 实施的细节。这些关键的计划要素包括：通过由志愿药物分发者推动的基于证据的多渠道沟通和教育运动，确保社区有强烈的意识；通过确保招募和培训有适当尊重的社区成员、对他们进行监督、识别和激励，增强社区对药物分发者的信任；实施“直接观察治疗”策略；通过众多分发点和强大的药物供应链提供便捷的治疗途径；并确保收集高质量的数据，用于指导和告知 MDA 策略。这些策略有效的证据在于所获得的高治疗覆盖率-2012 年实现了 100%的地理覆盖，几乎所有地区都始终远远超过 LF 和 STH 的流行病学覆盖率目标（65%和 75%）-以及感染负担的显著减少-45 个公社已经达到停止 LF 治疗的目标阈值。通过利用持续的国际财政和技术支持，特别是在过去八年中，海地非常成功的 MDA 运动取得了稳步进展，朝着 LF 消除的目标迈进，并为持续的 STH 控制奠定了坚实的基础。正如所描述的那样，这些努力不仅有助于确立全球 NTD 控制的“最佳实践”组合，而且也有望帮助解决两个最重要的未来 NTD 挑战-如何在社区为基础的 LF“治疗平台”停止后保持 STH 感染的控制，以及如何确保当前患有淋巴丝虫病的患者得到适当的发病率管理。
