为何在喀麦隆西南部每年进行15次伊维菌素群体给药后盘尾丝虫病传播仍持续存在。
Why onchocerciasis transmission persists after 15 annual ivermectin mass drug administrations in South-West Cameroon.
作者信息
Forrer Armelle, Wanji Samuel, Obie Elisabeth Dibando, Nji Theobald Mue, Hamill Louise, Ozano Kim, Piotrowski Helen, Dean Laura, Njouendou Abdel J, Ekanya Relindis, Ndongmo Winston Patrick Chounna, Fung Ebua Gallus, Nnamdi Dum-Buo, Abong Raphael A, Beng Amuam Andrew, Eyong Mathias Esum, Ndzeshang Bertrand L, Nkimbeng Desmond Akumtoh, Teghen Samuel, Suireng Anicetus, Ashu Ernerstine Ebot, Kah Emmanuel, Murdoch Michele M, Thomson Rachael, Theobald Sally, Enyong Peter, Turner Joseph D, Taylor Mark J
机构信息
Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, Merseyside, UK.
Department of Disease Control, Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon.
出版信息
BMJ Glob Health. 2021 Jan;6(1). doi: 10.1136/bmjgh-2020-003248.
INTRODUCTION
Onchocerciasis is targeted for elimination mainly with annual community-directed treatment with ivermectin (CDTI). High infection levels have been reported in South-West Cameroon, despite ≥15 years of CDTI. The aim of this study was to assess factors associated with continued onchocerciasis transmission and skin disease.
METHODS
A large-scale cross-sectional study was conducted in 2017 in 20 communities in a loiasis-risk area in South-West Cameroon. A mixed-methods approach was used. Associations between infection levels, skin disease and adherence to CDTI were assessed using mixed regression modelling. Different community members' perception and acceptability of the CDTI strategy was explored using semi-structured interviews.
RESULTS
Onchocerciasis prevalence was 44.4% among 9456 participants. 17.5% of adults were systematic non-adherers and 5.9% participated in ≥75% of CDTI rounds. Skin disease affected 1/10 participants, including children. Increasing self-reported adherence to CDTI was associated with lower infection levels in participants aged ≥15 years but not in children. Adherence to CDTI was positively influenced by perceived health benefits, and negatively influenced by fear of adverse events linked with economic loss. Concern of lethal adverse events was a common reason for systematic non-adherence.
CONCLUSION
CDTI alone is unlikely to achieve elimination in those high transmission areas where low participation is commonly associated with the fear of adverse events, despite the current quasi absence of high-risk levels of loiasis. Such persisting historical memories and fear of ivermectin might impact adherence to CDTI also in areas with historical presence but current absence of loiasis. Because such issues are unlikely to be tackled by CDTI adaptive measures, alternative strategies are needed for onchocerciasis elimination where negative perception of ivermectin is an entrenched barrier to community participation in programmes.
引言
盘尾丝虫病主要通过每年进行的社区定向伊维菌素治疗（CDTI）来实现消除目标。尽管已经开展了≥15年的CDTI，但喀麦隆西南部仍报告有高感染水平。本研究的目的是评估与盘尾丝虫病持续传播和皮肤病相关的因素。
方法
2017年在喀麦隆西南部一个有罗阿丝虫病风险的地区的20个社区进行了一项大规模横断面研究。采用了混合方法。使用混合回归模型评估感染水平、皮肤病与CDTI依从性之间的关联。通过半结构化访谈探讨了不同社区成员对CDTI策略的认知和可接受性。
结果
在9456名参与者中，盘尾丝虫病患病率为44.4%。17.5%的成年人是系统性不依从者，5.9%的人参与了≥75%的CDTI轮次。皮肤病影响了十分之一的参与者，包括儿童。自我报告的CDTI依从性增加与≥15岁参与者的较低感染水平相关，但与儿童无关。对CDTI的依从性受到感知到的健康益处的积极影响，并受到与经济损失相关的不良事件恐惧的负面影响。对致命不良事件的担忧是系统性不依从的常见原因。
结论
尽管目前罗阿丝虫病的高风险水平几乎不存在，但在那些低参与率通常与对不良事件的恐惧相关的高传播地区，仅靠CDTI不太可能实现消除目标。这种持续存在的历史记忆和对伊维菌素的恐惧可能也会影响在有罗阿丝虫病历史但目前不存在该病的地区对CDTI的依从性。由于这些问题不太可能通过CDTI适应性措施得到解决，因此在伊维菌素的负面认知成为社区参与项目的顽固障碍的地区，需要采取替代策略来消除盘尾丝虫病。
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