Assessing Performance of Community-Directed Treatment with Ivermectin between Onchocerciasis Control and Elimination Programs in Uganda Open Access

Tollefson, Deanna Kristine (2012)

Permanent URL: https://etd.library.emory.edu/concern/etds/qj72p7320?locale=en
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Abstract

Purpose: Despite the success of community-directed treatment with ivermectin (CDTI) to control onchocerciasis, onchocerciasis continues to annually cost the world one million DALYs. Despite effective CDTI in Uganda, 2.5 million people remain at risk for onchocerciasis. To address this, in 2007 Uganda changed its onchocerciasis programs from control to elimination, replacing once-annual with twice-annual distribution of ivermectin. This evaluation assesses the effectiveness of Uganda's elimination program in comparison to its control program, and it determines factors associated with CDTI success to ensure Uganda can move successfully toward elimination.

Methods: Annual surveys collected data on CDTI from households in Uganda. Data were compared under onchocerciasis control and elimination programs (2004-2006 versus 2007, 2009, and 2010, respectively). Ivermectin treatment coverage was analyzed at the household, community, and district level, with at least 90% ivermectin coverage of the eligible population defined as success. Multivariate logistic regressions were used to identify associations between CDTI programming variables and receipt of ivermectin. Trends in CDTI programming were compared over time.

Results: Approximately eleven thousand persons were sampled from 2004-2010, with ≥90% reporting to have received ivermectin each year. Ivermectin coverage increased under the elimination program, with 97.1% and 94.0% of respondents receiving at least once-annual and twice-annual treatment, respectively, compared to 92.3% receiving ivermectin under the onchocerciasis control program. Compared to the control program, the percentage of communities achieving 90% ivermectin coverage was greater for once-annual treatment but lesser for twice-annual treatment under elimination policy. Personal investment in CDTI was strongly associated with receiving once-annual treatment in both control and elimination programs, whereas the location of treatment and coordination with the kinship unit were strongly associated with twice-annual receipt of ivermectin. The elimination program increased convenience of ivermectin treatment, but it may be less rooted in the community than the control program.

Discussion:
To date, Uganda's onchocerciasis elimination approach has been more effective in providing ivermectin than the control program, but increased efforts are necessary to ensure twice-annual ivermectin coverage is achieved in all communities. Factors extrinsic to the community involvement in CDTI must be investigated to better understand variables that influence twice-annual receipt of ivermectin.


Table of Contents

Introduction.................................1

Literature Review..........................3

Purpose of Study.........................10

Methods.....................................11

Results.......................................15

Objective One.....................15

Objective Two.....................18

Objective Three...................20

Discussion..................................23

Limitations.........................27

Programming Implications

and Future Research...........28

Conclusion.................................30

References.................................31

Figures......................................38

Tables.......................................43

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