Assessing Performance of Community-Directed Treatment with Ivermectin between Onchocerciasis Control and Elimination Programs in Uganda Público
Tollefson, Deanna Kristine (2012)
Published
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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