Reaching the London Declaration on Neglected Tropical Diseases Goals for Onchocerciasis: An Economic Evaluation of Increasing the Frequency of Ivermectin Treatment in Africa

Turner, Hugo C.; Walker, Martin; Churcher, Thomas S.; Osei-Atweneboana, Mike Y.; Biritwum, Nana‐Kwadwo; Hopkins, Adrian; Prichard, Roger K.; Basáñez, María‐Gloria

doi:10.1093/cid/ciu467

Cited by 86 publications

(104 citation statements)

References 28 publications

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“…Current approaches to increase the frequency of MDA from annual to biannual treatments are predicted to improve the chances of reaching the 2020/2025 elimination goals at least in some countries. However, its benefits and costs are highly sensitive to systematic noncompliance and it may not always be feasible to implement biannual treatment, particularly in hard-to-reach populations [6, 7, 42]. In addition, given the problem of re-emergence of infections, suboptimal efficacy of IVM [10] and regions that are co-endemic for Loa loa , the development of new drugs or drug regimens is urgently needed to achieve the elimination of onchocerciasis.…”

Section: Discussionmentioning

confidence: 99%

“…Simulation studies have suggested that administering IVM at shorter intervals of 6 instead of 12 months intervals have a higher likelihood of eliminating the infection, but incur large logistical costs on health infrastructures of the endemic countries [6, 7]. Immigration of infected persons into areas where filariasis is considered eliminated and IVM treatment has ceased may occur with potential re-emergence of the disease.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of Doxycycline, Minocycline, Doxycycline plus Albendazole and Albendazole Alone in Their Efficacy against Onchocerciasis in a Randomized, Open-Label, Pilot Trial

et al. 2017

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The search for new macrofilaricidal drugs against onchocerciasis that can be administered in shorter regimens than required for doxycycline (DOX, 200mg/d given for 4–6 weeks), identified minocycline (MIN) with superior efficacy to DOX. Further reduction in the treatment regimen may be achieved with co-administration with standard anti-filarial drugs. Therefore a randomized, open-label, pilot trial was carried out in an area in Ghana endemic for onchocerciasis, comprising 5 different regimens: the standard regimen DOX 200mg/d for 4 weeks (DOX 4w, N = 33), the experimental regimens MIN 200mg/d for 3 weeks (MIN 3w; N = 30), DOX 200mg/d for 3 weeks plus albendazole (ALB) 800mg/d for 3 days (DOX 3w + ALB 3d, N = 32), DOX 200mg/d for 3 weeks (DOX 3w, N = 31) and ALB 800mg for 3 days (ALB 3d, N = 30). Out of 158 randomized participants, 116 (74.4%) were present for the follow-up at 6 months of whom 99 participants (63.5%) followed the treatment per protocol and underwent surgery. Histological analysis of the adult worms in the extirpated nodules revealed absence of Wolbachia in 98.8% (DOX 4w), 81.4% (DOX 3w + ALB 3d), 72.7% (MIN 3w), 64.1% (DOX 3w) and 35.2% (ALB 3d) of the female worms. All 4 treatment regimens showed superiority to ALB 3d (p < 0.001, p < 0.001, p = 0.002, p = 0.008, respectively), which was confirmed by real-time PCR. Additionally, DOX 4w showed superiority to all other treatment arms. Furthermore DOX 4w and DOX 3w + ALB 3d showed a higher amount of female worms with degenerated embryogenesis compared to ALB 3d (p = 0.028, p = 0.042, respectively). These results confirm earlier studies that DOX 4w is sufficient for Wolbachia depletion and the desired parasitological effects. The data further suggest that there is an additive effect of ALB (3 days) on top of that of DOX alone, and that MIN shows a trend for stronger potency than DOX. These latter two results are preliminary and need confirmation in a fully randomized controlled phase 2 trial.Trial Registration: ClinicalTrials.gov #06010453

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of Doxycycline, Minocycline, Doxycycline plus Albendazole and Albendazole Alone in Their Efficacy against Onchocerciasis in a Randomized, Open-Label, Pilot Trial

et al. 2017

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“…Lymphatic filariasis (caused by infection with Brugia malayi , Brugia timori or Wuchereria bancrofti ) and onchocerciasis (caused by infection with Onchocerca volvulus ) together result in the loss of 5.7 million disability adjusted life years (Mathers et al, 2007). As a result, these diseases have been identified by the international community as two of the five Neglected Tropical Diseases (NTDs) worldwide, and both have been targeted for elimination by the international community in the London Declaration on Neglected Tropical Diseases (Turner et al, 2014). …”

Section: Introductionmentioning

confidence: 99%

Phenotypic and molecular analysis of the effect of 20-hydroxyecdysone on the human filarial parasite Brugia malayi

Mhashilkar

Adapa

Jiang

et al. 2016

International Journal for Parasitology

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A homologue of the ecdysone receptor has been identified and shown to be responsive to 20-hydroxyecdysone in Brugia malayi. However, the role of this master regulator of insect development has not been delineated in filarial nematodes. Gravid adult female B. malayi cultured in the presence of 20-hydroxyecdysone produced significantly more microfilariae and abortive immature progeny than control worms, implicating the ecdysone receptor in regulation of embryogenesis and microfilarial development. Transcriptome analyses identified 30 genes whose expression was significantly up-regulated in 20-hydroxyecdysone-treated parasites compared with untreated controls. Of these, 18% were identified to be regulating transcription. A comparative proteomic analysis revealed 932 proteins to be present in greater amounts in extracts of 20-hydroxyecdysone-treated adult females than in extracts prepared from worms cultured in the absence of the hormone. Of the proteins exhibiting a greater than two-fold difference in the 20-hydroxyecdysone-treated versus untreated parasite extracts, 16% were involved in transcriptional regulation. RNA interference (RNAi) phenotype analysis of Caenorhabditis elegans orthologs revealed that phenotypes involved in developmental processes associated with embryogenesis were significantly over-represented in the transcripts and proteins that were up-regulated by exposure to 20-hydroxyecdysone. Taken together, the transcriptomic, proteomic and phenotypic data suggest that the filarial ecdysone receptor may play a role analogous to that in insects, where it serves as a regulator of egg development.

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“…There are also a few reports of the effects of drug donation programs in the form of monographs [24, 25]. Additionally, there are a few published economic evaluations of medical donation programs [26–29]. Given the size and scale of global donation programs, there is a need for more impact assessments and greater consistency and transparency in reporting performance metrics.…”

Section: Introductionmentioning

confidence: 99%

Assessment of the scope and practice of evaluation among medical donation programs

Jenny

Ashbourne

et al. 2016

Global Health

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BackgroundMedical donation programs for drugs, other medical products, training and other supportive services can improve access to essential medicines in low- and middle-income countries (LMICs) and provide emergency and disaster relief. The scope and extent to which medical donation programs evaluate their impact on recipients and health systems is not well documented.MethodsWe conducted a survey of the member organizations of the Partnership for Quality Medical Donations (PQMD), a global alliance of non-profit and corporate organizations, to identify evaluations conducted in conjunction with donation programs.ResultsTwenty-five out of the 36 PQMD organizations that were members at the time of the survey participated in the study, for a response rate of 69 %. PQMD members provided information on 34 of their major medical donation programs. Half of the donation programs reported conducting trainings as a part of their donation program. Twenty-six (76 %) programs reported that they conduct routine monitoring of their donation programs. Less than 30 % of donation programs were evaluated for their impact on health. Lack of technical staff and lack of funding were reported as key barriers to conducting impact evaluations.ConclusionsMember organizations of PQMD provide a broad range of medical donations, targeting a wide range of public health issues and events. While some level of monitoring and evaluation was conducted in nearly 80 % of the donation programs, a program’s impact was infrequently evaluated. Opportunities exist to develop consistent metrics for medical donation programs, develop a common framework for impact evaluations, and advocate for data collection and analysis plans that collect meaningful metrics.

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Reaching the London Declaration on Neglected Tropical Diseases Goals for Onchocerciasis: An Economic Evaluation of Increasing the Frequency of Ivermectin Treatment in Africa

Cited by 86 publications

References 28 publications

Comparison of Doxycycline, Minocycline, Doxycycline plus Albendazole and Albendazole Alone in Their Efficacy against Onchocerciasis in a Randomized, Open-Label, Pilot Trial

Comparison of Doxycycline, Minocycline, Doxycycline plus Albendazole and Albendazole Alone in Their Efficacy against Onchocerciasis in a Randomized, Open-Label, Pilot Trial

Phenotypic and molecular analysis of the effect of 20-hydroxyecdysone on the human filarial parasite Brugia malayi

Assessment of the scope and practice of evaluation among medical donation programs

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