The Leogane, Haiti Demonstration Project: Decreased Microfilaremia and Program Costs After Three Years of Mass Drug Administration

Abstract

To support the global program to eliminate lymphatic filariasis (LF), well-monitored demonstration projects are important for defining the relationship between coverage and reductions in microfilaremia. We are using mass treatment with diethylcarbamazine (DEC) and albendazole in an effort to eliminate LF from Leogane, Haiti. Wuchereria bancrofti microfilaremia prevalence at baseline ranged from 0.8% to 15.9% in four sentinel sites. After three rounds of DEC-albendazole mass drug administration (MDA), both microfilaremia prevalence and intensity decreased dramatically. Mild and moderate adverse reactions after treatment were common, especially after the first MDA, but decreased after subsequent MDAs. Drug coverage for the first year was estimated to be 72%, but concerns about adverse reactions appeared to decrease drug coverage in the second MDA. As a result of community education efforts that focused on providing a greater understanding of adverse reactions, coverage increased dramatically for the third round. Program efficiency increased substantially; the costs per person treated for three rounds of MDA were 2.23 US dollars, 1.96 US dollars, and 1.30 US dollars per person, respectively. The Leogane experience highlights the importance of adapting community education and mobilization campaigns to achieve and maintain good coverage.

A Longitudinal Analysis of the Effect of Mass Drug Administration on Acute Inflammatory Episodes and Disease Progression in Lymphedema Patients in Léogane, Haiti

“…39 Before initiation of MDA, antigen prevalence in Léogane was 50.1%. 37 Antigen prevalence steadily decreased from 29 39 In addition to the missed MDA, systematic noncompliance, which has been reported in Lé ogane, could also contribute to the recrudescence of infection in the area. As an alternative hypothesis, significant increase in ADL episodes in this cohort since 2000 could reflect the status of the hospital's lymphedema management program and patient compliance with lymphedema management techniques.…”

“…The LF transmission level was estimated for each patient by the section of the Léogane Commune in which the patient's home was located and rated as low, intermediate, or high level transmission based on antigenemia data obtained from sentinel site surveys during 1995-2008. 37,39,44 Lymphedema-specific covariates included self-reported number of years with lymphedema and physical examination findings of number of interdigital lesions at each visit. Compliance with lymphedema management was assessed by using a hygiene composite score, which was created for each person at every time point where information was available.…”

“…37 Yearly MDA with DEC began in Lé ogane in October 2000 for persons more than two years of age. Because of concerns of toxicity, women of childbearing age were not administered albendazole until 2002.…”

Unfulfilled potential: using diethylcarbamazine-fortified salt to elimate lymphatic filariasis

“…In the context of a functioning iodization programme, existing salt distribution networks can be exploited and the costs for the intervention are largely driven by the cost of the DEC, approximately US$ 0.05-0.10 per person per year. Such costs compare favourably with annual costs for mass drug administration in many countries 39,40 and fortification with DEC has been noted to be a costeffective intervention by the Disease Control Priorities Project (a joint project of the Fogarty International Center of the US National Institutes of Health, WHO and the World Bank). 41 In countries with efficient vector transmission, such as areas of the Pacific where Aedes polynesiensis is the vector, DEC-fortified salt could have a critical role in eliminating transmission by maintaining a low level of drug pressure to provide a prophylactic benefit as well as a therapeutic benefit.…”

Costs of Integrated Mass Drug Administration for Neglected Tropical Diseases in Haiti

“…These costs were annualized by using a procedure that included years of useful life, scrap value, and a discount rate of 3%. 10 The cost data were collected in U.S. dollars and Haitian Gourdes, which were converted to U.S. dollars by using historical exchange rate information calculated during the study period ( , as in the case of training, which is a separate category in this study but was included in the social mobilization and MDA categories listed in the report by de Rochars et al 8 Adverse event treatment was a separate activity category in 2002, but in the recent cost study, the acquisition of the adverse event drugs was considered part of the expenditures for the delivery and distribution of the intervention.…”