Onchocerciasis control in Africa

Oncho cerciasis control in Africa Onchocerciasis Control Programme (OCP) African Programme for Onchocerciasis Control in West Africa (APOC) Investing in Onchocerciasis control World health experts have concluded that onchocerciasis (River Blindness) can be eliminated as a public health problem. Two distinct programmes, the OCP (1974-2002) and APOC (1995-2010), were created to pursue the same primary objectives: o To eliminate onchocerciasis as a public health problem and as an obstacle to socioeconomic development o To enhance national and regional capacities to control the disease and negate its impact on development. They are pro-poor, self-help disease control initiatives, implemented for Africans by Africans using resources and support provided by a diverse range of highly committed global partners. For over 30 years these programmes have been unique, pathfinding, regional public health goods serving the poorest of the poor in isolated rural communities. Each has broken new ground, learned lessons, developed highly successful and promising new health intervention tools and techniques, and freed tens of millions of Africans from a dreadful and disfiguring disease in the process. Building on past successes, APOC aims to permanently release the remaining at-risk 150 million people in 30 countries from the threat of infection. Efforts now need to be focused on achieving that goal and to protect what has already been Scaling-up Onchocerciasis controll ! rhase I - OCP (stage l) ! fnr.e I - OCP (stage 2) IPnu."2-APoc LT}IIOPIA g ,tr NIGERIA .!$',' KFNYA AFRI(JA t ALGERIA LIBYA CHAD SUDAN UL SOUTTI XMNWE ZAMBIA DEM REP of mNc{) I 't For further information please refer to APOC WebSite: http://www.apoc.bf *'{-..a<; "ri ttALr NIGER i 2 APoc (2006) Phase I (1974 accomplished by OCP.-1986) OCP - Stage I member stotes: Burkina Faso, Benin, Ghana, Cote d'Ivoire, Mali, Niger, Togo Intervention focus - aerial spraying of insecticides over breeding sites of vector blackflies in fast- flowing waters Phase I (1986-2002) OCP - Stage 2 member states: Guinea, Guinea-Bissau, Senegal, Sierra Leone Intervention focus - aerial spraying of insecticides over breeding sites of vector flies (plus secondary health-system operated Mass drug distribution (MDA) of ivermectin when the drug became available in 1988) Phase 2 (1996-2010) APOC - Stage 3 member states: Angola, Burundi, Cameroon, Central African Republic, Chad, Democratic Republic of Congo, Republic of Congo, Equatorial Guinea, Ethiopia, Gabon, Kenya, Liberia, Malawi, Mozambique, Nigeria, Rwanda, Sudan, Tanzania, Uganda. Intervention focus - MDA using community-directed treatment (ComDT) with ivermectin (with a very few highly-localised vector control projects in Uganda, Tanzania and Equatorial Guinea). Covers 85% of the global disease burden (90 million people) Current Control Partnership Partnership is the driving force behind both OCP and APOC substantial achievements. The campaign to prevent, control and eliminate onchocerciasis in Africa is a pioneering, pro-poor, multifaceted, multidisciplinary global partnership, attuned to local needs, cultures, religions and environments. Partners of OCP and APOC include: 20 International Donors (govemments, foundations, etc), 30 Participating countries,149,000 rural communities. 16 national and intemational NGOs. 1 multinational pharmaceutical firm. 325,288 community-based drug distributors. 2 Research institution partners. 24,000 specially-trained trained Health workers. Regional management team staffed by Africans "The progress that has been made in combuting River Blindness represents one of the most triumphant public health campaigns ever waged in the developing world." (LINESCO World Science Report 2005) Onchocerciasis control: Investments Phase I (I974-2002): Onchocerciasis Control Programme in West Africa (OCP) : $570 million Phase 2 (1996-2010): African Programme for Onchocerciasis Control (APOC) o APOC donors : 5135 million o NGOs : $45 million o Merck & Co. Inc : $1.4 billion in in-kind donation of essential Mectizan@ drugs. The involvement of partners leods to improved resource allocation and efJiciency based on economies of scale and exploitation of comparative advontages. Onchocerciasis Control Strategies and Challenges From 1974 to 1987, the primary onchocerciasis disease control strategy of the partners in areas within the ambit of the OCP was aerial application of effective and environmentally-friendly insecticides to breeding sites of the vector (Simulium-blackfly) in fast-flowing river waters. For further information please refer to APOC WebSite: http://www.apoc.bf APoC (2006) 3 Although expensive, during Phase l, aerial spraying was undertaken for 15 years by the Onchocerciasis Control Programme (OCP) in West Africa as its sole control intervention until the advent of the drug ivermectin in 1987. Aerial larviciding was successful inthe Central OCP area where onchocerciasis infection and transmission virtually stopped and active control was replaced by surveillance. In the APOC countries, vector control was not considered feasible or cost-effective, except for a few small isolated onchocerciasis foci in Uganda, Tanzania and Equatorial Guinea. The drug, ivermectin (Mectizan@) is effective and well tolerated and should be taken once a year, for at least 15 years awaiting the natural death of the adult worms (microfilaria). The strategy APOC has developed and put in place for an effective and efficient distribution of the drug is Community-Directed Treatment with Ivermectin (CDTI) in which communities themselves design and implement treatment of its members. It is estimated that if 65-85% of the total population in an endemic area takes ivermectin annually, Simulium flies can continue to bite human hosts but they will not find microfilaria to transmit. Thus, mass treatment with ivermectin may lead to the elimination of onchocerciasis as a public health problem. Ivermectin delivery occurs through a partnership comprising Ministries of Health, the WHO or IINICEF country offices, NGOs, health workers and rural communities directly affected by the disease. Community planning and management of treatment has proved highly proficient in all aspects of drug delivery, monitoring and reporting. The main limitation of ivermectin is that it has little effect on the adult worms that continue to produce microfilariae, and re-treatment is therefore required at annual intervals. Mass treatment with ivermectin reduces but does not intemrpt disease transmission. Therefore, a macrofilaricide is needed to accelerate the elimination of onchocerciasis in all affected countries. After the closure of OCP in 2002, APOC and TDR have continued to finance the search for a macrofilaricidal drug that is safe and has effect on the parasite adult worms. Achievements of APOC and APOC OCP Results (197 4-2002\ APOC Results (f996-2005) o 40 million people in 1 1 countries prevented from infection and eye lesions o40 million people in 16 countries under re gular ivermectin treatment o 600,000 cases ofblindness prevented o 500,000 DALYs per year averted o 25 million hectares of abandoned arable land reclaimed for settlement and agricultural production, capable of feeding 17 million people annually o 117,000 communities mobilized .Workforce of 261,000 community- directed distributors trained and available for other programmes oEconomic Rate of Retum of 20o/o o Economic Rate of Reixrr of l7%;o .US $ 7 per DALY averted Pro-poor focus: Of Africa's 600 million inhabitants, S)yo farm for their livelihoods. Although rapid urbanization will see 50o/o of Africans living in cities by 2020, 630/o remain scattered in communities in impoverished, isolated rural areas with limited access to resources, markets, capital, credit, communications or health care. Poor people have the worst health outcomes, ill health pushing them fuither into poverty. They are usually excluded from support networks that enhance the social and economic benefits of health, and are also less efficient at translating health services into better health. APOC like the OCP speciJically targets und serves ultra-poor clients, helping strengthen national health systems ond sustainability in the process, ond butlding local capacity where health services are weakest. For further information please refer to APOC WebSite: http://www.apoc.bf I 4 APoc (2006) Cost-effectiveness: In ComDT, the poor plan, implement, monitor, and pay for all local costs incurred. Like governments, they cannot afford anything but the most cost-effective and efficient of health interventions. ComDT represents the Close-to-Client (CTC) system designated as one of the highest priorities for ensuring the delivery of essential services to the poor. APOC's ComDT is highly cost-effective ($0.58 per treotment and $7 per DALY averted). Value-added: APOC, Phase 2 of the onchocerciasis control Programme is leading the way forthe Neglected Tropical Disease Coalition, Malaria Quick Impact Initiative, and others as ComDT systems can be used to deliver other cost-effective interventions for high-burden diseases (e.g. Malaria, Lymphatic Filariasis, Trachoma, intestinal helminths, Schistosomiasis, STDs and micronutrient deficiency) as well as improve health behaviours in remote, under-served communities Why invest in the African Programme for Onchocerciasis Control (APOC) When OCP closed in2002, onchocerciasis was no longer a public health problem in these countries. Now, due to the movement of human populations, social/political upheavals in the region and the migration of Simulium black flies (vectors of the disease-causing parasite), there is a high risk of transmission recurring and a recrudescence of disease. We are on the brink of possibly losing much of what has been so arduously won. To lose this unprecedented success and allow infected flies from Nigeria or Sierra Leone to invade neighbouring countries would be a serious setback. In this context, there is a concern that countries with less effective programmes are not only increasing the burden of disease for their own people but also increasing the risk of re-introducing river blindness into neighboring countries, whose resources and investments, alongside the longstanding contributions from donors, have brought the disease under control. There is also the grave concern that the impact of the funds already invested by countries and their development partners, together with the drug donation programme (more than US$1.5 billion), will be lost. APOC will ensure monitoring and cotective action should Onchocerciasis reappear in cleared areas. For further information please refer to APOC WebSite: http://www.apoc.bf t