The importance of patient compliance in repeated rounds of mass drug administration (MDA) for the elimination of intestinal helminth transmission.
The importance of patient compliance in repeated rounds of mass drug administration (MDA) for the elimination of intestinal helminth transmission.
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DOI：
10.1186/s13071-017-2206-5
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发表时间：
2017-06-12
影响因子：
3.2
通讯作者：
Anderson RM
中科院分区：
文献类型：
--
作者：
Farrell SH;Truscott JE;Anderson RM
一部分合格人群对化疗治疗的系统性不依从性被认为是通过大规模给药（MDA）消除蠕虫感染的主要障碍。由于人类宿主不能对再感染产生完全的保护性免疫力，因此蠕虫的MDA以规定的时间间隔重复，例如每年或每2年。因此，一个人如何遵守这些重复的MDA回合可以对寄生虫传播产生重大影响。目前对这一因素的重要性了解甚少。很少有流行病学研究检查了在地方性蠕虫感染地区的许多社区的依从性的纵向趋势，这些社区正在经历MDA。减少系统性不遵守行为显然会增加接受治疗的人数，但也可能改变寄生虫传播的动态。在这里，我们开发了一个基于个人的随机模型的蠕虫传播和MDA治疗，调查如何不同的模式的合规性影响MDA的影响，两组蠕虫，土壤传播的线虫感染和寄生虫。我们研究了几种替代治疗和遵守模式的动态传输的效果。我们发现，不同依从性模式的影响，从每轮化疗的随机治疗到一定比例的人群的系统性不依从性，非常依赖于特定环境中的传播强度和治疗所针对的感染类型。系统性不依从对通过强化MDA消除曼氏血吸虫传播的潜力的影响大于对蛔虫的影响。我们讨论了我们的研究结果的影响，MDA方案的资源的优先顺序和监测和评估方案的设计。分析产生的关键信息是，必须非常小心地记录每一轮MDA的个别纵向遵守模式，而不仅仅是记录总体覆盖率。本文的在线版本（doi：10.1186/s13071-017-2206-5）包含补充材料，可供授权用户使用。
Systematic non-compliance to chemotherapeutic treatment among a portion of the eligible population is thought to be a major obstacle to the elimination of helminth infections by mass drug administration (MDA). MDA for helminths is repeated at defined intervals such as yearly or every 2 years, as a consequence of the inability of the human host to develop fully protective immunity to reinfection. As such, how an individual complies to these repeated rounds of MDA can have a significant impact on parasite transmission. The importance of this factor is poorly understood at present. Few epidemiological studies have examined longitudinal trends in compliance in the many communities in areas of endemic helminth infection that are undergoing MDA. Reducing systematic non-compliance will obviously increase the number of individuals treated, but it may also alter the dynamics of parasite transmission. Here we develop an individual-based stochastic model of helminth transmission and MDA treatment to investigate how different patterns of compliance influence the impact of MDA for two groups of helminths, the soil transmitted nematode infections and the schistosome parasites. We study the effect of several alternative treatment and compliance patterns on the dynamics of transmission. We find that the impact of different compliance patterns, ranging from random treatment at each round of chemotherapy to systematic non-compliance by a proportion of the population, is very dependent on both transmission intensity in a defined setting and the type of infection that the treatment is targeted at. Systematic non-compliance has a greater impact on the potential for elimination of Schistosoma mansoni transmission by intensive MDA, than it does on Ascaris lumbricoides. We discuss the implications of our findings for the prioritisation of resources in MDA programmes and for monitoring and evaluation programme design. The key message generated by the analyses is that great care must be taken to record individual longitudinal patterns of compliance at each round of MDA as opposed to just recording overall coverage. The online version of this article (doi:10.1186/s13071-017-2206-5) contains supplementary material, which is available to authorized users.