Elimination of African onchocerciasis: modeling the impact of increasing the frequency of ivermectin mass treatment.
Elimination of African onchocerciasis: modeling the impact of increasing the frequency of ivermectin mass treatment.
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DOI：
10.1371/journal.pone.0115886
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
de Vlas SJ
中科院分区：
文献类型：
--
作者：
Coffeng LE;Stolk WA;Hoerauf A;Habbema D;Bakker R;Hopkins AD;de Vlas SJ
非洲盘尾丝虫病控制规划目前正将其重点从发病率控制转向消除感染。为提高消除该病的可能性并加快实现这一目标，规划可考虑将伊维菌素大规模治疗的频率从每年增加到6个月甚至更高。在一项计算机模拟研究中，我们研究了增加不同设置的质量处理频率的潜在影响。使用ONCHOSIM模型，我们模拟了92610种情况，这些情况与传播条件、大规模治疗历史、未来大规模治疗策略和伊维菌素疗效的不同假设有关。模拟结果用于确定达到99%消除概率所需的最小剩余程序持续时间和治疗轮数。将治疗频率从一年增加一倍至6个月或3个月，预计将分别减少约40%或60%的剩余疗程。这些减少是以额外治疗轮次为代价的，特别是在3个月大规模治疗的情况下。此外，上述削减高度依赖于维持覆盖范围，如果将来大规模治疗的覆盖范围下降，可能完全无效。在低覆盖率情况下，增加治疗覆盖率几乎与增加治疗频率同样有效。我们的结论是，6个月的大规模治疗可能只有在年度治疗预计需要很长时间才能实现消除的情况下才值得付出努力，尽管治疗覆盖率很好，例如由于不利的传播条件或由于最近开始了大规模治疗。
The African Programme for Onchocerciasis Control (APOC) is currently shifting its focus from morbidity control to elimination of infection. To enhance the likelihood of elimination and speed up its achievement, programs may consider to increase the frequency of ivermectin mass treatment from annual to 6-monthly or even higher. In a computer simulation study, we examined the potential impact of increasing the mass treatment frequency for different settings. With the ONCHOSIM model, we simulated 92,610 scenarios pertaining to different assumptions about transmission conditions, history of mass treatment, the future mass treatment strategy, and ivermectin efficacy. Simulation results were used to determine the minimum remaining program duration and number of treatment rounds required to achieve 99% probability of elimination. Doubling the frequency of treatment from yearly to 6-monthly or 3-monthly was predicted to reduce remaining program duration by about 40% or 60%, respectively. These reductions come at a cost of additional treatment rounds, especially in case of 3-monthly mass treatment. Also, aforementioned reductions are highly dependent on maintained coverage, and could be completely nullified if coverage of mass treatment were to fall in the future. In low coverage settings, increasing treatment coverage is almost just as effective as increasing treatment frequency. We conclude that 6-monthly mass treatment may only be worth the effort in situations where annual treatment is expected to take a long time to achieve elimination in spite of good treatment coverage, e.g. because of unfavorable transmission conditions or because mass treatment started recently.
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