The World Health Organization 2030 goals for onchocerciasis: Insights and perspectives from mathematical modelling: NTD Modelling Consortium Onchocerciasis Group.
The World Health Organization 2030 goals for onchocerciasis: Insights and perspectives from mathematical modelling: NTD Modelling Consortium Onchocerciasis Group.
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DOI：
10.12688/gatesopenres.13067.1
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发表时间：
2019-01-01
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世界卫生组织 (WHO) 已启动磋商进程，以完善针对盘尾丝虫病等优先被忽视热带病 (NTD) 的 2030 年目标。目前的目标包括到 2020 年在拉丁美洲、也门和选定的非洲国家消除传播 (EOT)。新目标提出，到2030年，EOT在10个国家得到验证； 34 个国家的至少一个重点地区停止使用伊维菌素进行大规模药物管理（MDA）；至少 16、14、12 和 10 个国家不再需要 MDA 的人口比例分别等于或大于 25%、50%、75% 和 100%。 NTD 建模联盟盘尾丝虫病团队已使用 EPIONCHO 和 ONCHOSIM 为这些目标提供建模见解。 EOT 在低中度流行地区似乎是可行的，长期 MDA 覆盖率高（≥75%），但在流行程度较高、覆盖率和依从性较差的地区以及 MDA 尚未或最近才开始的地区则不确定。各国将根据这些类别对不同比例的流行地区进行分类，干预前患病率和 MDA 持续时间的分布以及规划的成功将决定实现拟议的 MDA 戒断目标的可行性。高流行地区将受益于改用每年两次或每季度一次的 MDA 并在可能的情况下实施病媒控制（确定反病媒干预措施的最佳频率和持续时间需要更多研究）。无罗阿丝病且尚未启动 MDA 的地区应从一开始就实施每两年一次（最好使用莫昔克丁）或每季度一次 MDA。以前未治疗过的罗阿病地区将受益于实施基于测试和（非）治疗的干预措施、病媒控制和抗沃尔巴克氏体疗法，但其成功将取决于所达到和持续的筛查和覆盖水平。 IgG4 Ov16 血清学评估 EOT 的诊断性能目前尚不确定。 EOT 的验证需要在个体和群体层面上进行新的诊断。
The World Health Organization (WHO) has embarked on a consultation process to refine the 2030 goals for priority neglected tropical diseases (NTDs), onchocerciasis among them. Current goals include elimination of transmission (EOT) by 2020 in Latin America, Yemen and selected African countries. The new goals propose that, by 2030, EOT be verified in 10 countries; mass drug administration (MDA) with ivermectin be stopped in at least one focus in 34 countries; and that the proportion of the population no longer in need of MDA be equal or greater than 25%, 50%, 75% and 100% in at least 16, 14, 12, and 10 countries, respectively. The NTD Modelling Consortium onchocerciasis teams have used EPIONCHO and ONCHOSIM to provide modelling insights into these goals. EOT appears feasible in low-moderate endemic areas with long-term MDA at high coverage (≥75%), but uncertain in areas of higher endemicity, poor coverage and adherence, and where MDA has not yet, or only recently, started. Countries will have different proportions of their endemic areas classified according to these categories, and this distribution of pre-intervention prevalence and MDA duration and programmatic success will determine the feasibility of achieving the proposed MDA cessation goals. Highly endemic areas would benefit from switching to biannual or quarterly MDA and implementing vector control where possible (determining optimal frequency and duration of anti-vectorial interventions requires more research). Areas without loiasis that have not yet initiated MDA should implement biannual (preferably with moxidectin) or quarterly MDA from the start. Areas with loiasis not previously treated would benefit from implementing test-and(not)-treat-based interventions, vector control, and anti- Wolbachia therapies, but their success will depend on the levels of screening and coverage achieved and sustained. The diagnostic performance of IgG4 Ov16 serology for assessing EOT is currently uncertain. Verification of EOT requires novel diagnostics at the individual- and population-levels.