Anthelminthic treatment receipt and its predictors in Lake Victoria fishing communities, Uganda: Intervention coverage results from the LaVIISWA cluster randomised trial.
Anthelminthic treatment receipt and its predictors in Lake Victoria fishing communities, Uganda: Intervention coverage results from the LaVIISWA cluster randomised trial.
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DOI：
10.1371/journal.pntd.0008718
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发表时间：
2020-10
影响因子：
3.8
通讯作者：
LaVIISWA trial team
中科院分区：
文献类型：
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作者：
Akurut H;Sanya RE;Lubyayi L;Nampijja M;Kizza M;Kaweesa J;Kizindo R;Sewankambo M;Nsubuga D;Tukahebwa E;Kabatereine NB;Elliott AM;Webb EL;LaVIISWA trial team
大规模给药（MDA）是控制寄生虫的基石。在血吸虫病流行地区，有50%的学龄儿童受到感染，世界卫生组织（世卫组织）建议在社区范围内使用吡喹酮进行大规模预防接种，目标覆盖率为75%。使用来自MDA治疗策略的聚类随机试验的数据，我们旨在描述接受MDA治疗的合格居民的比例和治疗接受的预测因子，并评估与寄生虫流行的关系。在乌干达维多利亚湖的Koome群岛，基线血吸虫病患病率（通过单一粪便样本，Kato Katz）总体为52%（所有年龄），学龄儿童为67%，我们进行了一项社区范围内强化MDA（每季度单剂量吡喹酮40mg/kg；三剂量阿苯达唑400mg）与乌干达标准政府干预（每年单剂量吡喹酮40mg/kg； 6个月单剂量阿苯达唑）的聚类随机试验。随机选取26个渔村，每个试验组13个，为期4年。每轮治疗时，研究组直接观察吡喹酮治疗和阿苯达唑第一剂治疗，更新村民登记表，记录符合条件者中接受治疗的比例。在四年的大规模干预计划期间，在每一轮治疗中，26个村庄平均登记了13382人（标准和强化干预村庄分别为7153人和6229人）。总体而言，接受吡喹酮治疗的合格患者比例低于阿苯达唑（60%对65%），特别是在标准组（61%对71%）与强化组（60%对62%）相比。阿苯达唑与吡喹酮同时使用时，其回收率较低。缺席是不接受治疗的最常见原因（阿苯达唑81%，吡喹酮77%），其次是拒绝（阿苯达唑14%，吡喹酮18%）。学龄儿童接受治疗的比例最低，但性别差异不大。对一组在研究期间没有移动的居民进行纵向分析，发现该亚组中持续不接受治疗的情况很少见。拒绝接受治疗的比例在成年人中最高，在女性中更为常见。在血吸虫病高危社区，要实现世卫组织的目标，可能需要采取增加治疗覆盖面的综合办法，如延长治疗提供期和提供奖励。世界卫生组织（World Health organization）建议在蠕虫负担沉重的社区进行大规模除虫，但覆盖率可能不够理想。我们使用了在乌干达维多利亚湖一个蠕虫严重负担地区进行的一项为期四年的集群随机对照试验的数据，以调查社区提供阿苯达唑和吡喹酮治疗的覆盖率。我们还调查了哪些因素与接受治疗和拒绝治疗有关。我们发现，平均而言，接受吡喹酮治疗的居民比例低于阿苯达唑，缺席和拒绝是不接受治疗的最常见原因。在缺乏足够的水和卫生设施或有效疫苗的情况下，可能需要采用创新方法来增加治疗覆盖面，以大幅减少蠕虫的流行。
Mass drug administration (MDA) is a cornerstone of control of parasitic helminths. In schistosomiasis-endemic areas with >50% of school-aged children infected, community-wide MDA with praziquantel is recommended by the World Health Organisation (WHO), with target coverage of >75%. Using data from a cluster-randomised trial of MDA treatment strategies, we aimed to describe the proportion of eligible residents who received MDA and predictors of treatment receipt, and to assess associations with helminth prevalence. In the Koome islands of Lake Victoria, Uganda, where baseline schistosomiasis prevalence (by single stool sample, Kato Katz) was 52% overall (all ages) and 67% among school-aged children, we conducted a cluster-randomised trial of community-wide, intensive MDA (quarterly single-dose praziquantel 40mg/kg; triple-dose albendazole 400mg) versus standard, Uganda government intervention (annual single-dose praziquantel 40mg/kg; 6-monthly single-dose albendazole). Twenty-six fishing villages were randomised, 13 per trial arm, for four years. At each treatment round, praziquantel treatment and the first dose of albendazole treatment were directly observed by the study team, registers of village residents were updated and the proportion receiving treatment among those eligible recorded. During the four-year MDA, at each treatment round an average of 13,382 people were registered in the 26 villages (7,153 and 6,229 in standard and intensive intervention villages, respectively). Overall, the proportion of those eligible receiving praziquantel was lower than for albendazole (60% versus 65%), particularly in the standard arm (61% versus 71%) compared to the intensive arm (60% versus 62%). Albendazole receipt was lower when given concurrently with praziquantel. Absence was the commonest reason for non-receipt of treatment (81% albendazole, 77% praziquantel), followed by refusal (14% albendazole, 18% praziquantel). Proportions receiving treatment were lowest among school-aged children, but did not differ by sex. Longitudinal analysis of a subgroup of residents who did not move during the study period found that persistent non-receipt of treatment in this subgroup was rare. Refusal to receive treatment was highest among adults and more common among females. In schistosomiasis high-risk communities, a combination of approaches to increasing treatment coverage, such as extended periods of treatment delivery, and the provision of incentives, may be required to achieve WHO targets. Mass de-worming is recommended by the World Health Organisation in communities with a heavy burden of worms, but coverage can be sub-optimal. We used data from a four-year long cluster randomised controlled trial conducted in a heavy worm burden area on Lake Victoria, Uganda, to investigate coverage of community-delivered albendazole and praziquantel treatment. We also investigated which factors were associated with receipt of treatment and with refusal. We found that, on average, a lower proportion of residents received praziquantel than albendazole, and that absence and refusal were the most common reasons for not receiving treatment. In the absence of adequate provision of water and sanitation, or of an effective vaccine, innovative approaches to increasing treatment coverage are likely to be needed to substantially reduce worm prevalence.
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影响因子：
3.2
作者：
Shuford KV;Turner HC;Anderson RM
通讯作者：
Anderson RM
DOI：
10.4103/1755-6783.95962
发表时间：
2012-03-01
期刊：
ANNALS OF TROPICAL MEDICINE AND PUBLIC HEALTH
影响因子：
--
作者：
Njomo, Doris W.;Amuyunzu-Nyamongo, M.;Njenga, Sammy M.
通讯作者：
Njenga, Sammy M.
影响因子：
3.8
作者：
Budge, Philip J.;Sognikin, Edmond;Deming, Michael
通讯作者：
Deming, Michael
影响因子：
3.8
作者：
Burnim M;Ivy JA;King CH
通讯作者：
King CH
DOI：
10.1093/infdis/jix496
发表时间：
2017-12-12
期刊：
The Journal of infectious diseases
影响因子：
--
作者：
Wiegand RE;Mwinzi PNM;Montgomery SP;Chan YL;Andiego K;Omedo M;Muchiri G;Ogutu MO;Rawago F;Odiere MR;Karanja DMS;Secor WE
通讯作者：
Secor WE