IngentaConnect The challenges of community-directed treatment with ivermectin (C...

Authors: Amazigo, U.V.¹; Brieger, W.R.²; Katabarwa, M.³; Akogun, O.⁴; Ntep, M.⁵; Boatin, B.⁶; N'Doyo, J.⁷; Noma, M.¹; Sékétéli, A.¹

Source: Annals of Tropical Medicine and Parasitology, Volume 96, Supplement 1, March 2002 , pp. 41-58(18)

Publisher: Maney Publishing

Abstract:

The principal strategy adopted by the African Programme for Onchocerciasis Control (APOC), for the control of onchocerciasis in the 19 countries of Africa that now fall within the programme's remit, is that of community-directed treatment with ivermectin (CDTI). Halfway through its 12-year mandate, APOC has gathered enough information on the main challenges to guide its activities in Phase 2. An analysis of reports and other documents, emanating from consultants, scientists, monitors and national and project-level implementers, indicates that there are three broad categories of challenge: managerial; technical; and socio-political. Under these three categories, this review identifies the most pertinent concerns that APOC must address, during Phase 2, to enhance the prospects of establishing sustainable systems for ivermectin distribution. The major challenges include: (1) maintaining timely drug-collection mechanisms; (2) integrating CDTI with existing primary-healthcare services; (3) strengthening local health infrastructure; (4) achieving and maintaining an optimal treatment coverage; (5) establishing and up-scaling community self-monitoring; (6) designing and implementing operations research locally; (7) ensuring the adequacy of community-directed distributors; (8) increasing the involvement of local non-governmental develop organizations in the programme; (9) achieving financial sustainability; (10) implementing equitable cost-recovery systems; and (11) engaging in effective advocacy. The implications of the challenges and suggestions about how they are being (or could be) addressed are also highlighted in this brief review, which should be of value to other programmes and agencies that may be contemplating the adoption of this unique strategy.

Document Type: Research article

DOI: 10.1179/000349802125000646

Affiliations: 1: African Programme for Onchocerciasis Control (APOC), 01 B.P. 549, Ouagadougou 01, Burkina Faso 2: African Regional Health Education Centre, College of Medicine, University of Ibadan, Ibadan, Nigeria 3: The Cater Center, Global 2000 River Blindness Program, Kampala, Uganda 4: Federal University of Technology, Yola, Nigeria 5: Groupe de Travail de Lutte contre l'Onchocercose (GTNO), Ministére de la Santé publique, Yaounddé, Cameroon 6: Onchocerciasis Control Programme in West Africa (OCP), Ougadougou, Burkina Faso 7: Programme de Lutte contre l'Onchocercose et la Cécité, Ministére de la Santé de la Population, Bangui, Central African Republic

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The challenges of community-directed treatment with ivermectin (CDTI) within the African Programme for Onchocerciasis Control (APOC)