Onchocerciasis Clinical Trial
Official title:
Determination of the Prevalence of LF Infection in Districts Not Included in LF Control Activities and of the Basis for Integrated Implementation of LF - Onchocerciasis Elimination Strategies in Potentially Co-endemic Areas
Lymphatic filariasis is a neglected tropical disease earmarked for elimination as a public
health problem by the year 2020. Since the year 2000, the Global Program for the Elimination
of LF has together with endemic countries undertaken preventive chemotherapy in endemic
districts to entire at risk populations. In Ghana, treatment of LF is based on the drugs
Ivermectin and Albendazole. Remarkable achievements have been made towards the control and
elimination of LF in Ghana. However, there remain programmatic and implementation challenges
that need to be addressed in order to ensure that the gains made over the last 15 years are
sustained. Among these challenges is the persistent transmission of LF in some districts
despite more than 10 years of MDA.
Furthermore, LF cases have been identified in communities from eight districts, previously
considered as non-endemic. The extent of endemicity in these new districts is unknown. In
order to achieve the 2020 elimination targets, it is crucial to determine the distribution
and infection prevalence of LF in these districts. Evaluating these districts for LF
endemicity will help the implementation of appropriate strategies towards achieving the 2020
target.
This protocol describes the surveys to be undertaken in Ghana in 3 of these districts. The
current standard mapping methodologies of LF have the potential to miss LF endemic villages,
due to the focal nature of LF. As such, in order to enhance the chances to detect endemic
communities, this survey will use a combination of the WHO EPI cluster survey and current LF
mapping protocols. 15 communities will be selected in each district, with 100 survey
participants per community. Survey participants will be screened for LF infection using
immunological and parasitological methods. Study participants will also be tested for
onchocerciasis infection using immunological and parasitological methods in districts where
LF and oncho are co-endemic. The information from this survey will be combined with the data
on the LF vectors and their infection status in the survey areas and relevant data available
at the Ghana Health Service to:
1. determine whether LF intervention strategies are indicated in these three districts,
2. design, as indicated, appropriate intervention strategies to achieve LF elimination in
these three districts by 2020
3. inform, if indicated, co-implementation of control, monitoring and evaluation for LF and
onchocerciasis in the two onchocerciasis endemic districts
4. extract lessons learnt for the design and implementation of surveys in the other
districts currently considered non-endemic but where LF cases have been reported.
New rapid diagnostic tests have been developed to assess infection Lf and onchocerciasis
infection prevalence at the time of the decision to stop MDA and for surveillance for new
infections once MDA has been stopped. These include Rapid Diagnostic Tests (RDT) for
antibodies against the W. bancrofti antigen WB123 and the O. volvulus antigen Ov16. These
tests still require large scale field validation. Provided additional funding becomes
available, this survey will be used to obtain field validation data.
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