Investigating Persistent Lymphatic Filariasis Transmission
Investigating Persistent Lymphatic Filariasis Transmission
The Lymphatic Filariasis (LF) elimination programme in Ghana has achieved tremendous success through the mass drug administration (MDA) campaign and many regions have met the criteria to scale down distribution. Although MDA for LF has been conducted in an increasing number of communities for over 15 years in Ghana, the infection prevalence is highly varied and hotspots (areas with ongoing parasite transmission) persist in some parts of the country. It is likely that these variations are driven by differences in access to drugs, drug uptake, and local mosquito diversity, abundance, and biting rates. It is pivotal therefore, to assess both the success and the prospective timing of elimination in different settings at regional, community and individual-level (including by gender).
The aim of the research in Ghana was to provide evidence to support rapid and sustainable scale-up of complementary intervention strategies to eliminate lymphatic filariasis in Ghana. This was achieved through evaluating the social, entomological and epidemiological characteristics of hotspot communities to identify the causes of persistent transmission, alongside evaluating the impacts of an integrated MDA and vector control programme on service delivery, community participation and LF transmission.
The collected information was used to identify opportunities for better planning and co-implementation of the interventions at the district and community level. Tools were developed to inform scale-down of interventions, including the application of disease transmission models to predict the impacts of interventions on lymphatic filariasis to help setting locally relevant targets for elimination, and the evaluation and optimisation of available and emerging tools for the sensitive detection of the parasite in the mosquito vectors for post-MDA surveillance.
Ongoing work is generating evidence on the social acceptance and cost-effectiveness of alternative strategies for implementation in "hotspot" areas or in post-MDA endgame scenarios, where test and treat strategies become more cost effective and deliverable. COUNTDOWN is working to identify "hot-spots" and predict the impact of MDA and vector control on LF transmission. In addition, the feasibility and cost of integrating long-lasting insecticidal ned (LLIN) distribution with MDA is being assessed and evaluated on how vector characteristics might influence the impacts of LLIN.