Impact of different mass drug administration strategies for gaining and sustaining control of schistosoma mansoni and schistosoma haematobium infection in Africa
Author(s)
Type
Journal Article
Abstract
This report summarizes the design and outcomes of randomized controlled operational research trials
performed by the Bill & Melinda Gates Foundation–funded Schistosomiasis Consortium for Operational Research and
Evaluation (SCORE) from 2009 to 2019. Their goal was to define the effectiveness and test the limitations of current WHOrecommended schistosomiasis control protocols by performing large-scale pragmatic trials to compare the impact of
different schedules and coverage regimens of praziquantel mass drug administration (MDA). Although there were limitations to study designs and performance, analysis of their primary outcomes confirmed that all tested regimens of
praziquantel MDA significantly reduced local Schistosoma infection prevalence and intensity among school-age children.
Secondary analysis suggested that outcomes in locations receiving four annual rounds of MDA were better than those in
communities that had treatment holiday years, in which no praziquantel MDA was given. Statistical significance of
differences was obscured by a wider-than-expected variation in community-level responses to MDA, defining a persistent hot spot obstacle to MDA success. No MDA schedule led to elimination of infection, even in those communities
that started at low prevalence of infection, and it is likely that programs aiming for elimination of transmission will need to
add supplemental interventions (e.g., snail control, improvement in water, sanitation and hygiene, and behavior change
interventions) to achieve that next stage of control. Recommendations for future implementation research, including
exploration of the value of earlier program impact assessment combined with intensification of intervention in hot spot
locations, are discussed.
performed by the Bill & Melinda Gates Foundation–funded Schistosomiasis Consortium for Operational Research and
Evaluation (SCORE) from 2009 to 2019. Their goal was to define the effectiveness and test the limitations of current WHOrecommended schistosomiasis control protocols by performing large-scale pragmatic trials to compare the impact of
different schedules and coverage regimens of praziquantel mass drug administration (MDA). Although there were limitations to study designs and performance, analysis of their primary outcomes confirmed that all tested regimens of
praziquantel MDA significantly reduced local Schistosoma infection prevalence and intensity among school-age children.
Secondary analysis suggested that outcomes in locations receiving four annual rounds of MDA were better than those in
communities that had treatment holiday years, in which no praziquantel MDA was given. Statistical significance of
differences was obscured by a wider-than-expected variation in community-level responses to MDA, defining a persistent hot spot obstacle to MDA success. No MDA schedule led to elimination of infection, even in those communities
that started at low prevalence of infection, and it is likely that programs aiming for elimination of transmission will need to
add supplemental interventions (e.g., snail control, improvement in water, sanitation and hygiene, and behavior change
interventions) to achieve that next stage of control. Recommendations for future implementation research, including
exploration of the value of earlier program impact assessment combined with intensification of intervention in hot spot
locations, are discussed.
Date Issued
2020-07-09
Date Acceptance
2019-12-20
Citation
American Journal of Tropical Medicine and Hygiene, 2020, 103 (1), pp.14-23
ISSN
0002-9637
Publisher
American Society of Tropical Medicine and Hygiene
Start Page
14
End Page
23
Journal / Book Title
American Journal of Tropical Medicine and Hygiene
Volume
103
Issue
1
Copyright Statement
© 2020 by The American Society of Tropical Medicine and Hygiene. This is an open-access article distributed under the terms of the
Creative Commons Attribution (CC-BY) License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Creative Commons Attribution (CC-BY) License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
License URL
Sponsor
Bill & Melinda Gates Foundation
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000554606800003&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Grant Number
RR374-053/4892956
Subjects
Science & Technology
Life Sciences & Biomedicine
Public, Environmental & Occupational Health
Tropical Medicine
PRAZIQUANTEL
CHEMOTHERAPY
PREVALENCE
CHILDREN
KENYA
Publication Status
Published
Date Publish Online
2020-05-12