The achievements and challenges of the African Programme for Onchocerciasis Control (APOC)

Abstract

The main strategy of APOC, of community-directed treatment with ivermectin (CDTI), has enabled the programme to reach, empower and bring relief to remote and under-served, onchocerciasis-endemic communities. With CDTI, geographical and therapeutic coverages have increased substantially, in most areas, to the levels required to eliminate onchocerciasis as a public-health problem. Over 20 million people received treatment in 2000. APOC has also made effective use of the combination of the rapid epidemiological mapping of onchocerciasis (REMO) and geographical information systems (GIS), to provide information on the geographical distribution and prevalence of the disease. This has led to improvements in the identification of CDTI-priority areas, and in the estimates of the numbers of people to be treated. A unique public-private-sector partnership has been at the heart of APOC's relative success. Through efficient capacity-building, the programme's operations have positively influenced and strengthened the health services of participating countries. These laudable achievements notwithstanding, APOC faces many challenges during the second phase of its operations, when the full impact of the programme is expected to be felt. Notable among these challenges are the sustainability of CDTI, the strategy's effective integration into the healthcare system, and the full exploitation of its potential as an entry point for other health programmes. The channels created for CDTI, could, for example, help efforts to eliminate lymphatic filariasis (which will feature on the agenda of many participating countries during APOC's Phase 2). However, these other programmes need to be executed without compromising the onchocerciasis-control programme itself. Success in meeting these challenges will depend on the continued, wholehearted commitment of all the partners involved, particularly that of the governments of the participating countries.

Transmission of Onchocerca volvulus Continues in Nyagak-Bondo Focus of Northwestern Uganda after 18 Years of a Single Dose of Annual Treatment with Ivermectin

“…[4][5][6] The goal was to target the most highly onchocerciasis-endemic communities with a single annual dose of ivermectin through mass treatment using the CDTI strategy; therefore, the disease would no longer be a public health problem. [7][8][9] This goal was not defined but logi-cally taken to be when prevalence is driven below the original baseline threshold required to launch the mass ivermectin treatment program, which is an onchocercal nodule rate of 20% or an mf rate of 40%. 6 However, achieving elimination of onchocerciasis as a public health problem defined at these levels did not necessarily indicate interruption of transmission.…”

Community-directed interventions for priority health problems in Africa: results of a multicountry study

“…11 Adopted by the African Programme for Onchocerciasis Control (APOC) in the mid-1990s, the CDI strategy has helped to ensure and sustain the delivery of annual ivermectin treatment to over 75 million Africans, many living in remote areas. 12,13 The success of the CDI strategy in onchocerciasis control has sparked widespread interest in applying the strategy and using the established community network for other interventions. 14,15 The board of APOC, on which the health ministries of 19 African countries are represented, asked the Special Programme for Research and Training in Tropical Diseases (TDR), sponsored by the United Nations, The World Bank and the World Health Organization (WHO), to undertake a study on the potential use of the CDI approach to carry out interventions against other diseases.…”

Larviciding to control malaria

“…Paris Green, a arsenic-based compound toxic to larvae, contributed to the elimination of species belonging to the Anopheles gambiae complex in Egypt and Brazil (Soper 1943;Shousha 1948). Larviciding has also been hugely successful against other vector-borne diseases; for example, Bti and temephos were used to control species of the Simulium damnosum complex -vectors of onchocerciasis -in Brazil and the continent of Africa as a supplement to mass drug administration (MDA) (Sékétéli 2002;Gustavsen 2011). Larviciding has the potential to overcome several challenges currently facing malaria vector control.…”