Eliminating lymphatic filariasis

One of the oldest of the neglected tropical diseases, lymphatic filariasis, is caused by filarial worms transmitted by insect vectors that live in the lymphatic system and most commonly cause lymphedema, elephantiasis and hydrocele, which may lead to severe deformity, stigma and disability. Similar to other neglected tropical diseases, lymphatic filariasis occurs mostly among the poor disenfranchised populations living in highly endemic settings perpetuating a cycle that traps people into further poverty and destitution. Through the leadership of the World Health Organization, the Global Programme to Eliminate Lymphatic Filariasis has reached substantial achievements in decreasing the transmission of lympahtic filariasis in multiple settings. The strategic plan for the next 10 years of the Global Programme, in addition to working within the new 'neglected tropical diseases environment,' lays out necessary mass drug administration implementation goals for the filariasis-endemic countries that have not yet started their elimination programs (principally in Africa). The neglected tropical diseases programs-and the lymphatic filariasis program in particular-are among the very least expensive, most cost-effective tools to benefit needy populations of the developing world.

Integrated implementation of programs targeting neglected tropical diseases through preventive chemotherapy: proving the feasibility at national scale.

In 2006, the United States Agency for International Development established the Neglected Tropical Disease (NTD) Control Program to facilitate integration of national programs targeting elimination or control of lymphatic filariasis, onchocerciasis, schistosomiasis, soil-transmitted helminthiasis and blinding trachoma. By the end of year 3, 12 countries were supported by this program that focused first on disease mapping where needed, and then on initiating or expanding disease-specific programs in a coordinated/integrated fashion. The number of persons reached each year increased progressively, with a cumulative total during the first three years of 98 million persons receiving 222 million treatments with donated drugs valued at more than $1.4 billion. Geographic coverage increased substantially for all these infections, and the program has supported training of more than 220,000 persons to implement the programs. This current experience of the NTD Control Program demonstrates clearly that an integrated approach to control or eliminate these five neglected diseases can be effective at full national scale.

National mass drug administration costs for lymphatic filariasis elimination.

BACKGROUND: Because lymphatic filariasis (LF) elimination efforts are hampered by a dearth of economic information about the cost of mass drug administration (MDA) programs (using either albendazole with diethylcarbamazine [DEC] or albendazole with ivermectin), a multicenter study was undertaken to determine the costs of MDA programs to interrupt transmission of infection with LF. Such results are particularly important because LF programs have the necessary diagnostic and treatment tools to eliminate the disease as a public health problem globally, and already by 2006, the Global Programme to Eliminate LF had initiated treatment programs covering over 400 million of the 1.3 billion people at risk. METHODOLOGY/PRINCIPAL FINDINGS: To obtain annual costs to carry out the MDA strategy, researchers from seven countries developed and followed a common cost analysis protocol designed to estimate 1) the total annual cost of the LF program, 2) the average cost per person treated, and 3) the relative contributions of the endemic countries and the external partners. Costs per person treated ranged from $0.06 to $2.23. Principal reasons for the variation were 1) the age (newness) of the MDA program, 2) the use of volunteers, and 3) the size of the population treated. Substantial contributions by governments were documented - generally 60%-90% of program operation costs, excluding costs of donated medications. CONCLUSIONS/SIGNIFICANCE: MDA for LF elimination is comparatively inexpensive in relation to most other public health programs. Governments and communities make the predominant financial contributions to actual MDA implementation, not counting the cost of the drugs themselves. The results highlight the impact of the use of volunteers on program costs and provide specific cost data for 7 different countries that can be used as a basis both for modifying current programs and for developing new ones.