Implementation and sustainability of community-directed treatment of onchocerciasis with ivermectin: a multi-country study

Overview

This report describes the findings of a multi-country study that was designed to address the question of the long-term sustainability of community-directed treatment with ivermectin (CDTI) for onchocerciasis control. The development of CDTI was pioneered by TDR in 1995 and adopted by the African Programme for Onchocerciasis Control (APOC) in 1996. Based on the philosophy that communities take responsibility for organizing their own distribution of the drug ivermectin, CDTI was shown to improve treatment coverage in early short-term projects. As onchocerciasis control using ivermectin needs to continue for at least 15 years in endemic communities, the next step was to identify factors to predict sustainability and develop interventions to enhance the sustainability of CDTI.

Baseline studies conducted in Ghana, Mali, Togo, and at three sites in Nigeria, showed that there was poor communication and interaction between community members and health workers. An 'enhanced' CDTI was developed, which included stakeholders meetings that brought together community representatives, health workers and members of community-based organizations to plan CDTI in villages clusters. This enhanced method had no effect on treatment coverage, but according to several qualitative process indicators, it resulted in important reinforcement of the community-directed treatment process and enhanced commitment of both community and health workers to sustaining CDTI.

Full details of methodologies, results and conclusions are given in the report, which is organized into nine chapters: background, objectives, methodology, study sites, phase I findings, intervention process, phase II results, conclusions and references.