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9-2-15 PLOS Science Wednesday AMA Preview: River blindness programs improve health outcomes: Evidence for increased prioritization of NTDs in post-2015 global health agenda

River blindness (onchocerciasis) is an onerous neglected tropical disease (NTD) and the second-leading cause of preventable blindness worldwide. Onchocerciasis is transmitted by a bite from the black fly, which creates an inflammatory response that leads to blindness and other adverse outcomes. Today, more than 100 million people are at high risk of onchocerciasis infection, the majority of who live in sub-Saharan African countries [7].

In spite of its prevalence and high burden, onchocerciasis, like all NTDs, receives substantially less attention and funding than the “big three” diseases: HIV/AIDS, malaria, and tuberculosis. But emerging evidence shows that people co-infected with one or more NTD may adversely and exponentially affect an individual’s prognosis of having one of these priority diseases.

A recent article in PLOS Neglected Tropical Diseases titled, “The Contributions of Onchocerciasis Control and Elimination Programs toward the Achievement of the Millennium Development Goals” examined through data analysis and literature review how Onchocerciasis control and elimination programs have benefits beyond disease-specific outcomes.

To discuss the success of river blindness control and elimination programs and new priorities for NTDs, authors Caitlin Dunn, Kelly Callahan, and Dr. Deborah McFarland will be participating in this week’s ‘PLOS Science Wednesday’ redditscience ‘Ask Me Anything’ (AMA). They will be answering your questions about onchocerciasis control, NTDs, and the global health impacts of these diseases and their positioning on the global health agenda on redditscience at 1pm ET (10am PT) on Wed September 2, 2015. You can register on redditscience in preparation for this upcoming AMA (or on the day of), so you’ll be able to add your questions and comments to the live conversation.

The authors will discuss how onchocerciasis programs, particularly the Community-Directed Treatment with Ivermectin (CDTI) system, strengthened the capacity for community-directed delivery systems, improved disease surveillance, and served as a model for public-private partnerships with the pharmaceutical industry.

Caitlin Dunn and colleagues found that programs to control and eliminate river blindness were among the most high-impact, low-cost public health campaigns ever. The author’s findings showed while many onchocerciasis programs intersected with the health and development outcomes sought by the United Nations Millennium Development Goals (MDGs), a disproportionate amount of resources continue to be directed to the “big three” diseases in global health. The disparity in funding is illustrated in the 2010 numbers for international development assistance, with HIV/AIDS programs receiving 37% of the total assistance, and NTDs receiving 0.6% of total funds [57].

As the global health community transitions from the MDGs to the launch of the post-2015 United Nations Sustainable Development Goals (SDGs), the NTD research community is pressuring policymakers to prioritize these neglected diseases, including river blindness, in the new health agenda.

Selected Q&A with co-author Kelly Callahan, Director of the Trachoma Control Program at The Carter Center.

Kelly Callahan is the Director of the Trachoma Control Program at The Carter Center, and a co-author on the PLOS NTDs article: “The Contributions of Onchocerciasis Control and Elimination Programs toward the Achievement of the Millennium Development Goals."
Kelly Callahan is the Director of the Trachoma Control Program at The Carter Center, and a co-author on the PLOS NTDs article: “The Contributions of Onchocerciasis Control and Elimination Programs toward the Achievement of the Millennium Development Goals.”

Q: The resources invested in “the big three” diseases of global health (HIV, Tuberculosis, and Malaria) through The Global Fund as well as PEPFAR had a huge impact on scaling-up community programs and national prevention strategies in high-burden settings. Considering how frequently NTDs coincide with these priority diseases, it seems that it would make sense to integrate treatment for NTDs afflicting local communities in disease response programs for the “big three”. Are you aware of any discussion or efforts to integrate NTD response in “big three” community programs? Also, what are some common barriers to scaling-up onchocerciasis programs in endemic settings?

A: Great question – The Carter Center has integrated when and where possible to achieve the greatest impact.

The Carter Center’s Hispaniola Initiative works with ministries of health in Haiti and the Dominican Republic to accelerate the elimination of malaria and lymphatic filariasis from the countries’ shared island, Hispaniola, by 2020.

The Carter Center also carried out integrated malaria and onchocerciasis and malaria and trachoma activities in Ethiopia with great success. In 2007 these integrated programs assisted the Federal Ministry of Health in the distribution of over 20 million bed nets in the fight against malaria. The integrated programs also carried out health education and treatment activities. The malaria and trachoma activities were combined to treat the entire regional population for trachoma with the antibiotic Zithromax®, donated by Pfizer Inc-a population approaching 20 million people annually. At the same time we screened every person for malaria. If they had a fever, they were tested with the best rapid diagnostic tests available and provided treatment. It was also an opportunity to reinforce the ongoing health education messages for preventing the two diseases.

Despite success in malaria and other NTD integration, The Carter Center is very careful about integration… Integration is a fantastic concept however, integration needs to be reviewed carefully by the ministry of health and partners to ensure decisions to integrate are data driven and focused on the greatest impact, make sense and are carried out in the most reasonable and cost efficient manner.

Q: The Carter Center has made huge gains toward eradicating guinea worm. In what ways has the Guinea Worm Eradication Program served as a blueprint for control, elimination, and eradication efforts for other NTDs, likes river blindness?

A: The NTD Programs at The Carter Center are modeled after the Guinea Worm Eradication Program. Each of these programs is data driven and outcome oriented. The progress of each program is measured annually during Program reviews, just like the Guinea Worm Eradication Program.

The International Task Force for Disease Eradication (ITFDE) formed at The Carter Center reviews and assesses disease that can be potentially eradicated. The ITFDE reviews the progress of disease selected for eradication or control and make recommendations based upon these reviews.

NOTE: The ITFDE identified onchocerciasis as one of three NTDs that are eligible for elimination or better control, but not eradication. The ITFDE includes more information about the key factors that determine if a disease is eligible for eradication.

Do you have more questions about river blindness? Kelly Callahan and co-authors Caitlin Dunn and Dr. Deborah McFarland will be taking your questions about river blindness, Neglected Tropical Diseases, and post-2015 global health priorities on RedditScience September 2 at 1pm ET (10am PT)!

Featured image: A man, 30-40 years old, blind due to onchocerciasis. Photo by Pak Sang Lee, originally published in: Revue de Santé Oculaire Communautaire Vol. 1 No. 1 2004. Photo courtesy of Flickr.


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