END In Africa Countries Forge Ahead with New End-Game Activities in FY 2017

January 4th, 2017

Children line up for a disease-specific assessment in Togo. Photo: HDI

Seven years into the END in Africa project, five of the six implementing countries (Burkina Faso, Ghana, Niger, Togo, and Sierra Leone) have made remarkable progress toward the elimination of trachoma and lymphatic filariasis (LF).[1] Current data from the original five project countries indicate that 73.3% of endemic districts (88 out of 120) have stopped mass drug administration (MDA) for trachoma, while 64.0% of endemic districts (142 out of 221) have stopped treatment for LF.

Established by the United States Agency for International Development (USAID) in 2010 and managed by FHI 360, the END in Africa project helps national neglected tropical disease programs (NTDP) implement and scale-up integrated MDA for the control/elimination of neglected tropical diseases (NTDs) targeted through preventive chemotherapy (PC).

Most of the five original END in Africa implementing countries are reaching the end game for trachoma and LF in FY 2017 and will be conducting a number of stop-MDA evaluations. The five countries are also currently conducting post-MDA surveillance for trachoma and LF in many districts that have already reached WHO threshold for stopping MDA.

While the five original project countries are stopping MDA for PC NTDs in FY 2017 in districts that have reached the World Health Organization (WHO) threshold, END in Africa is supporting Côte d’Ivoire in finishing a nationwide trachoma map to identify all the areas that need disease treatment. The project will also help the country scale up treatment coverage to 100% for all targeted PC NTDs.

In Ghana, success has brought unique new demands. After conducting MDA for trachoma for almost nine years, followed by six years of post-MDA surveillance, the country did a pre-validation survey in 2015/2016, using WHO guidelines and protocols. The results showed that although the WHO threshold for one indicator of elimination (trachoma inflammation-follicular or TF) was reached in all 37 trachoma-endemic districts, one of the 37 districts did not reach the threshold for the second indicator (trachomatous trichiasis or TT). Therefore with END in Africa support, the NTDP will conduct a door-to-door TT case search in this district in FY 2017, followed by surgery for people with TT. The project will also help the country put together a dossier demonstrating trachoma elimination in the country during FY 2017. Once the TT surgeries are completed, the dossier will be finalized and submitted to the WHO, likely during the second half of FY 2017.

Niger is also facing an unusual situation in FY 2017. Although the country has never treated its population for onchocerciasis (oncho) because baseline data suggested that MDA was not necessary,[2] the country can only be taken off the list of oncho-endemic countries if it can demonstrate that transmission of onchocerciasis has been interrupted. The NTDP therefore must conduct serology studies in FY 2017 among children under 10 years of age in 5 districts to show that less than 0.1% of these children were exposed to the disease and carry the onchocerciasis antibody in their blood. The END in Africa project will provide technical assistance for the serological assessment and its presentation to the WHO.

In October 2016, FHI 360 organized a meeting on cross-border collaboration in regard to NTD control in FY 2017. Participating countries signed agreements signed to synchronize MDA treatments in border districts that are endemic for NTDs in order to improve NTD control. The END in Africa project will support the countries in developing comprehensive soil transmitted helminthiasis (STH)/schistosomiasis (SCH) strategies for drug distribution and disease assessment after the LF MDA program ends. As part of this support, FHI 360 will organize a partners meeting in Accra in FY 2017, with representatives from the ministries of health, USAID, the WHO, the US Centers for Disease Prevention and Control, the WASH project, the Global Task Force’s NTD Support Centre, the ENVISION project and FHI 360, for a preliminary discussion of STH/SCH strategies post-LF elimination.

Although the countries will of course continue implementing many tried and true NTD control and prevention activities in FY 2017, they will also be leading the way through innovations on new end-game activities in the coming year.

Project efforts in the countries are in part very successful due to the strong technical assistance that countries receive from the organizations that collaborate to manage the END in Africa project (FHI360 and Deloitte Consulting LLP) and the sub-grantees in the countries supported (Helen Keller International (HKI) for Burkina Faso, Niger, and Sierra Leone; Health & Development International (HDI) for Togo). FHI360 is directly responsible for project implementation in Cote d’Ivoire and Ghana.

[1] The sixth country, Côte d’Ivoire, was just included in the END in Africa project in FY 2016, after many years of civil strife that impeded program efforts to control/eliminate PC NTDs. Côte d’Ivoire is therefore at the initial phase of program implementation for all PC NTDs.

[2] Five districts were identified as only hypo-endemic. Also, recent epidemiological studies in those five districts showed that microfilaremia rates are either zero or close to zero and recent entomology studies in the same districts showed no Onchocerca volvulus infection or infectivity among the black flies (the vector responsible for onchocerciasis transmission).