review · Tropical Medicine and Infectious Disease
Onchocerciasis is endemic across all provinces of the Democratic Republic of the Congo. Clinical use of ivermectin began in 1987, followed by mass administration in 1989. The National Program for Onchocerciasis Control was established in 1996 using community-directed treatment with ivermectin, with mapping surveys initiated in 1999 to outline project zones. Community distributions began in 2001 but faced disruption in 2005 due to serious adverse events, prompting additional surveys to account for co-endemic loiasis before restarting in 2006. Activities continued until the conclusion of the African Program for Onchocerciasis Control in 2015, after which a broader neglected tropical disease programme took over in 2016. Overall, local public awareness of the disease and its community treatment remains poor. Given the weak historical outcomes of the national programme, the 2025 disease elimination target will not be met, signalling an urgent need to reform control strategies.
Onchocerciasis affects communities across all provinces of the Democratic Republic of the Congo, yet public awareness of the infection and its treatments remains low. Reviewing decades of national intervention data demonstrates why past mass treatment programmes have underperformed and why current elimination targets will be missed. These insights help health authorities and international partners recognise the necessity of restructuring disease control strategies.
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Here, we review all data available at the Ministry of Public Health in order to describe the history of the National Program for Onchocerciasis Control (NPOC) in the Democratic Republic of the Congo (DRC). Discovered in 1903, the disease is endemic in all provinces. Ivermectin was introduced in 1987 as clinical treatment, then as mass treatment in 1989. Created in 1996, the NPOC is based on community-directed treatment with ivermectin (CDTI). In 1999, rapid epidemiological mapping for onchocerciasis surveys were launched to determine the mass treatment areas called "CDTI Projects". CDTI started in 2001 and certain projects were stopped in 2005 following the occurrence of serious adverse events. Surveys coupled with rapid assessment procedures for loiasis and onchocerciasis rapid epidemiological assessment were launched to identify the areas of treatment for onchocerciasis and loiasis. In 2006, CDTI began again until closure of the activities of African Program for Onchocerciasis Control (APOC) in 2015. In 2016, the National Program for Neglected Tropical Diseases Control using Preventive Chemotherapy (PNMTN-CP) was launched to replace NPOC. Onchocerciasis and CDTI are little known by the population. The objective of eliminating onchocerciasis by 2025 will not be achieved due to the poor results of the NPOC. The reform of strategies for eliminating this disease is strongly recommended.
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DOI: 10.3390/tropicalmed4020092
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