Triple-drug filaria therapy to roll out countrywide

─New strategy will aid in reaching target in two years

DPI, Guyana, Tuesday, March 26, 2019

The Ministry of Public Health and The Pan America Health Organisation/World Health Organisation (PAHO/WHO) have redoubled efforts to eliminate Lymphatic Filariasis by the end of 2020.

More specifically, the Mass Drug Administration (MDA) has been revisited with the aim of effecting the elimination goal. In addition to the double-drug therapy administered, a new drug has been introduced to the combination. According to the Deputy Chief Medical Officer of the Ministry, Dr. Karen Campbell, the new triple-drug therapy including Ivermectin, Diethylcarbamazine and Albendazole will be rolled out in all ten administrative regions.

“Guyana has signalled the political will to implement the use of triple therapy, IDA, where we will be using ivermectin, diethylcarbamazine and albendazole from 2019. Two successful years of IDA coverage of over 80 percent is mandatory if Guyana is to be successful in the interruption of transmission by 2020. Our current use of DA (Diethylcarbamazine and Albendazole) will not achieve this and therefore we don’t really have much choice, we have to embrace IDA if we want to qualify.”

Since the first MDA in 2016, Guyana has only achieved successes in the years 2017 and 2018. Taking note of this in reviewing the MDA initiative there were two observations.

Firstly, PAHO/WHO notes that in order for a country to qualify for elimination status of Lymphatic Filariasis they would have had to achieve five successful years of MDA, consecutively using the double-drug therapy of Diethylcarbamazine and Albendazole.

Secondly, MDA must be executed countrywide. Guyana has only implemented the MDA in four endemic regions, namely Regions Three, Four, Five and Ten. Therefore, the two modifications to the MDA exercises are the addition of the third drug and expanding the reach of the MDA.

Campbell added, “Key to scaling up the geographical coverage to 100 percent is a remapping survey which is being conducted in six regions that have not yet implemented the mass drug administration. This survey will give an updated picture as to which other implementation units need to be included in the mass drug administration exercise.”

In 2018, a remapping of all regions was done in preparation of the countrywide roll-out.  WHO’s target number to qualify from elimination status is 65 percent countrywide coverage of the MDA.

Concerned stakeholders of the Ministry of Public Health and PAHO/WHO believe achieving this in the next two years is possible considering that coverage in the last two year surpasses the target.

Guyana and Haiti are the last two countries in the Americas to actively eliminate Lymphatic Filariasis. Brazil and the Dominican Republic have made progress and are currently in the assessment phase. PAHO/WHO representative, Dr. William Adu-Krow said that there is now the golden opportunity to build on gains to achieve the goal of elimination.

“MDA is a WHO-recommended preventative chemotherapy strategy to stop the transmission of LF infection. MDA involves administering preventative chemotherapy to all eligible persons in all LF endemic areas with a drug combination. MDA reduces the parasites in the blood of infected persons and the prevalence of infection in the communities to such low levels that transmission cannot be sustained and new infections will eventually cease. When the level of infection has been reduced below target thresholds MDA is considered no longer required.”

The new MDA strategy reserves the previous method of targeting populations within schools and workplaces with support coverage at fixed points including market places, religious institutions and mop-up exercises in targeted households.

Delicia Haynes

Images: Keno George