Research Project

Barriers and Opportunities to Offering Ivermectin Continuously in the Primary Health Care System

An Exploratory Study of Stakeholders in Cameroon

Summary

The Centre for Research on Filariasis and Other Tropical Diseases conducted a mixed-methods study on the challenges, opportunities, and cost for integrating ivermectin administration into Cameroon’s primary health care system.

Cameroon

Neglected Tropical Diseases. Onchocerciasis

  • Make ivermectin available for three months after mass drug administration
  • Establish policies for managing adverse reactions to ivermectin
  • Raise community awareness about ivermectin availability

Key Messages

Ivermectin has proven effective for controlling onchocerciasis. The Centre for Research on Filariasis and Other Tropical Diseases explored the feasibility of partially integrating ivermectin administration into Cameroon’s primary health care system. Specifically, researchers examined ivermectin campaign costs and the opportunities and obstacles associated with partially integrating ivermectin campaigns. They held interviews and focus groups with stakeholders and analyzed data from previous ivermectin campaigns in five regions of Cameroon.

  • Ivermectin administration may be relatively simple to partially integrate, and stakeholders are highly motivated to support such integration.
  • Partial integration of ivermectin distribution with the primary health care system’s regular mass drug administration (MDA) campaigns would promote ivermectin campaign sustainability.
  • Key challenges to partial integration of ivermectin distribution include the possibilities of ivermectin misuse and adverse effects from treatment, as well as obstacles to community drug distributor services.
  • Recommended strategies for mitigating these challenges include closely monitoring ivermectin stocks, leveraging resources from other MDA campaigns to address adverse effects, and involving community drug distributors who support other health campaigns.

Background

Context

Onchocerciasis is a leading cause of infection-related blindness globally. In 2017, this disease infected approximately 21 million people. Almost all of these impacted individuals (99%) resided in 31 African countries, including Cameroon. In many of these countries, the administration of ivermectin effectively eliminated or disrupted transmission of the disease.

Problems or Gap

While many countries impacted by onchocerciasis have controlled or eliminated the disease, it remains endemic in 60% of Cameroon’s health districts. This prevalence points to a gap in the implementation of ivermectin treatment in Cameroon. Absences during mass drug administration (MDA) campaigns and the failure of community drug distributors to deliver treatments have contributed significantly to this gap in coverage. Thus, the Centre for Research on Filariasis and Other Tropical Diseases explored the potential partial integration of this intervention with Cameroon’s primary health care system as an approach to improving ivermectin coverage.

Study Objectives

The objectives of this study were to:

  • Describe challenges and opportunities related to health personnel, stakeholders, communities, or resources that may arise during the addition of continuous ivermectin distribution through local health facilities to usual mass drug administration campaigns.
  • Illustrate the cost-effectiveness of ivermectin mass drug administration through campaigns.
Map on right: The study was conducted in 10 districts in Cameroon (white circles on map).
 
For details on the methods, please see the slides or research brief.

Results

Summary

This study revealed the following opportunities associated with the partial integration of ivermectin distribution in Cameroon:

  • Across the regions studied, the demand for ivermectin treatment was high.
  • Most of the study participants approved of the proposed partial integration and expressed strong motivation to support its implementation.
  • In general, stakeholders viewed partial integration as simple to implement. They also remarked that if certain parameters are met, this integration will enhance the sustainability of ivermectin distribution campaigns.
  • An anticipated advantage of this partial integration is the opportunity to catch up those who were unable to receive ivermectin treatment during the campaign or who refused the drug during the campaign but later changed their minds.

Dr. Guy Sadeu Wafeu of the Center for Research on Filariasis and Other Tropical Diseases, presents the results, lessons and promising practices.

Key Findings

Study participants identified the following challenges in connection to partial implementation:

  • The need to manage adverse effects that may occur after treatment
  • Heightened risk of ivermectin misuse
  • Gaps in coverage by community drug distributors due to large service areas and lack of reimbursement for transportation costs

To help mitigate these challenges, participants recommended the following strategies:

  • Involve community drug distributors in follow-up care and provide resources for the management of potential adverse effects.
  • Closely monitor ivermectin use and track data on its administration.
  • Leverage community workers from other campaigns, such as HIV/AIDS campaigns, to help distribute ivermectin, since renumeration is already in place for them.

By analyzing data from the most recent mass ivermectin administration, researchers found the following:

 

  • Ivermectin coverage was 81.5% across the districts.
  • At the district level, the total direct cost of the campaign ranged from 1,249,000 to 8,103,200 CFA francs. 

““It [ivermectin integration to the primary health care system] really needs to be accompanied by measures to manage severe adverse events.”
–Study Participant

  • For three months after the campaign closes, keep ivermectin available in health centers for those who missed the campaign.
  • Provide incentives to motivate drug distribution personnel to adhere to changes under the partial campaign integration.
  • Track ivermectin use after campaigns conclude to help prevent illegal usage.
  • Leverage community drug distributors from other campaigns to support ivermectin distribution, since they are familiar with the populations served and may be aware of individuals who missed the campaign.
  • Establish a policy for managing adverse events.
  • Gather data on reasons why individuals refuse ivermectin treatment and work to address their concerns.
  • Raise awareness about the campaign and educate communities about the low likelihood of adverse effects. Local radio announcements are an especially effective channel for such informational campaigns.
  • Note individuals who were ineligible for treatment during the campaign but may later become eligible, such as those who were pregnant at the time, and offer them treatment later.
  • Identify ivermectin storage locations for use after the campaign.

Photo Credit: University of the Andes