@article{fdi:010077733,
  title = {{I}mplications for annual retesting after a test-and-not-treat strategy for onchocerciasis elimination in areas co-endemic with {L}oa loa infection : an observational cohort study},
  author = {{P}ion, {S}{\'e}bastien and {N}ana-{D}jeunga, {H}. and {N}iamsi-{E}malio, {Y}. and {C}hesnais, {C}edric and {D}eleglise, {H}. and {M}ackenzie, {C}. and {S}tolk, {W}. and {F}letcher, {D}. {A}. and {K}lion, {A}. {D}. and {N}utman, {T}. {B}. and {B}oussinesq, {M}ichel and {K}amgno, {J}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground {A} test-and-not-treat ({T}a{NT}) strategy has been developed to prevent people with high concentrations of circulating {L}oa boa microfilariae (>20 000 microfilariae per m{L}) developing serious adverse events after ivermectin treatment during mass drug administration to eliminate onchocerciasis. {A}n important question related to cost and programmatic issues is whether annual retesting is required for everyone. {W}e therefore aimed to investigate changes in {L} boa microfilarial densities during {T}a{NT} campaigns run 18 months apart. {M}ethods {I}n this observational cohort study, we assessed the participants of two {T}a{NT} campaigns for onchocerciasis. {T}hese campaigns, which were run by a research team, together with personnel from the {M}inistry of {H}ealth and community health workers, were done in six health areas (in 89 communities) in {O}kola health district ({C}ameroon); the first campaign was run between {A}ug 10, and {O}ct 29, 2015, and the second was run between {M}arch 7, and {M}ay 26, 2017. {A}ll individuals aged 5 years and older were invited to be screened for {L}oa boa microfilaraemia before being offered ivermectin (unless contraindicated). {L} boa microfilarial density was measured at the point of care using the {L}oa{S}cope. {A}ll those with a {L}. boa microfilarial density of 20 000 microfilariae per m{L} or less were offered treatment; in the first 2 weeks of the 2015 campaign, a higher exclusion threshold of 26 000 microfilariae per m{L} or less was used. {A}t both rounds of the intervention, participants were registered with a paper form, in which personal information were collected. {I}n 2017, we also recorded whether each individual reported participation in the 2015 campaign. {T}he primary outcome, assessed in all participants, was whether {L} boa microfilarial density was above or below the exclusion threshold (ie, the criteria that guided the decision to treat). {F}indings {I}n the 2015 {T}a{NT} campaign, 26 415 people were censused versus 29 587 people in the 2017 {T}a{NT} campaign. {A}ll individuals aged 5 years and older without other contraindications to treatment (22842 people in 2015 and 25 421 people in 2017) were invited to be screened for {L} boa microfilaraemia before being offered ivermectin. {I}n 2015, 16 182 individuals were examined with the {L}oa{S}cope, versus 18 697 individuals in the same communities in 2017. 344 (2.1%) individuals were excluded from ivermectin treatment because of a high {L} boa microfilarial density in 2015, versus 283 (1.5%) individuals in 2017 (p<0.0001). {R}ecords from 2017 could be matched to those from 2015 for 6983 individuals (43.2% of the 2015 participants). {I}n this cohort, in 2017, 6981 (>99.9%) of 6983 individuals treated with ivermectin in 2015 had {L} boa microfilariae density below the level associated with neurological serious adverse events. {I}nterpretation {I}ndividuals treated with ivermectin do not need to be retested for {L} boa microfilaraemia before the next treatment, provided that they can be re-identified. {T}his adjusted approach will enable substantial cost savings and facilitate reaching programmatic goals for elimination of onchocerciasis in areas that are co-endemic for loiasis.},
  keywords = {{CAMEROUN}},
  booktitle = {},
  journal = {{L}ancet {I}nfectious {D}iseases},
  volume = {20},
  numero = {1},
  pages = {102--109},
  ISSN = {1473-3099},
  year = {2020},
  DOI = {10.1016/s1473-3099(19)30554-7},
  URL = {https://www.documentation.ird.fr/hor/fdi:010077733},
}