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Am. J. Trop. Med. Hyg., 79(4), 2008, pp. 480-484
Copyright © 2008 by The American Society of Tropical Medicine and Hygiene

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Determinants of Success in National Programs to Eliminate Lymphatic Filariasis: A Perspective Identifying Essential Elements and Research Needs

Dominique Kyelem*, Gautam Biswas, Moses J. Bockarie, Mark H. Bradley, Maged El-Setouhy, Peter U. Fischer, Ralph H. Henderson, James W. Kazura, Patrick J. Lammie, Sammy M. Njenga, Eric A. Ottesen*, Kapa D. Ramaiah, Frank O. Richards, Gary J. Weil, AND Steven A. Williams
Lymphatic Filariasis Support Center, Task Force for Child Survival and Development, Decatur, Georgia; Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland; Lymphatic Filariasis Support Centre, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; Global Community Partnerships, GlaxoSmithKline, Brentford, United Kingdom; Department of Public Health, Ain Shams University, Cairo, Egypt; School of Medicine, Washington University, St. Louis, Missouri; Center for Global Health & Diseases, Case Western Reserve University, Cleveland, Ohio; Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Nairobi, Kenya; Vector Control Research Centre, Indian Council of Medical Research, Pondicherry, India; Carter Center, Atlanta, Georgia; Clark Science Center, Smith College, Northampton, Massachusetts

The Global Programme to Eliminate Lymphatic Filariasis (GPELF) was launched in 2000. To understand why some national programs have been more successful than others, a panel of individuals with expertise in LF elimination efforts met to assess available data from programs in 8 countries. The goal was to identify: 1) the factors determining success for national LF elimination programs (defined as the rapid, sustained reduction in microfilaremia/antigenemia after repeated mass drug administration [MDA]); 2) the priorities for operational research to enhance LF elimination efforts.

Of more than 40 factors identified, the most prominent were 1) initial level of LF endemicity; 2) effectiveness of vector mosquitoes; 3) MDA drug regimen; 4) population compliance.

Research important for facilitating program success was identified as either biologic (i.e., [1] quantifying differences in vectorial capacity; [2] identifying seasonal variations affecting LF transmission) or programmatic (i.e., [1] identifying quantitative thresholds, especially the population compliance levels necessary for success, and the antigenemia or microfilaremia prevalence at which MDA programs can stop with minimal risk of resumption of transmission; [2] defining optimal drug distribution strategies and timing; [3] identifying those individuals who are "persistently non-compliant" during MDAs, the reasons for this non-compliance and approaches to overcoming it).

While addressing these challenges is important, many key determinants of program success are already clearly understood; operationalizing these as soon as possible will greatly increase the potential for national program success.

Received June 16, 2008. Accepted for publication August 20, 2008.

* Address correspondence to Dominique Kyelem or Eric A. Ottesen, Lymphatic Filariasis Support Center, Task Force for Child Survival and Development, Decatur, Georgia. E-mails: dkyelem{at}taskforce.org and eottesen{at}taskforce.org

Authors’ addresses: Dominique Kyelem, Task Force for Child Survival and Development, 325 Swanton Way, Decatur, GA 30030, E-mail: dkyelem{at}taskforce.org. Gautam Biswas, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland, Tel: +41-22-791-21-11, Fax: +41-22-791-31-11, E-mail: biswasg{at}who.int. Moses J. Bockarie, Case Western Reserve University, Center for Global Health and Diseases, Wolstein Research Building Rm. 4129, 2103 Cornell Road, Cleveland, OH 44106, Tel: (216) 368-6285, Fax: (216) 368-4825, E-mail: mbockarie{at}gmail.com. Mark H. Bradley, Glaxo-SmithKline, Global Community Partnerships, 980 Great West Road, Brentford, Middlesex TW8 9GS, United Kingdom, E-mail: mark.h.bradley{at}gsk.com. Maged El-Setouhy, Professor, Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Abbasia, Cairo, Egypt, Tel: +(202) 2685-3276, Fax: +(202) 2483-7888, E-mails: maged_elsetouhy{at}yahoo.com and maged.elsetouhy{at}gmail.com. Peter U. Fischer, Washington University School of Medicine, Infectious Disease Division, Campus Mailbox 8051, 660 S. Euclid Ave., St. Louis, MO 63110, Tel: 314-454-7876, Fax: 314-454-5293; E-mail: PUfische{at}im.wustl.edu. Ralph H. Henderson, Task Force for Child Survival and Development, 325 Swanton Way, Decatur, GA 30030, E-mail: rafeh{at}bellsouth.net. James W. Kazura, Case Western Reserve University, Center for Global Health and Diseases, Wolstein Research Building Rm. 4129, 2103 Cornell Road, Cleveland, OH 44106, Tel: (216) 368-4810, Fax: (216) 368-4825, E-mail: james.kazura{at}case.edu. Patrick J. Lammie, U.S. Centers for Disease Control and Prevention, DPD/NCID/CCID, 4770 Buford Hwy NE, MS F-13, Atlanta, GA 30342-3742, Tel: 001-770-488-4054, E-mail: pjl1{at}cdc.gov. Sammy M. Njenga, Kenya Medical Research Institute, P.O. Box 54840, 00200 Nairobi, Kenya, Tel: +254-20-2722541, Fax: +254-20-2720030, E-mail: snjenga{at}kemri-nuitm.or.ke. Eric A. Ottesen, Task Force for Child Survival and Development, 325 Swanton Way, Decatur, GA 30030, E-mail: eottesen{at}taskforce.org. Kapa D. Ramaiah, VCRC, No: 12, Bhaktavatsalam Street, Tagore Nagar, Lawspet, Pondicherry—605 008, India, E-mail: ramaiahk{at}yahoo.com. Frank O. Richards, The Carter Center, One Copenhill, 453 Freedom Parkway, Atlanta, GA 30307, Tel: 404-420-5100, E-mail: fxr1{at}cdc.gov. Gary J. Weil, Washington University School of Medicine, Infectious Disease Division, Campus Mailbox 8051, 660 S. Euclid Ave., St. Louis, MO 63110, Tel: 314-454-7782, Fax: 314-454-5293, E-mail: GWEIL{at}im.wustl.edu. Steven A. Williams, Smith College, Clark Science Center, 44 College Lane, Northampton, MA 01063, Tel: 413-585-3857 ext. 3826, Fax: 413-585-3786, E-mail: swilliam{at}email.smith.edu.

* Defined by the proportion of the population targeted by the program that was provided with the appropriate drugs.

{dagger} Defined by the proportion of eligible individuals actually ingesting the drugs provided to them.






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