African Programme for Onchocerciasis Control (APOC)

How community-directed treatment with ivermectin (CDTI) began

The treatment for onchocerciasis is ivermectin (Mectizan®). In 1987 the manufacturers of the drug –Merck & Co., Inc. – pledged to provide an unlimited supply of ivermectin free of charge to all those at risk from onchocerciasis and for as long as necessary. With drug supplies secured, the challenge for onchocerciasis control programmes was to work out a way to deliver the treatment to the people who needed it, and to sustain the delivery for a sufficiently long period to bring about control of the disease.

Community-directed treatment with ivermectin
People in affected communities manage and direct their own treatment for onchocerciasis

There were some basic requirements for the ivermectin distribution system:

  • it had to be cheap,
  • it had to work in some of the most difficult, remote, war-torn areas of Africa, many of which were far from urban health centres,
  • it had to be sustainable – to break transmission of the parasite, ivermectin has to be given once a year for 16–18 years to all eligible populations at high risk.

The solution was community-directed treatment – where communities in affected areas are encouraged to direct and manage their own treatment. This strategy took community involvement in public health to a level that no programme had done before.

CDTI timeline

1988: OCP use mobile teams of health workers to distribute ivermectin. There is very little community involvement and costs to the health system are high.

1995: Experts at WHO, the World Bank, and the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) recruit a team of African scientists to find a more sustainable and cost-effective method to deliver the treatment.

1996: Results from a multi-country study show that community-directed treatment is a feasible, effective and sustainable approach.

1997: APOC formally adopts the CDTI strategy, which proves to be a huge success.

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