Community-directed treatment (ComDT)

In an evaluation of the African Programme for Onchocerciasis Control (APOC), it was concluded that 'ComDT has been a timely and innovative strategy... and communities have been deeply involved in their own health care on a massive scale... ComDT is a strategy that could be used as a model in developing other community-based programmes'.

In 1995, ComDT was shown to be a feasible and effective means of ivermectin delivery for the treatment of onchocerciasis. The method was subsequently adopted by all onchocerciasis-endemic countries in Africa as the principal strategy for drug delivery in onchocerciasis control.

ComDT was effective in achieving the treatment coverage required to eliminate onchocerciasis as a public health problem. In 2000, 20 million people in Africa received ivermectin treatment through ComDT.Pictorial instructions were given on how to take the drugs.

ComDT is now also recommended for mass treatment for lymphatic filariasis elimination in Africa.

Community directed treatment (ComDT) encourages communities to take control of their own treatment - to collect drugs from supply points, treat all eligible members, refer cases of severe adverse reaction, and report. Such a system is possible for the treatment of lymphatic filariasis and onchocerciasis because the treatment for these diseases is free (or low cost) and simple - consisting of a single dose taken just once a year.

WHAT WAS TDR ROLE?

In 1994, TDR launched a multi-country study to evaluate and further develop methods for community-based ivermectin delivery. TDR:

  • Developed and tested the concept of ComDT
  • Demonstrated that ComDT was a feasible and effective means of ivermectin delivery for the treatment of onchocerciasis
  • Addressed critical implementation issues such as integration of ComDT in the health services and sustainability issues
  • Supported research to enhance and improve ComDT
  • Demonstrated the effectiveness of ComDT for the treatment of lymphatic filariasis in Africa.

The feasibility, sustainability and cost-effectiveness of the home treatment strategy remains to be demonstrated on a large scale. This is a challenge for implementation research.

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