CDTI perceptions of individuals in Maridi, 2023.

BackgroundA high onchocerciasis disease burden and a low coverage of community-directed treatment with ivermectin (CDTI) have been observed in many parts of South Sudan. In the Maridi County, CDTI was re-introduced in 2017 and various interventions implemented to improve coverage.MethodsThrough successive community-based surveys, we investigated whether an onchocerciasis awareness campaign and a switch from annual to bi-annual distribution of ivermectin in Maridi County increased CDTI coverage. We also reviewed the evolution of ivermectin distribution in Maridi since 2017 and identified the determinants for ivermectin uptake.ResultsFor past years in Maridi, CDTI programme performance has been highly variable due to security concerns, limited funding, misconceptions about ivermectin, and poor organisation of mass treatment campaigns. Community-based surveys conducted between 2018 and 2024 in Maridi found that upon switching from annual CDTI (2017–2019) to bi-annual CDTI (2021 onward), therapeutic coverage significantly increased from 40.8% in 2017 to 70.3% in 2023. Lower age, male gender, more CDTI information sources, and awareness of a link between onchocerciasis and epilepsy were all associated with increased uptake of ivermectin.ConclusionThis study showed that with reinforced awareness raising accompanying biannual CDTI, a higher ivermectin treatment coverage is achievable. The findings present an opportunity for the health system to advance its onchocerciasis elimination scheme in remote, conflict-stricken communities in South Sudan.

研究背景：南苏丹诸多地区盘尾丝虫病（onchocerciasis）负担沉重，且伊维菌素社区导向治疗（CDTI）覆盖率偏低。马里迪县于2017年重新推行CDTI，并实施多项干预措施以提升治疗覆盖率。
研究方法：本研究通过系列社区调查，探究马里迪县开展盘尾丝虫病宣传活动，以及将伊维菌素年度分发调整为每半年1次的分发模式，是否提升了CDTI覆盖率；同时梳理了2017年以来马里迪县伊维菌素分发的演变情况，并明确了伊维菌素服用率的影响因素。
研究结果：过往数年，马里迪县CDTI项目执行情况波动剧烈，诱因包括安全顾虑、经费不足、民众对伊维菌素存在认知误区，以及大规模治疗活动组织不力。2018年至2024年间在马里迪县开展的社区调查显示，当CDTI模式从年度执行（2017-2019年）调整为每半年1次执行（2021年起）后，治疗覆盖率从2017年的40.8%显著提升至2023年的70.3%。年龄更小、男性、可获取更多CDTI相关信息渠道，以及知晓盘尾丝虫病与癫痫存在关联的人群，其伊维菌素服用率更高。
研究结论：本研究表明，配合强化宣传的每半年1次CDTI模式，可实现更高的伊维菌素治疗覆盖率。该研究结果为南苏丹偏远且受冲突影响地区的卫生系统推进盘尾丝虫病消除计划提供了可行路径。