Main characteristics of included papers.

Background Strongyloides stercoralis is a neglected soil-transmitted helminth (STH) that leads to significant morbidity in endemic populations. Infection with this helminth has recently been recognised by the World Health Organization (WHO) as a major global health problem to be addressed with ivermectin preventive chemotherapy, and therefore, there is now, the need to develop guidelines for strongyloidiasis control that can be implemented by endemic countries. This study aimed to evaluate the impact of ivermectin preventive chemotherapy (PC) on S. stercoralis prevalence in endemic areas to generate evidence that can inform global health policy. Methodology/Principal findings This study was a systematic review and meta-analysis. We searched PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and LILACS for literature published between 1990 and 2022 and reporting prevalence of S. stercoralis before and after PC with ivermectin, administered either at school or at community level. The search strategy identified 933 records, eight of which were included in the meta-analysis. Data extraction and quality assessment were carried out by two authors. Meta-analysis of studies based on fecal testing demonstrated a significant reduction of S. stercoralis prevalence after PC: prevalence Risk Ratio (RR) 0.18 (95% CI 0.14–0.23), I2 = 0. A similar trend was observed in studies that used serology for diagnosis: RR 0.35 (95% CI 0.26–0.48), I2 = 4.25%. A sensitivity analysis was carried out for fecal tests where low quality studies were removed, confirming a post-intervention reduction in prevalence. The impact of PC could not be evaluated at different time points or comparing annual vs biannual administration due to insufficient data. Conclusions/Significance Our findings demonstrate a significant decrease of S. stercoralis prevalence in areas where ivermectin PC has taken place, supporting the use of ivermectin PC in endemic areas.背景 粪类圆线虫（Strongyloides stercoralis）是一种被忽视的土壤传播蠕虫（soil-transmitted helminth, STH），在流行地区可造成显著的患病负担。世界卫生组织（World Health Organization, WHO）近期已将该蠕虫感染列为需要通过伊维菌素预防性化疗（preventive chemotherapy, PC）加以应对的主要全球公共卫生问题，因此当前亟需制定类圆线虫病防控指南，供流行国家落地实施。本研究旨在评估伊维菌素预防性化疗对流行地区粪类圆线虫感染率的影响，以期为全球卫生政策制定提供循证依据。 方法学/主要结果 本研究为系统评价与荟萃分析。我们检索了1990年至2022年间发表于PubMed、EMBASE、Cochrane对照试验中心注册库（Cochrane Central Register of Controlled Trials）以及LILACS数据库的文献，筛选报道了以学校或社区为单位开展伊维菌素预防性化疗前后粪类圆线虫感染率的研究。初始检索共获取933条记录，最终纳入8项研究进行荟萃分析。由两名研究者独立完成数据提取与质量评价。基于粪便检测的研究荟萃分析结果显示，预防性化疗后粪类圆线虫感染率显著降低：感染率风险比（Risk Ratio, RR）为0.18（95%置信区间CI：0.14~0.23），I²=0。采用血清学检测的研究也呈现相似趋势：RR=0.35（95%置信区间CI：0.26~0.48），I²=4.25%。针对粪便检测研究开展了敏感性分析，剔除低质量研究后，进一步验证了干预后感染率的降低效果。由于可用数据不足，无法评估不同时间节点或年度与每半年一次给药方案对干预效果的影响差异。 结论与意义 本研究结果证实，实施伊维菌素预防性化疗的流行地区粪类圆线虫感染率显著下降，支持在流行地区采用伊维菌素预防性化疗方案。