By Lior Miller/IMA World Health
Neglected tropical diseases (NTDs) affect more than one billion people globally. In 1997, the World Health Organization classified lymphatic filariasis (LF), as eradicable, due to advances in diagnostic and treatment options. WHO then launched the Global Programme to Eliminate Lymphatic Filariasis, with the goal of eliminating LF as a public health problem by 2020.
Haiti is one of four countries in the Americas where LF is endemic. It is a country that faces many challenges, including high rates of infant and maternal mortality and poverty. Moreover, Haiti is still recovering from the massive 2010 earthquake that killed more than 160,000 people and displaced over 1.5 million.
In this challenging context, the National Program to Eliminate Lymphatic Filariasis (NPELF), part of the Haiti Ministry of Public Health and Population (MSPP), has achieved remarkable gains, with financial support from USAID through the ENVISION project. ENVISION is led by RTI International and implemented by IMA World Health in Haiti. Other implementing partners include the University of Notre Dame and l’Hôpital St. Croix.
Since the start of mass drug administration (MDA) for LF in 2000 and soil transmitted helminths in 2004, over 35,000 community drug distributors and community leaders have been trained and mobilized to carry out MDA. The drugs, Diethylcarbamazine and Albendazole, help stop the spread of infection and can lead to the elimination of LF when at least five rounds of annual MDA are carried out with at least 65% population epidemiological coverage.
By 2014, 48 of Haiti’s 140 communes were eligible to conduct transmission assessment surveys (TAS) to determine whether they could stop treating the population. Passing a TAS in a given area is an incredible milestone toward elimination, since it means that infection has been reduced to levels where transmission is assumed to be no longer sustainable and recurrence is unlikely to occur.
With strong buy-in and support from MSPP and the National Laboratory, 26 dedicated MSPP and partners’ lab technicians were trained to conduct TAS. From November 2014 through June 2015, the NPELF and implementing partners carried out TAS, a logistically complex, two to three-week survey, in hundreds of schools and communities testing over 16,000 children using the immunochromatographic card test (ICT), an approved rapid diagnostic for LF. In 46 of these communes, the number of ICT-positive cases was below the critical cutoff, meaning these communes passed the TAS and no longer need treatment.
From 2016-2019, an additional 94 communes will be ready for TAS. If they all pass TAS by 2019, there may be no communes left needing treatment, and Haiti will be on track to achieve its 2020 LF elimination goal. Haiti’s story is an inspiring example for other national LF programs, and elimination in Haiti would be a significant contribution in the global effort to eliminate the disease. Haiti’s achievements demonstrate how USAID’s ENVISION project helps strengthen national NTD programs to rapidly and effectively scale-up in some of the most challenging environments.