Progress Towards Elimination: Act | West Countries Highlight Efforts Against Onchocerciasis

“Based on surveillance, we don’t have onchocerciasis anymore.”

—Dr. Amadou Salissou, National Coordinator of Niger’s Onchocerciasis and Lymphatic Filariasis Program

Benin, Cameroon, Cote d’Ivoire, Niger, Mali, Senegal, Sierra Leone, Togo, Ghana, Guinea, Burkina Faso together form the Act | West consortium. These countries have made great strides during their tenure  in the Act | West program towards the elimination of onchocerciasis (OV). During a recent onchocerciasis program review workshop in Ghana, progress made towards onchocerciasis elimination among countries was recognized and common challenges and potential solutions to address those challenges were discussed. 

Act | West countries have made notable progress and achieved key successes over the past several years.

Of the countries currently working to eliminate onchocerciasis, Niger stands out. Just last year, in February 2022, the country was able to submit their onchocerciasis dossier to the World Health Organization (WHO) for verification that the disease is no longer transmitted in the country.  While there is no ongoing transmission across Niger’s national borders, Dr. Salissou was

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Current state of OV in Togo, 2023, as presented at the May 2023 Act | West OV Program Review Workshop. Credit: Togo PNMTN

careful to note that, “We have to collaborate with other countries for surveillance in the border districts to continue [our efforts].”

Countries also made other successes and progress against onchocerciasis.

  • Senegal was able to stop onchocerciasis mass drug administration (MDA) in all of its formerly endemic districts in 2023 following an MDA that occurred in December 2022. 
  • Benin has taken steps to complete analysis of the results of the entomological survey, build on digitization efforts during MDA, and continue cross-border work which includes sharing updated maps of which border areas have undergone MDA with neighboring Togo.
  • Togo stopped MDA for OV in the Maritime region in FY2023. The country is aiming to conduct two rounds of MDA this fiscal year and strengthen its laboratory capacity in addition to its cross-border partnerships.

OV img 2Ghana noted the importance of cross-national collaboration. As the country has 12 districts bordering Togo , eight bordering Burkina Faso , and 11 bordering Cote d’Ivoire. Ghana has had an ongoing collaboration with Togo since 2018 and hosts activities such as cross border district level. consultation and collaboration around MDAs. Discussions have even started to implement a framework for cross border collaboration between Burkina Faso and Côte d’Ivoire like the one in place between Ghana and Togo.

  • Burkina Faso has been working to increase training of community health workers and town criers with information related to OV and to increase capacity building of the national NTD program.
  • Similarly, Guinea has also been working to synchronize studies and surveys along its border with Sierra Leone andOV img 3 Liberia. The country has managed to eliminate the risk of blindness for the populations that live within range of the black flies that transmit OV. While some areas had been abandoned due to the high risk of contracting OV, support, and funding from partners such as USAID has enabled people to be able to start living in those places again.
  • While Mali has made great progress against OV, notably stopping MDA for two districts in 2016, the country is looking forward to the future of its OV efforts. These include providing laboratories with additional equipment, developing, and putting in place a post-treatment monitoring plan, and developing a cross-border Onchocerciasis surveillance plan.
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Ivermectin distribution in Cote d'Ivoire.  Photo credit: Cote d’Ivoire PNLMTN CP
  • Côte d’Ivoire is working to interrupt OV transmission in 97 health districts by 2030.
  • In Sierra Leone, they have brought forth a few strategies to support the elimination of OV: conducting MDA on a bi-annual basis, subjecting vector breeding sites to elimination mapping, and supporting capacity building for the NTDP to coordinate and champion the elimination of selected NTDs.
  • For Cameroon, they shared their challenge with loa loa co-endemicity with onchocerciasis. If treated with Ivermectin, this disease can cause severe adverse neurological effects, including and up to death. A proposed treatment solution consisted of implementing a test-and-not-treat approach with Ivermectin in loa loa-OV co-endemic areas. Additionally, USAID in collaboration with ESPEN and the NTDP proposed extending test-and-not-treat to 28 health districts co-endemic OV/Loais (7 out of the 28 HDs are partially treated). This proposal remains in the early stages as the national NTD program consults internally and conducts desk reviews and analyses. Other recommendations for onchocerciasis treatment included: mapping of blackfly breeding sites,
    OV img 5
    Current OV prevalence in Cameroon as presented at the May 2023 Act | West OV Program Review Workshop. Credit: Cameroon NTDP
    carrying out epidemiological assessment (pre-stop; routine assessment, elimination mapping) throughout the country , and creating sub-committees to develop guidelines for OV elimination (evaluation, protocols and framework ) and work on quality assurance.

As countries move into their sixth year of the Act | West program, several common activities contributing towards countries’ success were noted: 

  • Training of additional health workers and town criers.
  • Collaboration across borders to help control onchocerciasis transmission 
  • Building laboratory capacity and data analysis 

Common challenges around onchocerciasis elimination among Act | West countries included occurrences of OV transmission in border regions and out of date mapping of blackfly breeding sites.

Countries have planned strategies to control OV transmission for implementation over the coming years.

As countries move forward in their efforts against onchocerciasis within the Act | West program, a few countries also shared strategies and solutions for implementation in the coming years to resolve challenges faced. These included:  

  • Resolving digitization issues and improving training around the digitization to better support MDA 
  • Synchronizing MDA across national borders or along border towns 
  •  Conducting advocacy and communications to obtain direction from high-level government authorities to facilitate cross-border collaboration in border districts
  • Improving and sharing cross-border information directly with neighboring countries and inviting other countries to collaborate in the same way
  • Putting in place an integrated system for entomological surveillance
  • Creating a network of laboratories in connection with LABO ESPEN 
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The shared information exchanged at the OV program review workshop shed light on the countries that Act | West works alongside and their efforts against OV and the tactics that countries will be implementing as they move forward in the coming years in their efforts to control and eliminate the disease. All the work brought forth by the countries puts them closer to the aim of OV elimination by 2030 and WHO targets.

We will be getting to elimination by 2030 as the program projected.” 

—Dr. Yacouba Sangare, coordinator of Mali’s national OV elimination program coordinator