Findings from a new study in Zanzibar, published January 23 in PLoS Neglected Tropical Diseases, pave the way for the World Health Organization (WHO) to recommend the mass co-delivery of three anti-parasitic drugs for the first time.
The study shows the safety of delivering three drugs simultaneously – ivermectin, albendazole and praziquantel – in order to tackle three diseases, elephantiasis (lymphatic filariasis), soil-transmitted worms (helminths), and schistosomiasis. Public health interventions based on distribution of these drugs have generally been implemented using one drug at a time. But a coordinated approach could prove to be much more resource- and cost-effective.
“Only through integration will we reduce distribution costs, make the best use of our available human resources and increase community participation and compliance, without any added risk to the population,” said study author Khalfan A. Mohammed, Manager of the new Zanzibar Integrated Helminth Control Programme of the Ministry of Health and Social Welfare.
The study, initiated by the WHO in cooperation with the Ministry of Health and Social Welfare of Zanzibar, United Republic of Tanzania, and the Liverpool School of Tropical Medicine's Lymphatic Filariasis Support Centre, examined the possible side-effects of a triple-drug administration in Zanzibar, United Republic of Tanzania, where several previous treatment rounds with one or two drugs had already taken place.
First, a total of 5055 Zanzibari children and adults living in areas endemic for lymphatic filariasis, soil-transmitted helminthiasis (STH), and schistosomiasis were enrolled in a pilot study. After finding there were no severe adverse events associated with the combined triple-therapy treatment, the researchers scaled up the intervention to make it country wide, treating the entire eligible population of over 700,000 individuals.
Surveillance carried out during both intervention periods showed that the side-effects attributable to the co-delivery of the three drugs were mild and required no medical attention. The data suggest that co-administration of the three drugs is safe in areas where LF, STH and schistosomiasis are co-endemic and populations have received repeated treatments previously.