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other·epidemiology, public health, infectious disease, preclinical research, biomedical research·PMC10231811

Lymphatic filariasis endgame strategies: Using GEOFIL to model mass drug administration and targeted surveillance and treatment strategies in American Samoa

PLOS Neglected Tropical Diseases · 13 authors, 4 centres

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TL;DR

This simulation study used a spatially explicit agent-based model to compare territory-wide mass drug administration with targeted household-based strategies for controlling lymphatic filariasis in American Samoa. The central result is that targeted household-based strategies can achieve similar long-term control probabilities as mass drug administration while requiring substantially fewer treatments, though they demand more intensive testing.

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This study employed the GEOFIL agent-based model to simulate and compare lymphatic filariasis control strategies in American Samoa. The model incorporated a synthetic population with realistic daily routines and transmission dynamics. Simulations compared three coverage levels (65%, 73%, 85%) of territory-wide triple-drug MDA with targeted surveillance and treatment strategies relying on household-based testing and reactive treatment within a defined radius. The primary outcome was 'control probability'—the proportion of simulations where microfilariae prevalence decreased between 2030 and 2035. Results indicated that without intervention, antigen prevalence is predicted to rebound. A 90% control probability required at least 4, 3, or 2 further rounds of MDA at 65%, 73%, or 85% coverage, respectively. School- and workplace-based strategies were ineffective.

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other

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epidemiology

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ORIGINAL PAPER

PMC10231811

Lymphatic filariasis endgame strategies: Using GEOFIL to model mass drug administration and targeted surveillance and treatment strategies in American Samoa

PLOS Neglected Tropical Diseases

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ABSTRACT

Abstract American Samoa underwent seven rounds of mass drug administration (MDA) for lymphatic filariasis (LF) from 2000-2006, but subsequent surveys found evidence of ongoing transmission. American Samoa has since undergone further rounds of MDA in 2018, 2019, and 2021; however, recent surveys indicate that transmission is still ongoing. GEOFIL, a spatially-explicit agent-based LF model, was used to compare the effectiveness of territory-wide triple-drug MDA (3D-MDA) with targeted surveillance and treatment strategies. Both approaches relied on treatment with ivermectin, diethylcarbamazine, and albendazole. We simulated three levels of whole population coverage for 3D-MDA: 65%, 73%, and 85%, while the targeted strategies relied on surveillance in schools, workplaces, and households, followed by targeted treatment. In the household-based strategies, we simulated 1-5 teams travelling village-to-village and offering antigen (Ag) testing to randomly selected households in each village. If an Ag-positive person was identified, treatment was offered to members of all households within 100m-1km of the positive case. All simulated interventions were finished by 2027 and their effectiveness was judged by their ‘control probability’—the proportion of simulations in which microfilariae prevalence decreased between 2030 and 2035. Without future intervention, we predict Ag prevalence will rebound. With 3D-MDA, a 90% control probability required an estimated ≥ 4 further rounds with 65% coverage, ≥ 3 rounds with 73% coverage, or ≥ 2 rounds with 85% coverage. While household-based strategies were substantially more testing-intensive than 3D-MDA, they could offer comparable control probabilities with substantially fewer treatments; e.g. three teams aiming to test 50% of households and offering treatment to a 500m radius had approximately the same control probability as three rounds of 73% 3D-MDA, but used < 40% the number of treatments. School- and workplace-based interventions proved ineffective. Regardless of strategy, reducing Ag prevalence below the 1% target threshold recommended by the World Health Organization was a poor indicator of the interruption of LF transmission, highlighting the need to review blanket elimination targets.

CITATION EXPORT

Callum Shaw, Angus McLure, Patricia M Graves et al.. Lymphatic filariasis endgame strategies: Using GEOFIL to model mass drug administration and targeted surveillance and treatment strategies in American Samoa. PLOS Neglected Tropical Diseases. (2023). https://doi.org/10.1371/journal.pntd.0011347

AUTHORS

13 · 4 CENTRES

Callum Shaw, Angus McLure, Patricia M Graves, Colleen L Lau, Kathryn Glass, María-Gloria Basáñez, Cinzia Cantacessi, María-Gloria Basáñez, Cinzia Cantacessi, María-Gloria Basáñez, Cinzia Cantacessi, María-Gloria Basáñez, Cinzia Cantacessi

1National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
2College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
3School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
4Imperial College London, Faculty of Medicine, School of Public Health, UNITED KINGDOM