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Can mass drug administration of moxidectin accelerate onchocerciasis elimination in Africa?

Kura, K; Milton, P; Hamley, JID; Walker, M; Bakajika, DK; Kanza, EM; Opoku, NO; Howard, H; Nigo, MM; Asare, S; Olipoh, G; Attah, SK; Mambandu, GL; Kennedy, KK; Kataliko, K; Mumbere, M; Halleux, CM; Hopkins, A; Kuesel, AC; Kinrade, S; Basáñez, MG


K Kura

P Milton

JID Hamley

M Walker

DK Bakajika

EM Kanza

NO Opoku

H Howard

MM Nigo

S Asare

G Olipoh

SK Attah

GL Mambandu

KK Kennedy

K Kataliko

M Mumbere

CM Halleux

A Hopkins

AC Kuesel

S Kinrade

MG Basáñez


Epidemiological and modelling studies suggest that elimination of Onchocerca volvulus transmission (EoT) throughout Africa may not be achievable with annual mass drug administration (MDA) of ivermectin alone, particularly in areas of high endemicity and vector density. Single-dose Phase II and III clinical trials demonstrated moxidectin's superiority over ivermectin for prolonged clearance of O. volvulus microfilariae. We used the stochastic, individual-based EPIONCHO-IBM model to compare the probabilities of reaching EoT between ivermectin and moxidectin MDA for a range of endemicity levels (30 to 70% baseline microfilarial prevalence), treatment frequencies (annual and biannual) and therapeutic coverage/adherence values (65 and 80% of total population, with, respectively, 5 and 1% of systematic non-adherence). EPIONCHO-IBM's projections indicate that biannual (six-monthly) moxidectin MDA can reduce by half the number of years necessary to achieve EoT in mesoendemic areas and might be the only strategy that can achieve EoT in hyperendemic areas. Data needed to improve modelling projections include (i) the effect of repeated annual and biannual moxidectin treatment; (ii) inter- and intra-individual variation in response to successive treatments with moxidectin or ivermectin; (iii) the effect of moxidectin and ivermectin treatment on L3 development into adult worms; and (iv) patterns of adherence to moxidectin and ivermectin MDA.This article is part of the theme issue 'Challenges in the fight against neglected tropical diseases: a decade from the London Declaration on NTDs'.


Kura, K., Milton, P., Hamley, J., Walker, M., Bakajika, D., Kanza, E., …Basáñez, M. (2023). Can mass drug administration of moxidectin accelerate onchocerciasis elimination in Africa?. Philosophical Transactions of the Royal Society B: Biological Sciences, 378(1887),

Journal Article Type Article
Acceptance Date Apr 11, 2023
Online Publication Date Oct 21, 2023
Publication Date 2023
Deposit Date Oct 26, 2023
Publicly Available Date Oct 26, 2023
Print ISSN 0962-8436
Publisher The Royal Society
Peer Reviewed Peer Reviewed
Volume 378
Issue 1887
Keywords onchocerciasis; moxidectin; ivermectin; mass drug administration; MDA; modelling; ANNUAL IVERMECTIN TREATMENT; RIVER-BLINDNESS; VOLVULUS; FOCUS; INFECTION; PREVALENCE; INTENSITY; ASUBENDE; EFFICACY; PROGRAM


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