Final published version, 1.01 MB, fulltext
Available under license: CC BY: Creative Commons Attribution 4.0 International License
Final published version
Licence: CC BY: Creative Commons Attribution 4.0 International License
Research output: Contribution to Journal/Magazine › Journal article › peer-review
Research output: Contribution to Journal/Magazine › Journal article › peer-review
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TY - JOUR
T1 - An Ensemble Framework for Projecting the Impact of Lymphatic Filariasis Interventions Across Sub-Saharan Africa at a Fine Spatial Scale
AU - Touloupou, Panayiota
AU - Fronterre, Claudio
AU - Cano, Jorge
AU - Prada, Joaquin M
AU - Smith, Morgan
AU - Kontoroupis, Periklis
AU - Brown, Paul
AU - Rivera, Rocio Caja
AU - de Vlas, Sake J
AU - Gunawardena, Sharmini
AU - Irvine, Michael A
AU - Njenga, Sammy M
AU - Reimer, Lisa
AU - Seife, Fikre
AU - Sharma, Swarnali
AU - Michael, Edwin
AU - Stolk, Wilma A
AU - Pulan, Rachel
AU - Spencer, Simon E F
AU - Hollingsworth, T Déirdre
PY - 2024/5/15
Y1 - 2024/5/15
N2 - BackgroundLymphatic filariasis (LF) is a neglected tropical disease targeted for elimination as a public health problem by 2030. Although mass treatments have led to huge reductions in LF prevalence, some countries or regions may find it difficult to achieve elimination by 2030 owing to various factors, including local differences in transmission. Subnational projections of intervention impact are a useful tool in understanding these dynamics, but correctly characterizing their uncertainty is challenging.MethodsWe developed a computationally feasible framework for providing subnational projections for LF across 44 sub-Saharan African countries using ensemble models, guided by historical control data, to allow assessment of the role of subnational heterogeneities in global goal achievement. Projected scenarios include ongoing annual treatment from 2018 to 2030, enhanced coverage, and biannual treatment.ResultsOur projections suggest that progress is likely to continue well. However, highly endemic locations currently deploying strategies with the lower World Health Organization recommended coverage (65%) and frequency (annual) are expected to have slow decreases in prevalence. Increasing intervention frequency or coverage can accelerate progress by up to 5 or 6 years, respectively.ConclusionsWhile projections based on baseline data have limitations, our methodological advancements provide assessments of potential bottlenecks for the global goals for LF arising from subnational heterogeneities. In particular, areas with high baseline prevalence may face challenges in achieving the 2030 goals, extending the "tail" of interventions. Enhancing intervention frequency and/or coverage will accelerate progress. Our approach facilitates preimplementation assessments of the impact of local interventions and is applicable to other regions and neglected tropical diseases.
AB - BackgroundLymphatic filariasis (LF) is a neglected tropical disease targeted for elimination as a public health problem by 2030. Although mass treatments have led to huge reductions in LF prevalence, some countries or regions may find it difficult to achieve elimination by 2030 owing to various factors, including local differences in transmission. Subnational projections of intervention impact are a useful tool in understanding these dynamics, but correctly characterizing their uncertainty is challenging.MethodsWe developed a computationally feasible framework for providing subnational projections for LF across 44 sub-Saharan African countries using ensemble models, guided by historical control data, to allow assessment of the role of subnational heterogeneities in global goal achievement. Projected scenarios include ongoing annual treatment from 2018 to 2030, enhanced coverage, and biannual treatment.ResultsOur projections suggest that progress is likely to continue well. However, highly endemic locations currently deploying strategies with the lower World Health Organization recommended coverage (65%) and frequency (annual) are expected to have slow decreases in prevalence. Increasing intervention frequency or coverage can accelerate progress by up to 5 or 6 years, respectively.ConclusionsWhile projections based on baseline data have limitations, our methodological advancements provide assessments of potential bottlenecks for the global goals for LF arising from subnational heterogeneities. In particular, areas with high baseline prevalence may face challenges in achieving the 2030 goals, extending the "tail" of interventions. Enhancing intervention frequency and/or coverage will accelerate progress. Our approach facilitates preimplementation assessments of the impact of local interventions and is applicable to other regions and neglected tropical diseases.
KW - Lymphatic Filariasis
KW - Ensemble Models
KW - Fine-scale Spatial Projections
KW - Intervention Impact
KW - Linking Maps With Models
KW - Humans
KW - Elephantiasis, Filarial
KW - Filaricides
KW - Prevalence
KW - Africa South of the Sahara
KW - Neglected Diseases
KW - Disease Eradication
U2 - 10.1093/cid/ciae071
DO - 10.1093/cid/ciae071
M3 - Journal article
VL - 78
SP - S108-S116
JO - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
SN - 1058-4838
IS - Suppl. 2
ER -