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THE LEOGANE, HAITI DEMONSTRATION PROJECT: DECREASED MICROFILAREMIA AND PROGRAM COSTS AFTER THREE YEARS OF MASS DRUG ADMINISTRATION

To support the global program to eliminate lymphatic filariasis (LF), well-monitored demonstration projects are important for defining the relationship between coverage and reductions in microfilaremia. We are using mass treatment with diethylcarbamazine (DEC) and albendazole in an effort to eliminate LF from Leogane, Haiti. Wuchereria bancrofti microfilaremia prevalence at baseline ranged from 0.8% to 15.9% in four sentinel sites. After three rounds of DEC-albendazole mass drug administration (MDA), both microfilaremia prevalence and intensity decreased dramatically. Mild and moderate adverse reactions after treatment were common, especially after the first MDA, but decreased after subsequent MDAs. Drug coverage for the first year was estimated to be 72%, but concerns about adverse reactions appeared to decrease drug coverage in the second MDA. As a result of community education efforts that focused on providing a greater understanding of adverse reactions, coverage increased dramatically for the third round. Program efficiency increased substantially; the costs per person treated for three rounds of MDA were $2.23, $1.96, and $1.30 per person, respectively. The Leogane experience highlights the importance of adapting community education and mobilization campaigns to achieve and maintain good coverage.

Received April 25, 2005. Accepted for publication June 29, 2005.

Acknowledgments: We thank the demonstration project staff in Leogane, the people living in the sentinel sites, colleagues at the Centers for Disease Control and Prevention, and especially the team at GlaxoSmithKline for their generous support for the LF program in Haiti and in other countries through their donation of albendazole. We especially thank Dr. Marie Denise Milord for her support of the program in Leogane, Gladys Mayard for her work with the focus groups, Joyanna Wendt for her work developing health communication messages, and Wendi McAfee and Michelle Sexton for essential support with logistics.

Financial support: This project was supported by the Emerging Infections Program of the Centers for Disease Control and Prevention and by a grant from the Bill & Melinda Gates Foundation to the University of Notre Dame.

^* Address correspondence to Patrick J. Lammie, Division of Parasitic Diseases, Mailstop F13, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341. E-mail: pjl1{at}cdc.gov

Authors’ addresses: Madsen Beau de Rochars, Hopital Ste. Croix, Leogane, Haiti, Telephone: 509-555-5246, Fax: 509-235-1845, E-mail: mbeauder{at}nd.edu. Sanjat Kanjilal, Lymphatic Filariasis Support Center, Emory University, 1518 Clifton Road, Atlanta, GA 30322, Telephone: 770-488-1187, Fax: 770-488-1148, E-mail: skanjilal{at}cdc.gov. Abdel N. Direny, Hopital Ste. Croix, Leogane, Haiti, Telephone: 509-551-6445, Fax: 509-235-1845, E-mail: adireny{at}nd.edu. Jeanne Radday, Division of Parasitic Diseases, Mailstop F22, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341, Telephone: 770-488-7538, Fax: 770-488-7761, E-mail: jradday{at}hotmail.com. Jack G. Lafontant, Hopital Ste. Croix, Leogane, Haiti, Telephone: 509-555-7692, Fax: 509-235-1845, E-mail: jglafontant{at}msn.com. Els Mathieu, Division of Parasitic Diseases, Mailstop F22, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341, Telephone: 770-488-3603, Fax: 770- 488-7761, E-mail: emm7{at}cdc.gov. Richard D. Rheingans, Lymphatic Filariasis Support Center, Emory University, 1518 Clifton Road, Atlanta, GA 30322, Telephone: 404-727-2425, Fax: 404-727-5530, E-mail: rrheing{at}sph.emory.edu. Anne C. Haddix, Lymphatic Filariasis Support Center, Emory University, 1518 Clifton Road, Atlanta, GA 30322, Telephone: 404-498-3337, Fax: 404-498-1111, E-mail: azh4{at}cdc.gov. Thomas G. Streit, Center for Tropical Diseases, University of Notre Dame, 351 Galvin Hall, Notre Dame, IN 46556, Telephone: 574-631-3273, Fax: 574-631-7413, E-mail: haiti{at}nd.edu. Michael J. Beach, Division of Parasitic Diseases Mail-stop F22, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341, Telephone: 770-488-7763, Fax: 770-488-7761, E-mail: mjb3{at}cdc.gov. David G. Addiss, Division of Parasitic Diseases, Mailstop F22, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341, Telephone: 770-488-7770, Fax: 770-488-7761, E-mail: dga1{at}cdc.gov. Patrick J. Lammie, Division of Parasitic Diseases, Mailstop F13, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341, Telephone: 770-488-4054, Fax: 770-488-4108, E-mail: pjl1{at}cdc.gov.

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