Researchers are launching a clinical trial with 1,500 people infected with onchocerciasis (river blindness) in Liberia, Ghana and the Democratic Republic of Congo to test a remedy that could help stop transmission, according to drug manufacturer Wyeth Pharmaceuticals and the World Health Organization (WHO).

Onchocerciasis – transmitted through black flies that breed near rivers – is one of the leading causes of blindness in Africa, according to WHO. The primary prevention method is black fly control, while treatment has been through annual doses of ivermectin, which relieves intense itchiness of the skin and eye lesions.

“The drug is harmless, like aspirin, and is given annually to people who are at risk,” said Boakye Boatin of the joint WHO, UN and World Bank tropical disease research programme. (See story below).

Nelson Weah from Liberia’s capital Monvoria told IRIN ivermectin treatments helped him to see again. “I once suffered from river blindness and could not see at all. I felt like I was living in a dark world. I could not do anything for myself and relied on others.”

But while ivermectin might successfully treat individuals, it does not stop the infection from spreading, said Boatin. “It reduces rather than stops transmission because it does not kill adult worms, only the eggs.”

Adult worms live in a person’s skin and lay eggs that are then picked up and carried by black flies. If adult worms are not killed they continue to lay eggs in the skin and the disease can be passed on.

The drug moxidectin is being studied for its potential to kill adult worms carrying the disease and to wipe out the disease in any high-risk area within six years, Boatin told IRIN. More than 100 million people, mostly in Africa, are at risk of infection, according to WHO.

More than 10 years in development, the trial drug moxidectin is manufactured by Wyeth Pharmaceuticals. The company’s vice-president, Henrietta Ukwu, told IRIN Wyeth has invested US$20 million over the last decade in the drug, including $6 million for the upcoming clinical trial expected to last two and a half years.

WHO estimates there are about half a million people, mostly in Africa, who are blind due to onchocerciasis.

This story, entitled Africa: River blindness drug trial launched, was datelined Dakar July 1, 2009 and written and distributed by IRIN News, the humanitarian news agency. The picture of a man suffering from onchocerciasis was taken by WHO and accompanied the IRIN story.

Local communities fight river blindness in their villages

The African Programme for Onchocerciasis Control (APOC) was launched in 1995, after non-governmental development organizations pioneered mass distribution of ivermectin in Africa between 1989 and 1994. APOC includes 19 Participating Countries with active involvement of Ministries of Health and their affected communities, several international and local NGDOs, the private sector (Merck & Co., Inc.), donor countries and UN agencies. The World Bank is APOC’s fiscal agent, and WHO is the executing agency.

APOC pioneered the Community-Directed Treatment with Ivermectin (CDTI), which empowers local communities to fight river blindness in their own villages, relieving suffering and slowing transmission. CDTI relies on active community participation to distribute ivermectin treatment to people who need it. At the end of 2007, over 54.6 million people living in 16 African countries were receiving regular ivermectin treatment through this pioneering approach.

APOC’s strategy of community-directed treatment, which has brought continent-wide success for onchocerciasis control in Africa while other health initiatives have floundered, is now being extended to include delivery of other health interventions such as insecticide treated nets for malaria.

Community-directed treatment is helping to supplement and reinforce health systems, while empowering communities to control disease. APOC argues that integrating community-directed treatment into existing health systems can improve efficiency, decrease the burden on health staff, improve access to health services, and improve the effectiveness of health spending.

Now extended to 2015, APOC regularly treats 54.6 million people annually, rising to 90 million people annually in 19 countries by 2010. Statistics as of December 2007 are provided below.

The control drug ivermectin has been donated by Merck for more than 20 years. Merck’s Mectizan Donation Program, the largest ongoing disease-specific drug donation program and public/private partnership of its kind in history, is widely regarded as one of the world's most successful public/private health collaborations.

The pictures, showing distribution of ivermectin in villages, comes from the APOC website.

Contact information for APOC:

Dr Uche V. Amazigo,Director, APOC

B.P. 549, Ouagadougou 01, Burkina Faso

Email

APOC’s achievements - (at December 2007)

• 16.2 million cases of infection prevented since the start of APOC corresponding to a drop of the number of cases from 41.8 million (1995) to 25.7 million (2008)
• 54.6 million people receiving regular treatment (90 million annually by 2010)
• 117 000 communities involved
• >600 000 community-directed distributors involved
• 108 projects running in 16 countries
• 49 000 health workers trained
• 850 000 disability adjusted life years (DALYs) per year averted
• Treatment cost of annual ComDT with ivermectin: US$0.57 per person
• 17% economic rate of return
• US$ 7 per DALY averted
• Health interventions co-implemented with CDTI: 10,737,298 persons were covered in 2007
• Protecting 102 million at-risk individuals in poor rural communities
• The itching prevalence was reduced by 68% between 1995 and 2008 with 8.9 million cases prevented since commencement of operations
• Blindness cases dropped from 385,000 cases in 1995 to 265,000 in 2008
• By 2010, sight of 800 million people will have been saved
• Estimated 7.5 million years of labour added (600,000 person-years annually)