Discussion

The World Health Organization 2021–2030 Roadmap on Neglected Tropical Diseases has three fundamental pillars: 1) accelerating programmatic action; 2) strengthening cross-cutting approaches, and 3) facilitating and supporting country ownership. For onchocerciasis (River Blindness), a vector-borne filarial infection, the Roadmap has proposed verification of elimination (interruption) of transmission by 2030 in 12 endemic countries. The main preventive chemotherapy and transmission control (PCT) strategy is based on Community-Directed Treatment with ivermectin (CDTi). CDTi was pioneered by the African Programme for Onchocerciasis Control (APOC) with the aim to strengthen communities’ agency over their own treatment and increase treatment coverage and sustainability. The platform of community-directed treatment proved to be very successful for the delivery of other health interventions. More recently, the notion of Community-Directed Vector Control has been introduced to reduce the reliance of antivectorial measures on chemical insecticides and incentivise the communities to reduce Simulium (blackfly vector) nuisance and onchocerciasis transmission. I will discuss the evolution of these strategies and how they form part of a broader engagement process with programme managers and national control and elimination efforts, including country-based onchocerciasis elimination committees. Finally, I will discuss experiences regarding engagement with the WHO, supranational stakeholders, NGOs, funders and R&D actors to ensure that policy-relevant transmission dynamics modelling is conducted to support onchocerciasis elimination.