April 10,2017

Letter from the Director

Global STH control: at a crossroads

For more than a decade globally, programming to control of soil-transmitted helminthiasis (STH) has rightly focused on preventive chemotherapy with great success.

Indeed, we’re pleased that the global community is on track to reach the World Health Organization (WHO) target of treating 75% of at-risk children with anthelmintic drugs by 2020. However, the number of endemic countries which are unlikely to reach the 75% target is cause for concern and redoubled efforts. As we explore strategies to accelerate treatment coverage for STH, we find ourselves at a crossroads. The countries that have implemented mass drug administration (MDA), a relatively easy-to-implement, cost-effective intervention platform, need to understand their progress toward the WHO goal of elimination of STH as public health problem (defined as less than 1% of the at-risk population has infection of moderate or high intensity). Understanding such progress requires robust, statistically valid parasitologic monitoring. After successive treatments of millions of people over multiple years, STH control requires measurement of impact.

Program impact is best assessed through measuring disease prevalence and intensity of infection in the at-risk population and at the district-level. Parasitologic data would not only help show program impact but potentially allow implementers to focus resources on other risk groups and highly endemic geographic areas. The need for increased parasitologic monitoring was highlighted at the annual meeting of the STH Advisory Committee last October.  

Achieving the change from monitoring treatment coverage to also monitoring disease will require new tools such as parasitologic surveys. STH Coalition members currently use various survey methodologies which target different at-risk populations and use different sampling frames. There is a need to share the design, results, and costs of these surveys. Doing so would improve understanding of the impact of preventive chemotherapy. That would also further the discussion on how Coalition partners, national programs, and donors can most effectively use survey results and sustain survey implementation.

CWW is also supporting partnerships to field test and finalize more sensitive, field-friendly STH diagnostic assays.  And so, as we adapt to the evolving demands of STH control – from a focus on drugs donated to the measuring the disease itself – we must continue to build the partnerships that make these innovations possible.

In the coming months, CWW will continue this focus on improved data to better measure progress toward established STH targets. By improving data quality across all areas of STH programming, from supply chain to impact, we will together address the more ambitious goals for 2020 and beyond. 

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