Joint request for selected preventive chemotherapy medicines and joint reporting form: a user guide

Overview

What is preventive chemotherapy?

Preventive chemotherapy (PC) is defined as the single administration of quality-assured medicines, either alone or in combination, for use as a public-health tool against selected neglected tropical diseases (NTDs). The World Health Organization (WHO) recommendspreventive chemotherapy as one of the key public-health interventions against five NTDs: lymphatic filariasis, onchocerciasis, soil-transmitted helminthiases, schistosomiasis and blinding trachoma. The aim of preventive chemotherapy is to control morbidity in populations at risk of infection or illness and eventually to eliminate some of these diseases, alongside other interventions such as management of chronic cases and disability, control of vectors and their intermediate hosts, veterinary public health, and provision of safe water, sanitation and hygiene. The WHO roadmap targets implementation of preventive chemotherapy interventions with high coverage to ensure that the goals set for these five diseases are reached by 2020 and that selected regional and sub-regional milestones are achieved by 2015.

Delivery of preventive chemotherapy interventions requires a rational decision-making process to optimize the use and management of resources. Interventions are therefore planned and implemented in an integrated and coordinated manner where appropriate to maximize programme efficiencies, increase cost effectiveness, raise the visibility of otherwise neglected diseases, improve the acceptability of interventions in affected populations, and enhance ancillary and synergic impacts while reducing the risk of drug resistance. In areas where multiple diseases targeted by preventive chemotherapy are transmitted in the same geographical area in the implementation level (Figure 1), integrated and coordinated interventions are delivered to treat these diseases simultaneously. The decision to integrate activities is based on optimization criteria such as cost-effectiveness, enhanced impacts, political advantage, logistic convenience, timing and safety.

Recommended medicines for use in preventive chemotherapy

The selection of anthelminthic medicines recommended by WHO for use in public-health programmes is designed to control and eliminate helminth infections by reducing associated morbidity and transmission. Many of these medicines are broad-spectrum, allowing several diseases to be tackled simultaneously. Preventive chemotherapy interventions should therefore target the optimal, coordinated use of available medicines rather than specific forms of helminthiasis. Coordinated procurement of medicines against multiple diseases is therefore recommended based on the status of co-endemicity of diseases in each implementation unit. Where operationally feasible, WHO recommends the integrated delivery of combinations of preventive medicines to target multiple diseases. Eligibility for treatment differs by medicine. Table 3 lists the medicines and the target age groups currently recommended by WHO for treatment of lymphatic filariasis, onchocerciasis, schistosomiasis and soil-transmitted helminthiasis either alone or in combination, in the context of preventive chemotherapy interventions.