title: Are we nearly there yet? Coverage and compliance of mass drug administration for lymphatic filariasis elimination.
abstract: Lymphatic filariasis has been targeted for elimination by 2020, and a threshold of 65% coverage of mass drug administration (MDA) has been adopted by the Global Programme to Eliminate Lymphatic Filariasis (GPELF). A recent review by Babu and Babu of 36 studies of MDA for lymphatic filariasis in India found that coverage, defined as receipt of tablets, ranged from 48.8 to 98.8%, while compliance, defined as actual ingestion of tablets, was 22% lower on average. Moreover, the denominator for these coverage figures is the eligible, rather than total, population. By contrast, the 65% threshold, in the original modelling study, refers to ingestion of tablets in the total population. This corresponds to GPELF's use of 'epidemiological drug coverage' as a trigger for the Transmission Assessment Surveys (TAS), which indicate whether to proceed to post-MDA surveillance. The existence of less strict definitions of 'coverage' should not lead to premature TAS that could impair MDA's sustainability.
authors.affiliation: MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK neal.alexander@lshtm.ac.uk.
authors.forename: Neal D E
authors.initials: ND
authors.lastname: Alexander
mesh_terms: D004049:Diethylcarbamazine / Q000008:administration & dosage*; D060740:Disease Eradication; D004605:Elephantiasis, Filarial / Q000517:prevention & control*; D005369:Filaricides / Q000008:administration & dosage*; D006284:Health Plan Implementation / Q000458:organization & administration*; D006801:Humans
chemical_list: D005369:Filaricides; D004049:Diethylcarbamazine
keywords: Elimination; Lymphatic filariasis; Mass drug administration