title: Analysis of the population-level impact of co-administering ivermectin with albendazole or mebendazole for the control and elimination ofTrichuris trichiura.
abstract: BACKGROUND
  Soil-transmitted helminth (STH) infections are predominately controlled by providing children with preventive chemotherapy with either albendazole or mebendazole. However, neither has a high efficacy againstTrichuris trichiura. This low efficacy limits the overall effectiveness of the current STH control programmes againstT. trichiura. It has been demonstrated that co-administering ivermectin with albendazole or mebendazole significantly increases the efficacy of current treatments, which may increase the overall effectiveness of control programmes.
  
  
  METHODS
  Using a STH transmission mathematical model, we evaluated the potential impact of co-administering ivermectin with albendazole or mebendazole to treatT. trichiurawithin a preventive chemotherapy programme targeting children (2-15 year olds). We evaluated the impact in terms of reduction in prevalent infections, mean worm burden, and prevalence of heavy infections.
  
  
  RESULTS
  Although the current treatment strategy reducedT. trichiuraworm burden and prevalence of heavy infections, due to their poor efficacy the long term impact of preventive chemotherapy for children was smaller compared to the other STH. Co-administering ivermectin increased the projected impact of the preventive chemotherapy programme in terms of all three of the explored metrics, practically in high transmission settings. Furthermore, ivermectin co-administration greatly increased the feasibility of and timeframe for breaking transmission.
  
  
  CONCLUSIONS
  Co-administering ivermectin notably increased the projected impact of preventive chemotherapy in high transmission settings and increased the feasibility for breaking transmission. This has important implications for control programmes, some of which may be shifting focus from morbidity control to interruption of transmission, and some of which may be logistically unable to provide preventive chemotherapy twice a year as recommended. However, the benefit of co-administering ivermectin is limited by the fact that 2-5 year olds are often ineligible to receive treatment.
authors.affiliation: London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Mary's Campus, Imperial College London, Norfolk Place, London W2 1PG, UK; Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Mary's Campus, Imperial College London, Norfolk Place, London W2 1PG, UK.
authors.forename: Hugo C
authors.initials: HC
authors.lastname: Turner
authors.affiliation: London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Mary's Campus, Imperial College London, Norfolk Place, London W2 1PG, UK; Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Mary's Campus, Imperial College London, Norfolk Place, London W2 1PG, UK.
authors.forename: James E
authors.initials: JE
authors.lastname: Truscott
authors.affiliation: London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Mary's Campus, Imperial College London, Norfolk Place, London W2 1PG, UK; Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Mary's Campus, Imperial College London, Norfolk Place, London W2 1PG, UK.
authors.forename: Alison A
authors.initials: AA
authors.lastname: Bettis
authors.affiliation: Mathematics Institute, University of Warwick, Coventry CV4 7AL, UK; School of Life Sciences, University of Warwick, Coventry CV4 7AL, UK.
authors.forename: T Déirdre
authors.initials: TD
authors.lastname: Hollingsworth
authors.affiliation: Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Brooker
authors.affiliation: London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Mary's Campus, Imperial College London, Norfolk Place, London W2 1PG, UK; Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Mary's Campus, Imperial College London, Norfolk Place, London W2 1PG, UK.
authors.forename: Roy M
authors.initials: RM
authors.lastname: Anderson
keywords: ALB, albendazole; Control; ERRs, egg reduction rates; Elimination; IVM, ivermectin; Ivermectin co-administration; MBZ, mebendazole; Mass drug administration; Pre-SAC, preschool-aged; R0, basic reproductive number; SAC, school-aged children; STH, soil-transmitted helminth; Soil-transmitted helminth; Trichuris trichiura; WASH, water, sanitation and hygiene; WHO, World Health Organisation