title: Controlling Neglected Tropical Diseases (NTDs) in Haiti: Implementation Strategies and Evidence of Their Success.
abstract: Lymphatic filariasis (LF) and soil-transmitted helminths (STH) have been targeted since 2000 in Haiti, with a strong mass drug administration (MDA) program led by the Ministry of Public Health and Population and its collaborating international partners. By 2012, Haiti's neglected tropical disease (NTD) program had reached full national scale, and with such consistently good epidemiological coverage that it is now able to stop treatment for LF throughout almost all of the country. Essential to this success have been in the detail of how MDAs were implemented. These key programmatic elements included ensuring strong community awareness through an evidence-based, multi-channel communication and education campaign facilitated by voluntary drug distributors; strengthening community trust of the drug distributors by ensuring that respected community members were recruited and received appropriate training, supervision, identification, and motivation; enforcing a "directly observed treatment" strategy; providing easy access to treatment though numerous distribution posts and a strong drug supply chain; and ensuring quality data collection that was used to guide and inform MDA strategies. The evidence that these strategies were effective lies in both the high treatment coverage obtained- 100% geographical coverage reached in 2012, with almost all districts consistently achieving well above the epidemiological coverage targets of 65% for LF and 75% for STH-and the significant reduction in burden of infection- 45 communes having reached the target threshold for stopping treatment for LF. By taking advantage of sustained international financial and technical support, especially during the past eight years, Haiti's very successful MDA campaign resulted in steady progress toward LF elimination and development of a strong foundation for ongoing STH control. These efforts, as described, have not only helped establish the global portfolio of "best practices" for NTD control but also are poised to help solve two of the most important future NTD challenges-how to maintain control of STH infections after the community-based LF "treatment platform" ceases and how to ensure appropriate morbidity management for patients currently suffering from lymphatic filarial disease.
authors.affiliation: Ministry of Public Health and Population, Port-au-Prince, Haiti.
authors.forename: Jean Frantz
authors.initials: JF
authors.lastname: Lemoine
authors.affiliation: Ministry of Public Health and Population, Port-au-Prince, Haiti.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Desormeaux
authors.affiliation: IMA World Health, Port-au-Prince, Haiti.
authors.forename: Franck
authors.initials: F
authors.lastname: Monestime
authors.affiliation: IMA World Health, Port-au-Prince, Haiti.
authors.forename: Carl Renad
authors.initials: CR
authors.lastname: Fayette
authors.affiliation: Hôpital Sainte Croix, Léogâne, Haiti.|University of Notre Dame, Léogâne, Haiti.
authors.forename: Luccene
authors.initials: L
authors.lastname: Desir
authors.affiliation: RTI International, Washington, District of Columbia, United States of America.
authors.forename: Abdel Nasser
authors.initials: AN
authors.lastname: Direny
authors.affiliation: IMA World Health, Washington, District of Columbia, United States of America.
authors.forename: Sarah
authors.initials: S
authors.lastname: Carciunoiu
authors.affiliation: IMA World Health, Washington, District of Columbia, United States of America.
authors.forename: Lior
authors.initials: L
authors.lastname: Miller
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Alaine
authors.initials: A
authors.lastname: Knipes
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Patrick
authors.initials: P
authors.lastname: Lammie
authors.affiliation: U.S. Agency for International Development, Washington, District of Columbia, United States of America.
authors.forename: Penelope
authors.initials: P
authors.lastname: Smith
authors.affiliation: RTI International, Washington, District of Columbia, United States of America.
authors.forename: Melissa
authors.initials: M
authors.lastname: Stockton
authors.affiliation: RTI International Consultancy, Washington, District of Columbia, United States of America.
authors.forename: Lily
authors.initials: L
authors.lastname: Trofimovich
authors.affiliation: RTI International, Washington, District of Columbia, United States of America.
authors.forename: Kalpana
authors.initials: K
authors.lastname: Bhandari
authors.affiliation: RTI International, Washington, District of Columbia, United States of America.
authors.forename: Richard
authors.initials: R
authors.lastname: Reithinger
authors.affiliation: RTI International, Washington, District of Columbia, United States of America.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Crowley
authors.affiliation: RTI International, Washington, District of Columbia, United States of America.
authors.forename: Eric
authors.initials: E
authors.lastname: Ottesen
authors.affiliation: RTI International, Washington, District of Columbia, United States of America.
authors.forename: Margaret
authors.initials: M
authors.lastname: Baker
mesh_terms: D015766:Albendazole / Q000008:administration & dosage / Q000627:therapeutic use; D000818:Animals; D000871:Anthelmintics / Q000008:administration & dosage* / Q000627:therapeutic use; D004049:Diethylcarbamazine / Q000008:administration & dosage / Q000627:therapeutic use; D004605:Elephantiasis, Filarial / Q000188:drug therapy / Q000453:epidemiology / Q000469:parasitology / Q000517:prevention & control*; D005369:Filaricides / Q000008:administration & dosage* / Q000627:therapeutic use; D006205:Haiti / Q000453:epidemiology; D006373:Helminthiasis / Q000188:drug therapy / Q000453:epidemiology / Q000469:parasitology / Q000517:prevention & control*; D006376:Helminths / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D058069:Neglected Diseases / Q000453:epidemiology / Q000469:parasitology / Q000517:prevention & control* / Q000628:therapy; D011634:Public Health / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data
chemical_list: D000871:Anthelmintics; D005369:Filaricides; D015766:Albendazole; D004049:Diethylcarbamazine