title: Effectiveness of a triple-drug regimen for global elimination of lymphatic filariasis: a modelling study.
abstract: BACKGROUND
  Lymphatic filariasis is targeted for elimination as a public health problem by 2020. The principal approach used by current programmes is annual mass drug administration with two pairs of drugs with a good safety profile. However, one dose of a triple-drug regimen (ivermectin, diethylcarbamazine, and albendazole) has been shown to clear the transmissible stage of the helminth completely in treated individuals. The aim of this study was to use modelling to assess the potential value of mass drug administration with the triple-drug regimen for accelerating elimination of lymphatic filariasis in different epidemiological settings.
  
  
  METHODS
  We used three different transmission models to compare the number of rounds of mass drug administration needed to achieve a prevalence of microfilaraemia less than 1% with the triple-drug regimen and with current two-drug regimens.
  
  
  RESULTS
  In settings with a low baseline prevalence of lymphatic filariasis (5%), the triple-drug regimen reduced the number of rounds of mass drug administration needed to reach the target prevalence by one or two rounds, compared with the two-drug regimen. For areas with higher baseline prevalence (10-40%), the triple-drug regimen strikingly reduced the number of rounds of mass drug administration needed, by about four or five, but only at moderate-to-high levels of population coverage (>65%) and if systematic non-adherence to mass drug administration was low.
  
  
  CONCLUSIONS
  Simulation modelling suggests that the triple-drug regimen has potential to accelerate the elimination of lymphatic filariasis if high population coverage of mass drug administration can be achieved and if systematic non-adherence with mass drug administration is low. Future work will reassess these estimates in light of more clinical trial data and to understand the effect on an individual country's programme.
  
  
  BACKGROUND
  Bill & Melinda Gates Foundation.
authors.affiliation: School of Life Sciences, University of Warwick, Coventry, UK.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Irvine
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
authors.forename: Wilma A
authors.initials: WA
authors.lastname: Stolk
authors.affiliation: Department of Biological Sciences, University of Notre Dame, Notre Dame, South Bend, IN, USA.
authors.forename: Morgan E
authors.initials: ME
authors.lastname: Smith
authors.affiliation: Vector Control Research Centre (Indian Council of Medical Research), Indira Nagar, Puducherry, India.
authors.forename: Swaminathan
authors.initials: S
authors.lastname: Subramanian
authors.affiliation: Department of Biological Sciences, University of Notre Dame, Notre Dame, South Bend, IN, USA.
authors.forename: Brajendra K
authors.initials: BK
authors.lastname: Singh
authors.affiliation: Washington University School of Medicine, St Louis, MO, USA.
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Weil
authors.affiliation: Department of Biological Sciences, University of Notre Dame, Notre Dame, South Bend, IN, USA.
authors.forename: Edwin
authors.initials: E
authors.lastname: Michael
authors.affiliation: School of Life Sciences, University of Warwick, Coventry, UK; Mathematics Institute, University of Warwick, Coventry, UK. Electronic address: deirdre.hollingsworth@warwick.ac.uk.
authors.forename: T Deirdre
authors.initials: TD
authors.lastname: Hollingsworth
mesh_terms: D015766:Albendazole / Q000627:therapeutic use; D000818:Animals; D000871:Anthelmintics / Q000008:administration & dosage / Q000627:therapeutic use; D000977:Antiparasitic Agents / Q000627:therapeutic use; D004049:Diethylcarbamazine / Q000008:administration & dosage* / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination / Q000379:methods*; D004605:Elephantiasis, Filarial / Q000188:drug therapy* / Q000469:parasitology / Q000517:prevention & control / Q000635:transmission; D005369:Filaricides / Q000008:administration & dosage* / Q000627:therapeutic use; D014943:Global Health; D006801:Humans; D007559:Ivermectin / Q000627:therapeutic use; D015233:Models, Statistical
chemical_list: D000871:Anthelmintics; D000977:Antiparasitic Agents; D005369:Filaricides; D007559:Ivermectin; D015766:Albendazole; D004049:Diethylcarbamazine