For example, a study in the Gambia, which found that even without MDA, LF transmission may have been interrupted through the extensive and long-term decades use of insecticide-treated nets for malaria control [ 83 ]. A malaria eradication campaign in the Solomon Islands was also found to result in the interruption of LF transmission in the absence of MDA [ 84 ]. In addition, Nsakashalo-Senkwe et al. These studies highlight how the expansion of insecticide-treated nets for malaria control since [ 86 ], could have had a notable impact on LF transmission in some settings [ 87 ].
Due to the long-life expectancy of the adult worms and the delay between infection and morbidity, the use of vector control as a standalone strategy would result in a lag before any significant effect on the prevalence of infection and morbidity is seen [ 88 ].
This finding is mainly because vector control programmes only reduce exposure to new infections and do not have a direct effect on the established infections within the host population. Although the established adult worms will die naturally within their hosts, this occurs slowly due to their long-life expectancy [ 88 ].
However, in combination with MDA, vector control could potentially be beneficial in accelerating progress to elimination, preventing transmission hotspots and reducing the risk of the re-establishment of the transmission cycle from imported cases [ 82 , 87 , 88 , 89 ]. This indicates that in the context of economic evaluations, the true potential benefits of combining vector control with MDA are long-term - in contrast to additional short-term reductions in morbidity or infection. This means that economic evaluations of vector control would require a long-time horizon for the analysis and a model accounting for the possibility of elimination to capture its full long-term benefit.
It is noteworthy that the only study we identified evaluating the cost-effectiveness of integrating vector control with MDA which found that it did not appear to be cost-effective in the investigated setting [ 37 ] had only a five-year time horizon Table 1.
Due to this, the potential longer-term benefits of vector control were not necessarily fully captured. In the context of further economic evaluations of vector control for LF, it is essential to note that its benefit will be highly dependent on the local species of vector. For example, bednets will not be effective in areas where the predominant vector species bites during the day. This highlights the importance of not overgeneralizing the results of studies and policy in this area.
It is also important to consider issues relating to insecticide resistance and the additional benefits of vector control on other vector-borne diseases such as dengue and malaria [ 90 ]. As well as new interventions, we need to evaluate novel diagnostics and surveillance strategies. The importance of this research area is highlighted by a recent study which demonstrated resurgence of transmission six years after stopping MDA [ 91 ]. When considering new surveillance strategies, it is important to note the potential need to integrate surveillance for other NTDs such as STH [ 92 , 93 ].
Only one of the studies [ 20 ] we identified explicitly considered the cost of post-MDA surveillance. LF occurs across a wide and diverse range of epidemiological settings, making it difficult to draw conclusions regarding the value of LF interventions as a whole from studies based in a single country or setting. Also, due to the different aims of the identified studies and the different approaches used, it can be difficult to directly compare the results of the different studies.
However, overall this systematic review highlights that the WHO recommended strategies for LF elimination are consistently found to be cost-effective or cost-saving across a wide range of settings and assumptions. However, there are several important research gaps that need to be addressed as we move forward towards the milestones and beyond.
These include the evaluation of alternative interventions such as IDA, anti- Wolbachia therapy and vector control. Furthermore, elements of the studies were not always clear, and at times important pieces of methodological information were not reported. Moving forward it would be beneficial if studies adhered more to standardised guidelines for reporting cost-effectiveness analysis - allowing easier comparison of the different studies results.
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Theileria Dirk Dobbelaere. The Geohelminths Celia Holland. Table of contents Preface. Lymphatic filarial infections: an introduction to the filariae; J. Bartholomay, B. Williams, S. Fischer, D. The Epidemiology of Filariasis Control; E. Wolbachia Bacterial Endosymbionts; M. Mackenzie, et al.
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