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30Annual Report on Lymphatic Filariasis 2003Chapter 1 Progress of the Global Programme to Eliminate Lymphatic FilariasisThe 4th meeting of TAG-LF concluded that overallprogress made by GPELF was impressive, as demonstratedby the increases in populations treated with theco-administered drugs and by the development of managerialtools related to training, monitoring and evaluation,and social mobilization.Disability alleviation and prevention and resource mobilization(including for operational research and for thedevelopment of better diagnostic tools) remain majorchallenges.TAG-LF welcomed the actions taken by the Secretariatin pursuing the recommendations made at its thirdmeeting in March 2002.Monitoring and evaluationTAG-LF reviewed the background materials presentedby the Monitoring and Evaluation Working Group setup at its third meeting. These materials dealt with thetopics of coverage, stopping MDA, verification of interruptionof transmission, the role of simulation modelsin programme decisions, indicators for monitoring disabilityprevention, and applied research needs related tomonitoring and evaluation.TAG-LF accepted the recommendations provided in theexecutive summaries, with some suggestions for clarifications.It mandated the working group to continue todevelop recommendations related to these areas, notingthat field-testing of several of the current proposals wasneeded before definite recommendations could be madeto programme managers. It requested the Secretariatto disseminate those recommendations that are appropriatefor immediate implementation to national programmemanagers in appropriate formats, until suchtime as the national guidelines for programme managers7 could be amended.Assessment of drug coverageTAG-LF noted the desirability of using both the totalpopulation and the population eligible to receive treatmentas denominators for coverage data and suggestedthat separate columns for these two measures be incorporatedin reporting forms at global level. Reportingby age category is also desirable when surveys are performed.Stopping of mass drug administrationTAG-LF accepted that the current algorithm for determiningwhen to stop MDA might have been oversimplified.It welcomed the Monitoring and EvaluationWorking Group’s suggestions on taking additional stepsto confirm the
31TAG-LF recognized and welcomed the important contributionsof the researchers who contributed so generouslyto these trials and to those who have been helpingto develop other tests for Brugia malayi infections. Therecent findings from the Brugia Rapid test trials attestto the specificity of this diagnostic tool, and TAG-LF recommendedthat this new kit be used to develop a mappingstrategy for defining areas of Brugia endemicity.Update on modification of ICT cards by BinaxTAG-LF was presented with information regarding themodification of the ICT cards by Binax. It noted thatBinax had thus far been unsuccessful in improving uponthe currently available test card but was continuing itsefforts. TAG-LF recommended that, in the absence of abetter tool, national programmes should continue to usethe current ICT and ensure that the card is read accordingto the manufacturer’s guidelines at 10 minutes. TAG-LF stressed the urgent need to develop diagnostic kitsthat are easier to use in the field.Review of completed, ongoing and future researchThe fact that LF is now targeted for elimination has giventhe false impression that research is no longer relevant.TAG-LF recognized, however, that some technical componentsof monitoring and evaluating the progress of LFelimination need further research, and research is alsonecessary to improve the performance of the currentlyavailable and alternative diagnostic tools. TAG-LF recommendedthat TDR establish a Scientific Working Groupto define a strategic plan to focus on the key researchneeds of the programme and to advocate for more fundsfor research in LF, working with other initiatives towardsthis goal. This process must be as inclusive as possible.In addition, advantage should be taken of every opportunityto solicit support for further research in LF at scientificconferences and similar events.ChemotherapyUse of albendazole in children aged 1–5 yearsTAG-LF welcomed the presentation on the contributionof children 2–4 years old to W. bancrofti transmission inmass treatment settings. Excluding these children hasprogrammatic implications and could probably extendduration of mass drug treatment necessary to interruptW. bancrofti transmission by about one year, irrespectiveof overall coverage. Modelling is required for moreprecise estimates.Programmes using albendazole and ivermectin do notcurrently include children under 90 cm in height or15 kg in weight, corresponding to some 3–5 years ofage. It is now recognized that periodic treatment of childrenover one year of age for intestinal helminth infectionsresults in a significant health benefit, and TAG-LFrequested the Secretariat to provide a working paper forits consideration next year on the use of albendazole inchildren above one year of age, which will be helpful inclarifying its use in MDA incorporating ivermectin orDEC.Chemotherapy in Loa loa co-endemic areasTAG-LF took note of the ongoing and planned investigationsof L. loa-related encephalopathy following ivermectintreatment. In this context, the urgent need to carryout safety studies on co-administration of ivermectin andalbendazole for LF in L. loa-endemic areas was stressed,as such treatment is presently prohibited. It was thereforerecommended that the Secretariat liaise as neededwith the interested parties (TDR, Merck & Co., Inc., GSK,Mectizan® Expert Committee/Albendazole Coordination(MEC/AC), etc.) to facilitate the rapid implementation ofthe necessary studies.Introduction of DEC-fortified salt in GuyanaTAG-LF welcomed the presentation on preparations forintroducing DEC-fortified salt in Guyana. It urged theSecretariat to follow these developments closely with aview to sharing the experience and lessons learned inGuyana with other areas where DEC-fortified salt wouldbe appropriate for LF elimination programmes.Impact of MDA on reducing microfilaraemiaTAG-LF welcomed the presentation of preliminary datafrom selected sites, which related MDA coverage to mfprevalence. Although generally encouraging, these dataemphasized the challenges being faced at national andglobal levels in obtaining information of sufficient qualityto be useful for monitoring and evaluation. TAG-LF’s recommendationrelating to monitoring of coverage needsto be incorporated into national programmes as a steptowards overcoming the obstacle of inadequate data.Annual Report on Lymphatic Filariasis 2003Chapter 1 Progress of the Global Programme to Eliminate Lymphatic Filariasis
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