Effectiveness of one and two doses of ivermectin mass drug administration in reducing the prevalence and intensity of soil-transmitted helminth (STH) infections in Western Province, Solomon Islands: a cluster-randomised, before-after analysis

Brandon Le; Naomi E Clarke; Sze Fui Hii; Aisling Byrne; Alam Khattak; Susanna Lake; Erika Lazu; Salote Wickham; Handan Wand; Nick Olsen; Patsy A Zendejas-Heredia; Oliver Sokana; Lucia Romani; Daniel Engelman; Titus Nasi; Dickson Boara; John Kaldor; Andrew Steer; Rebecca Traub; Susana Vaz Nery

doi:10.1016/j.lanwpc.2023.100942

Effectiveness of one and two doses of ivermectin mass drug administration in reducing the prevalence and intensity of soil-transmitted helminth (STH) infections in Western Province, Solomon Islands: a cluster-randomised, before-after analysis

Lancet Reg Health West Pac. 2023 Oct 25:42:100942. doi: 10.1016/j.lanwpc.2023.100942. eCollection 2024 Jan.

Authors

Brandon Le¹, Naomi E Clarke¹, Sze Fui Hii², Aisling Byrne¹, Alam Khattak¹, Susanna Lake³, Erika Lazu⁴, Salote Wickham⁴, Handan Wand¹, Nick Olsen⁵, Patsy A Zendejas-Heredia², Oliver Sokana⁶, Lucia Romani^{1

3}, Daniel Engelman³, Titus Nasi⁶, Dickson Boara⁴, John Kaldor¹, Andrew Steer³, Rebecca Traub², Susana Vaz Nery¹

Affiliations

¹ The Kirby Institute, University of New South Wales, Sydney, Australia.
² The University of Melbourne, Melbourne, Australia.
³ Murdoch Children's Research Institute, Melbourne, Australia.
⁴ Gizo Hospital, Gizo, Solomon Islands.
⁵ Stats Central, University of New South Wales, Sydney, Australia.
⁶ Ministry of Health & Medical Services, Honiara, Solomon Islands.

Abstract

Background: Ivermectin mass drug administration (MDA) is effective for controlling onchocerciasis and scabies, with evidence supporting its role in some species of soil-transmitted helminth (STH) infections. In the context of RISE, a cluster-randomised trial for scabies, this study evaluated the effectiveness of ivermectin MDA in reducing STH burden in the Western Province of Solomon Islands.

Methods: Twenty villages were randomised 1:1 to receive ivermectin MDA as one dose (IVM-1) or two doses (IVM-2) for scabies. The effectiveness of one and two doses in reducing STH prevalence and intensity was evaluated before (May 2019) and 21 months after (February 2021) MDA in May 2019. All residents aged 12 months or older in the study villages were eligible to participate and provide stool specimens. Species-specific STH infection and intensity were assessed using quantitative PCR. We compared prevalence and intensity of infection between baseline and 21 months in each intervention arm individually using cluster-level analysis (adjusted for clustering) and individual-level analysis (adjusted for sex, age, and clustering). The primary outcomes were the prevalence risk difference (RD) from the cluster-level analysis, and the change in adjusted odds of infection from the individual-level analysis. Secondary outcomes included change in incident rates of mean eggs per gram (epg) of stool from baseline to 21 months, relative risk difference in prevalence and relative change in odds of infection between arms at 21 months. Sex data (male/female) were self-reported.

Findings: Overall, STH infection was assessed in 830 participants from 18 villages at baseline and 1172 from 20 villages at follow-up. Females represented 58% (n = 478) of the sample at baseline and 59% (n = 690) at follow-up. We observed a reduction in Strongyloides spp. prevalence following two doses of ivermectin MDA in the cluster-level analysis from 7.0% (32/458 participants) to 1.2% (8/674 participants), corresponding to a RD of -0.07 (95% CI -0.14 to -0.01, p = 0.036), and in the individual-level analysis (OR 0.11, 95% CI 0.04-0.33, p < 0.001). T. trichiura prevalence decreased following one dose from 19.4% (74/372 participants) to 11.7% (56/505 participants) (OR 0.44, 95% CI 0.26-0.73, p = 0.0040), while egg count reduced in both arms (IVM-1: IRR 0.28, 95% CI 0.11-0.70, p = 0.0070; IVM-2: IRR 0.18, 95% CI 0.08-0.40, p < 0.001), in the individual-level analysis. We did not detect a significant difference in effect measures between the one- and two-dose arms for any species after 21 months.

Interpretation: Our study highlights the long-term benefits of ivermectin MDA in reducing the burden of Strongyloides spp. and T. trichiura. STH control programs should leverage the geographical overlap of NTDs, existing drug distribution channels, and broad-spectrum agents.

Funding: The National Health and Medical Research Council of Australia.

Keywords: Ivermectin; Mass drug administration; Preventive chemotherapy; Soil-transmitted helminths.