Community Directed Ivermectin Treatment Coverage in Burundi: A Spatio-Temporal Analysis for 2030 World Health Organization Road Map

Abstract

Background: Integrated national programme for the control of neglected tropical diseases and blindness aims to achieve
a paradigm shift from control of morbidity to interruption of transmission and ultimately elimination.
Objective: The aim of this study was to understand onchocerciasis epidemiology and control strategies in the context
of Burundi. Specifically, the study sought to understand the coverage of Ivermectin treatment in onchocerciasis endemic
zones, to assess the impact of African Programme for Onchocerciasis Control (APOC) approach on treatment coverage
and forecast the therapeutic coverage to 2030 horizon in Burundi.
Methods: We used retrospective data collected from 2005 to 2019 in four onchocerciasis endemic provinces in
Burundi. For mapping and ivermectin coverage rates comparison, we respectively used a spatial analysis and welch
testing methods. After, we forecasted the therapeutic coverage using the Autoregressive Integrated Moving Average
(ARIMA) model, a statistical analysis model which uses time series data to predict future trends. All analysis were done
using Quantum Geographic Information System (QGIS) and the R 3.5.3 software.
Results: During study period, a mean population of 1,536, 392 (95% CI: 1,114 ,870 -1,932 ,403) has been targeted
by ivermectin treatment in all the four provinces. The ivermectin coverage rate was 77.8% (95% CI: 67.8% to 81.6%).
Specifically, ivermectin coverage rates were 76.4%, 76.6% and 78.7% in Rutana, Bururi and Cibitoke - Bubanza
respectively. After six years of massive drug administration under World Health Organization community guidelines
launched in 2011, the coverage rates were, except the 2016 year, above 80%. Forecasts for 2030 showed that the
coverage rate for treatment could increase.
Conclusion: This study showed that the ivermectin coverage rate significantly increased during the community-directed
treatment approach period. The coverage rate should remain over 80% until 2030 in endemic regions, a strategy which
should contribute to decrease the onchocerciasis prevalence and lead to onchocerciasis elimination.