Journal
EPIDEMICS
Volume 39, Issue -, Pages -Publisher
ELSEVIER
DOI: 10.1016/j.epidem.2022.100562
Keywords
Kala-azar; Integrated control; Distributed-lag; Regression discontinuity; Spatiotemporal; Elimination
Categories
Funding
- ICMR, India, Dept. of Health Research, Ministry of Health & Family Welfare, Govt. of India
- General of Health Services, Ministry of Health & Family Welfare, Govt. of India [OPP1184344]
- NTD Modelling Consortium [OPP1183986]
- Newton Fund, UK [69871277]
- EPSRC, UK, MRC & University of Warwick [EP/L015374/1]
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Visceral leishmaniasis (VL) is declining in India, and the goal of eliminating it as a public health problem by 2020, set by the World Health Organization (WHO), is nearing achievement. Intensified combined interventions may help reach this goal, although their impact has not been assessed. A pilot study in the highly-endemic Vaishali district, which implemented intensified interventions, showed a substantial decrease in VL cases. This approach should be considered in other highly-endemic districts.
Visceral leishmaniasis (VL) is declining in India and the World Health Organization's (WHO) 2020 'elimination as a public health problem' target has nearly been achieved. Intensified combined interventions might help reach elimination, but their impact has not been assessed. WHO's Neglected Tropical Diseases 2021-2030 roadmap provides an opportunity to revisit VL control strategies. We estimated the combined effect of a district-wide pilot of intensified interventions in the highly-endemic Vaishali district, where cases fell from 3,598 in 2012-2014 to 762 in 2015-2017. The intensified control approach comprised indoor residual spraying with improved supervision; VL-specific training for accredited social health activists to reduce onset-to-diagnosis time; and increased Information Education & Communication activities in the community. We compared the rate of incidence decrease in Vaishali to other districts in Bihar state via an interrupted time series analysis with a spatiotemporal model informed by previous VL epidemiological estimates. Changes in Vaishali's rank among Bihar's endemic districts in terms of monthly incidence showed a change pre-pilot (3rd highest out of 33 reporting districts) vs. during the pilot (9th) (p < 1e-10). The rate of decline in Vaishali's incidence saw no change in rank at 11th highest, both pre-pilot & during the pilot. Counterfactual model simulations suggest an estimated median of 352 cases (IQR 234-477) were averted by the Vaishali pilot between January 2015 and December 2017, which was robust to modest changes in the onset-to-diagnosis distribution. Strengthening control strategies may have precipitated a substantial change in VL incidence in Vaishali and suggests this approach should be piloted in other highly-endemic districts.
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