Achieving the Endgame: Integrated NTD Case Searches

Abstract Trachoma and Guinea Worm Disease (GWD) are neglected tropical diseases (NTDs) slated for elimination as a public health problem and eradication respectively by the World Health Organization. As these programs wind down, uncovering the last remaining cases becomes an urgent priority. In 2010, The Ghana Health Service, along with The Carter Center, Sightsavers, and other partners, conducted integrated case search for cases of both GWD and the last stage of trachoma disease, trachomatous trichiasis (TT), as well as providing treatment for trachoma to meet elimination and eradication targets. House to house case search for both diseases was conducted and two case management strategies were explored: a centralized referral to services method and a Point of Care (POC) delivery method. 835 suspected TT cases were discovered in the centralized method, of which 554 accepted surgery. 482 suspected TT cases were discovered in the POC method and all TT cases accepted surgery in the POC searches. The cost per TT case examined was lower in the POC searches compared to the centralized searches ($19.97 in the POC searches and $20.85 in the centralized searches). Both strategies resulted in high surgical uptake for TT surgery, with average uptakes of 72.4% and 83.9% for the centralized and POC searches respectively. We present here that house to house case search offering services at POC are feasible and a potential tool for elimination and eradication programs nearing their end. Author SummaryTrachoma and Guinea Worm Disease (GWD) are neglected tropical diseases (NTDs) slated for elimination as a public health problem and eradication respectively by the World Health Organization. As these programs wind down, uncovering the last remaining cases becomes an urgent priority in order to confirm that eradiation/elimination targets have been reached. Active case searches are one method of finding these last vestiges of disease. Searches for that look for multiple diseases are referred to as integrated searches. We piloted here integrated case searches for GWD and Trachoma with two case management strategies, a referral approach to a central location, and point of care approach (POC). POC approaches can difficult to implement in low resource settings because they require extensive personnel, financial, and logistical, support. However, POC approaches remove one of the biggest barriers to treatment, time spent traveling to a health center, and thus can improve treatment uptake. We found here that integrated active cases searches with a POC case management approach can be implemented in a low resource setting; and improve acceptance and uptake of trachoma examination and trichiasis surgery respectively without costing much more than the referral case management approach.