WHO has proposed elimination of transmission of onchocerciasis (river blindness) by 2030. More than 99% of cases of onchocerciasis are in sub-Saharan Africa. Vector control and mass drug administration of ivermectin have been the main interventions for many years, with varying success. We aimed to identify factors associated with elimination of onchocerciasis transmission in sub-Saharan Africa. For this systematic review and meta-analysis we searched for published articles reporting epidemiological or entomological assessments of onchocerciasis transmission status in sub-Saharan Africa, with or without vector control. We searched MEDLINE, PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials, African Index Medicus, and Google Scholar databases for all articles published from database inception to Aug 19, 2023, without language restrictions. The search terms used were “onchocerciasis” AND “ivermectin” AND “mass drug administration”. The three inclusion criteria were (1) focus or foci located in Africa, (2) reporting of elimination of transmission or at least 10 years of ivermectin mass drug administration in the focus or foci, and (3) inclusion of at least one of the following assessments: microfilarial prevalence, nodule prevalence, Ov16 antibody seroprevalence, and blackfly infectivity prevalence. Epidemiological modelling studies and reviews were excluded. Four reviewers (NM, AJ, AM, and TNK) extracted data in duplicate from the full-text articles using a data extraction tool developed in Excel with columns recording the data of interest to be extracted, and a column where important comments for each study could be highlighted. We did not request any individual-level data from authors. Foci were classified as achieving elimination of transmission, being close to elimination of transmission, or with ongoing transmission. We used mixed-effects meta-regression models to identify factors associated with transmission status. This study is registered in PROSPERO, CRD42022338986. Of 1525 articles screened after the removal of duplicates, 75 provided 282 records from 238 distinct foci in 19 (70%) of the 27 onchocerciasis-endemic countries in sub-Saharan Africa. Elimination of transmission was reported in 24 (9%) records, being close to elimination of transmission in 86 (30%) records, and ongoing transmission in 172 (61%) records. was 83·3% (95% CI 79·7 to 86·3). Records reporting 10 or more years of continuous mass drug administration with 80% or more therapeutic coverage of the eligible population yielded significantly higher odds of achieving elimination of transmission (log-odds 8·5 [95% CI 3·5 to 13·5]) or elimination and being close to elimination of transmission (42·4 [18·7 to 66·1]) than those with no years achieving 80% coverage or more. Reporting 15–19 years of ivermectin mass drug administration (22·7 [17·2 to 28·2]) and biannual treatment (43·3 [27·2 to 59·3]) were positively associated with elimination and being close to elimination of transmission compared with less than 15 years and no biannual mass drug administration, respectively. Having had vector control without vector elimination (−42·8 [−59·1 to −26·5]) and baseline holoendemicity (−41·97 [−60·6 to −23·2]) were associated with increased risk of ongoing transmission compared with no vector control and hypoendemicity, respectively. Blackfly disappearance due to vector control or environmental change contributed to elimination of transmission. Mass drug administration duration, frequency, and coverage; baseline endemicity; and vector elimination or disappearance are important determinants of elimination of onchocerciasis transmission in sub-Saharan Africa. Our findings underscore the importance of improving and sustaining high therapeutic coverage and increasing treatment frequency if countries are to achieve elimination of onchocerciasis transmission. The Bill & Melinda Gates Foundation and Neglected Tropical Diseases Modelling Consortium, UK Medical Research Council, and Global Health EDCTP3 Joint Undertaking. For the Swahili, French, Spanish and Portuguese translations of the abstract see Supplementary Materials section.

中文翻译：

---

在撒哈拉以南非洲地区，在有或没有媒介控制的情况下，通过长期伊维菌素大规模给药来消除盘尾丝虫病（河盲症）的传播：系统评价和荟萃分析

世界卫生组织建议到 2030 年消除盘尾丝虫病（河盲症）的传播。99% 以上的盘尾丝虫病病例发生在撒哈拉以南非洲地区。多年来，病媒控制和伊维菌素大规模给药一直是主要干预措施，并取得了不同程度的成功。我们的目的是确定与消除撒哈拉以南非洲盘尾丝虫病传播相关的因素。为了进行这项系统评价和荟萃分析，我们检索了已发表的文章，这些文章报告了撒哈拉以南非洲地区盘尾丝虫病传播状况的流行病学或昆虫学评估，无论有或没有病媒控制。我们检索了 MEDLINE、PubMed、Web of Science、Embase、Cochrane Central Register of Controlled Trials、African Index Medicus 和 Google Scholar 数据库，查找从数据库建立到 2023 年 8 月 19 日发表的所有文章，没有语言限制。使用的搜索词是“盘尾丝虫病”和“伊维菌素”和“大规模药物管理”。三个纳入标准是 (1) 病灶或病灶位于非洲，(2) 报告已消除传播或在病灶或病灶内至少 10 年大规模使用伊维菌素，以及 (3) 纳入至少一项以下评估：微丝蚴流行率、结节流行率、Ov16 抗体血清流行率和黑蝇传染性流行率。流行病学模型研究和评论被排除在外。四位审稿人（NM、AJ、AM 和 TNK）使用 Excel 开发的数据提取工具从全文文章中提取重复的数据，其中一栏记录了要提取的感兴趣的数据，一栏记录了每项研究的重要评论可以突出显示。我们没有要求作者提供任何个人层面的数据。病灶被分类为实现消除传播、接近消除传播或正在进行传播。我们使用混合效应元回归模型来识别与传播状态相关的因素。这项研究已在 PROSPERO 中注册，CRD42022338986。在删除重复项后筛选的 1525 篇文章中，75 篇提供了来自撒哈拉以南非洲 27 个盘尾丝虫病流行国家中的 19 个国家（70%）的 238 个不同疫源地的 282 条记录。 24 条记录 (9%) 报告已消除传播，86 条记录 (30%) 报告接近消除传播，172 条记录 (61%) 报告持续传播。为 83·3%（95% CI 79·7 至 86·3）。记录报告 10 年或以上连续大规模用药且合格人群的治疗覆盖率达到 80% 或以上，消除传播的几率显着更高（对数几率 8·5 [95% CI 3·5 至 13·5] ）或消除并接近消除传播（42·4 [18·7 至 66·1]），而不是那些没有达到 80% 或以上覆盖率的年份。报告 15-19 年的伊维菌素大规模给药（22·7 [17·2 至 28·2]）和半年治疗（43·3 [27·2 至 59·3]）与消除呈正相关，并接近消除与不到 15 年和每年两次大规模给药相比，消除了传播。在未消除病媒的情况下进行病媒控制（−42·8 [−59·1 至 -26·5]）和基线全流行（−41·97 [−60·6 至 -23·2]）与感染风险增加相关分别与无病媒控制和低流行情况进行比较。由于媒介控制或环境变化而导致的黑蝇消失有助于消除传播。大规模用药持续时间、频率和覆盖范围；基线流行；消除或消失媒介是消除撒哈拉以南非洲盘尾丝虫病传播的重要决定因素。我们的研究结果强调了如果各国要实现消除盘尾丝虫病传播，改善和维持高治疗覆盖率以及增加治疗频率的重要性。比尔及梅琳达·盖茨基金会和被忽视的热带病建模联盟、英国医学研究委员会和全球健康 EDCTP3 联合项目。有关摘要的斯瓦西里语、法语、西班牙语和葡萄牙语翻译，请参阅补充材料部分。