Onchocerciasis (river blindness), caused by the filarial worm species Onchocerca volvulus, is a serious vector-borne neglected tropical disease (NTD) of public health and socioeconomic concern. It is transmitted through the bite of black flies of the genus Simulium, and manifested in dermal and ocular lesions. Ninety-nine percent of the total global risk and burden of onchocerciasis is in Africa. This scoping review examines the key challenges related to the elimination of onchocerciasis by 2020–2025 in Africa, and proposes recommendations to overcome the challenges and accelerate disease elimination. To find relevant articles published in peer-reviewed journals, a search of PubMed and Google Scholar databases was carried out. Rigorous regional interventions carried out to control and eliminate onchocerciasis in the past four decades in Africa have been effective in bringing the disease burden under control; it is currently not a public health problem in most endemic areas. Notably, transmission of the parasite is interrupted in some hyperendemic localities. Recently, there has been a policy shift from control to complete disease elimination by 2020 in selected countries and by 2025 in the majority of endemic African countries. The WHO has published guidelines for stopping mass drug administration (MDA) and verifying the interruption of transmission and elimination of human onchocerciasis. Therefore, countries have revised their plans, established a goal of disease elimination in line with an evidence based decision to stop MDA and verify elimination, and incorporated it into their NTDs national master plans. Nevertheless, challenges remain pertaining to the elimination of onchocerciasis in Africa. The challenge we review in this paper are: incomplete elimination mapping of all transmission zones, co-endemicity of onchocerciasis and loiasis, possible emergence of ivermectin resistance, uncoordinated cross-border elimination efforts, conflict and civil unrest, suboptimal program implementation, and technical and financial challenges. This paper also proposes recommendations to overcome the challenges and accelerate disease elimination. These are: a need for complete disease elimination mapping, a need for collaborative elimination activities between national programs, a need for a different drug distribution approach in conflict-affected areas, a need for routine monitoring and evaluation of MDA programs, a need for implementing alternative treatment strategies (ATSs) in areas with elimination anticipated beyond 2025, and a need for strong partnerships and continued funding. National programs need to regularly monitor and evaluate the performance and progress of their interventions, while envisaging the complete elimination of onchocerciasis from their territory. Factors hindering the targeted goal of interruption of parasite transmission need to be identified and remedial actions should be taken. If possible and appropriate, ATSs need to be implemented to accelerate disease elimination by 2025.

中文翻译：

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到达最后一英里：与加速非洲盘尾丝虫病消除有关的主要挑战和建议

盘尾丝虫病（河盲症）由丝虫物种盘尾丝虫引起，是一种严重的媒介传播的被忽视的热带病（NTD），引起公共卫生和社会经济关注。它通过蚯蚓属的黑蝇叮咬传播，并表现在皮肤和眼部病变中。全球盘尾丝虫病总风险和负担的 99% 发生在非洲。本范围审查审查了与到 2020-2025 年在非洲消除盘尾丝虫病相关的主要挑战，并提出了克服挑战和加速消除疾病的建议。为了找到发表在同行评审期刊上的相关文章，对 PubMed 和 Google Scholar 数据库进行了搜索。过去四年在非洲为控制和消除盘尾丝虫病而采取的严格区域干预措施有效地控制了疾病负担；它目前在大多数流行地区都不是公共卫生问题。值得注意的是，寄生虫的传播在一些高流行地区被中断。最近，在选定的国家和到 2025 年在大多数流行非洲国家，政策已经从控制转向到 2020 年完全消除疾病。世卫组织已发布停止大规模药物管理 (MDA) 并验证人类盘尾丝虫病传播和消除的中断指南。因此，各国已经修订了他们的计划，根据以证据为基础的决定停止 MDA 并验证消除，确立了消除疾病的目标，并将其纳入其新唐人国家总体规划。然而，在非洲消除盘尾丝虫病方面仍然存在挑战。我们在本文中回顾的挑战是：所有传播区域的不完整消除映射、盘尾丝虫病和罗阿丝虫病的共同流行、伊维菌素耐药性的可能出现、不协调的跨境消除努力、冲突和内乱、计划实施不理想以及技术和财务挑战。本文还提出了克服挑战和加速消除疾病的建议。它们是：需要完整的疾病消除地图，需要在国家计划之间开展协作消除活动，需要在受冲突影响地区采用不同的药物分配方法，需要对 MDA 计划进行常规监测和评估，需要在预计 2025 年以后消除的地区实施替代治疗策略 (ATS)，以及需要强有力的伙伴关系和持续的资金。国家计划需要定期监测和评估其干预措施的绩效和进展，同时设想在其领土上彻底消除盘尾丝虫病。需要确定阻碍实现阻断寄生虫传播的目标的因素，并采取补救措施。如果可能和适当，需要实施 ATS 以加速到 2025 年消除疾病。国家计划需要定期监测和评估其干预措施的绩效和进展，同时设想在其领土上彻底消除盘尾丝虫病。需要确定阻碍实现阻断寄生虫传播的目标的因素，并采取补救措施。如果可能和适当，需要实施 ATS 以加速到 2025 年消除疾病。国家计划需要定期监测和评估其干预措施的绩效和进展，同时设想在其领土上彻底消除盘尾丝虫病。需要确定阻碍实现阻断寄生虫传播的目标的因素，并采取补救措施。如果可能和适当，需要实施 ATS 以加速到 2025 年消除疾病。