02971nas a2200385   4500000000100000008004100001260001200042653002700054653001500081653002900096653002100125653001700146653001000163100001700173700001400190700001300204700001600217700001200233700001500245700001100260700002300271700001200294700001200306700001300318700001200331700001600343700001400359700001800373245018900391856009900580300000900679490000700688520187600695022001402571       2026                            d  c02/202610aReaching the last mile10aIvermectin10aMass drug administration10aonchocerciasis  10aTransmission10aGhana1 aNditanchou R1 aOluwole A1 aBasnet S1 aChailloux A1 aSaare J1 aAgyemang D1 aKing S1 aOsei-Atweneboana M1 aSelby R1 aOpare J1 aHamill L1 aFodjo J1 aVerhoeven V1 aSchmidt E1 aColebunders R00aReaching the last mile with ivermectin mass drug administration against onchocerciasis: The case of Kwanware-Ottou persistent transmission focus in the Wenchi health district of Ghana.  uhttps://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0013958&type=printable  a1-210 v203 a<p><strong>BACKGROUND: </strong></p>

<p>Despite over two decades of Community-Directed Treatment with Ivermectin (CDTI), onchocerciasis transmission persists in localized pockets in Ghana, particularly in the Kwanware-Ottou community within the Wenchi Health District. This study trialled a scalable approach to identifying context-specific barriers and solutions for improving CDTI effectiveness.</p>

<p><strong>METHODOLOGY/PRINCIPAL FINDINGS: </strong></p>

<p>A mixed-methods approach was employed, including Geographical Information System mapping, community consultation, census and treatment coverage evaluation, and qualitative assessments. These informed the participatory development of an Action Plan, which was implemented and evaluated across three sub-districts. Key challenges identified and addressed included poor data quality, high population mobility, remote settlements with accessibility issues, limited awareness, and inadequate number and deployment of community drug distributors. As a result, therapeutic coverage increased from 70.8% to 88.2. Seven out of eight communities with pre-intervention coverage below the recommended 65% threshold not only achieved but exceeded this target. Ultimately, all communities met the coverage goal. The intervention also improved data accuracy and quality, community engagement, and adherence to directly observed treatment, while addressing systemic gaps in CDTI delivery.</p>

<p><strong>CONCLUSIONS/SIGNIFICANCE: </strong></p>

<p>This study demonstrates that a coordinated, locally adapted stimulus package can significantly enhance CDTI performance in areas of persistent onchocerciasis transmission. The approach presents a scalable model for similar endemic settings and aligns with the World Health Organization's 2021-2030 Roadmap for the elimination of Neglected Tropical Diseases.</p>
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