To enhance efforts to control and eliminate lymphatic filariasis and onchocerciasis through the optimization of drug therapies and development of strategies for mass drug administration. Our name says it all. Death to Onchocerciasis and Lymphatic Filariasis.
This project, supported by the Bill and Melinda Gates Foundation, includes an ambitious set of complementary applied research projects that share the common goal of optimizing therapy to accelerate the elimination of LF and Onchocerciasis. In addition, the project aims to improve chances for LF and/or Oncho control in regions of Africa and Asia that are behind the progress of other countries. We develop strategies to ensure that areas with low acceptance, hard to reach populations, and persistent infection benefit from drug therapy research. We convene with international partners including: DNDi, the World Health Organization, the Ghana University of Health and Allied Sciences, and others to ensure timely dissemination of our results.
Global Context for DOLF Research
Lymphatic filariasis (LF) also known by its symptom elephantisisi, and onchocerciasis (Oncho) which is also called river blindness are neglected tropical diseases (NTDs). These illnesses cause severe disability in low and middle income countries. These related diseases are caused by different species of filarial nematode parasites. The Onchocerciasis Control Programme under the World Health Organization was one of the first major international control programs for parasitic NTDs and the first to be based on mass drug administration (MDA). Current programs for LF and Oncho include the African Programme for Onchocerciasis Control (APOC), the Onchocerciasis Elimination Program for the Americas (OEPA), and the Global Program for the Elimination of Lymphatic Filariasis (GPELF). These programs focus on mass drug administration with donated drugs, namely ivermectin from Merck and albendazole from GSK. Many hundreds of millions of people in the tropics have benefited from these programs.
However, more effective MDA regimens and strategies will be needed if we are to achieve the goals of global elimination of LF and elimination of Oncho. The available drugs only temporarily clear microfilariae, the parasite larvae that are required for transmission, without killing all adult worms. Killing the adult worms is essential to stopping transmission entirely. Thus, MDA must be administered for the reproductive life of adult parasites. In areas with heavy infection this is more than 5 years for LF and more than 10 years for Oncho.
In 2017 the WHO changed their recommendation for LF treatment. The new recommendation, based largely upon research conducted by DOLF scientists in 4 LF-endemic countries, involves an annual combination treatment of ivermectin, diethycarbamazine and albendazole. The triple drug called IDA, has great potential to accelerate LF elimination in many regions of Africa.
However, IDA cannot yet be used in MDA treatment for LF in countries where onchocerciasis is present. This is due to adverse reactions that occur when diethylcarbamazine kills the eye-dwelling parasites related to onchocerciasis. Increasing the areas where IDA can be used is imperative for accelerating LF and oncho elimination. Thus, new research conducted by DOLF – a project called DOLF NextGen—will include clinical trials testing the safety of IDA for the treatment of LF.