Jointly led by IRD and INSERM, this research explores alternative strategies to combat filariasis in Central Africa.
Jérémy Campillo, researcher at TransVIHMI (Institut de Recherche pour le Développement).
Thesis defended in 2021 at the doctoral school École doctorale Sciences Chimiques et Biologiques pour la Santé (Montpellier ; 1992-....).
This research is the result of an international co-supervision between several partner institutions.
Referenced in the ABES/STAR network, this thesis meets the rigorous criteria of French higher education.
The elimination of filariasis, particularly onchocerciasis and lymphatic filariasis, represents a major challenge in Central Africa, a region where these parasitic diseases continue to cause human suffering and significant economic losses. Current control programs primarily rely on the mass administration of medications, such as ivermectin and albendazole, which have proven effective in reducing the prevalence of these infections. However, these treatments are not without risks, especially in co-endemic areas where loiasis, another parasitic infection, is also present. Ivermectin, while effective against onchocerciasis, can cause severe side effects in co-infected patients, such as severe inflammatory reactions. This raises a crucial question: how can we ensure effective control of these diseases while minimizing health risks for vulnerable populations?
The results of this research show that semi-annual administration of albendazole may be a viable solution in co-endemic areas. In parallel, the use of levamisole could reduce microfilaria levels of Loa loa, thus allowing for safer use of ivermectin. These innovative approaches pave the way for new treatment strategies that could transform the fight against filariasis. For example, studies have demonstrated that the combination of these medications could not only improve patient tolerance but also increase treatment efficacy by targeting multiple parasites simultaneously. But what about the economic and social implications of these new methods?
It is imperative to evaluate not only the effectiveness of treatments but also their acceptability by local populations. Clinical trials and pharmacovigilance studies are essential to ensure the safety of treatments. Furthermore, modeling the variability of blood microfilaria allows for a better understanding of the dynamics of loiasis and for adapting interventions accordingly. This raises another question: how can we integrate this new knowledge into public health policies? Decision-makers must consider not only scientific data but also the perceptions and needs of affected communities.
In summary, this research highlights promising avenues for improving the fight against filariasis in Central Africa. Decision-makers must seize these results to rethink treatment strategies and ensure equitable access to care. Collaboration between researchers, health institutions, and local communities will be essential for successfully making this transition. Governments must also invest in awareness campaigns to inform populations about the risks associated with filariasis and the importance of prevention.
It is also crucial to develop regional and international partnerships to strengthen local capacities in research and treatment. For example, initiatives such as the African Program for Neglected Tropical Disease Control (NTD) could play a key role in coordinating efforts to combat filariasis. Additionally, integrating new technologies, such as mobile applications for case tracking and medication distribution, could improve the efficiency of treatment programs.
Finally, it is essential to consider the economic dimensions of these new strategies. The financial impact of filariasis on health systems and local economies is considerable. By reducing the burden of these diseases, not only will the health of populations improve, but it could also stimulate economic development in affected regions. Decision-makers must therefore consider investments in research and the development of alternative treatments as a priority, not only for public health but also for the socio-economic development of Central Africa.
Thus, the elimination of filariasis in Central Africa requires a multidimensional approach that combines research, innovation, social acceptability, and community engagement. The challenges are numerous, but the opportunities for transformation are equally abundant. By uniting our efforts, it is possible to push back these diseases and improve the quality of life for millions of people.
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Sources and Access
Jérémy Campillo. Développement de stratégies alternatives pour l'élimination des filarioses en Afrique centrale. Médecine humaine et pathologie. Université Montpellier, 2021. Français. ⟨NNT : 2021MONTT040⟩. ⟨tel-03465102⟩