Advantages of Triple Drug Therapy as Compared to Double Drug Therapy

The DOLF (Death of Onchocerciasis and Lymphatic Filariasis) study conducted in India has demonstrated that triple drug therapy is superior to two-drug therapy.

The advantages of triple drug therapy are as follows:

1. Microfilaria (MF) clearance is faster with three drugs.
2. Sustained clearance of microfilaremia for up to two years with a single dose of IDA.
3. No significant increase in the adverse events associated with IDA.
4. Potentially cost-effective, as fewer Mass Drug Administration (MDA) rounds may be needed for attaining elimination.
5. Additional benefit of curing other infections like scabies, itching, etc.

IDA drastically reduces MF rates, and the low MF persists for up to two years. The impact of IDA covers the following parameters:

1) Parasitological Parameters:

• MF rate
• MF density
• Disease rate

2) Entomological Parameters:

• Mosquito density
• Infection rate
• Infectivity rate
• Mean number of L-3 infective mosquitoes

1. Role of Private Sector

The private health sector represents a substantial resource, especially in urban areas. Private medical practitioners can also be motivated through the professional organizations. These organizations can also identify areas in which the support of private physicians could best be utilized in mass drug administration and the MMDP.
The private sector, industrial houses, and private educational institutions are also important groups for organizing mass treatment campaigns for their employees. Large industries provide health services to their employees and their families and sometimes also provide health services to the industrial township. An inventory of private establishments will enhance planning for drug distribution .

2. Role of NGOs, CBOs, FBOs, Panchayats, etc.

Nongovernmental organizations, community-based organizations, and faith-based organizations can play an important role in LF elimination. These organizations should be invited to discussions when the annual strategic plan is prepared so that they can identify areas of interest for their participation, which could be incorporated in the national plan. A list of NGOs, CBOs, FBOs, and enterprising Panchayats with the possible areas of partnership should be prepared.

The possible areas of partnership for an active role of voluntary Organizations for elimination of LF in India are identified in the following three specific areas:

1. Mapping of areas through morbidity surveys
2. Social Mobilization for drug compliance
3. Supporting mass drug administration and management of adverse reaction
4. Morbidity management at the community level.