The African Programme for Onchocerciasis Control (APOC).

The African Programme for Onchocerciasis Control (APOC) was launched in 1995, ultimately to eliminate human onchocerciasis from the African countries in which the disease was endemic. This goal is being achieved, via a public-private partnership, using a strategy, of community-directed treatment (CDT) with ivermectin, that is based on the empowerment of each target community. It is estimated that the Programme saved 3 million disability-adjusted life-years between 1996 and 2005, and, with a free supply of ivermectin, this gives an estimated 17% economic rate of return on the cost of treatment delivery. In addition to the substantial direct benefits from the control of onchocerciasis, there are several indirect benefits, including the de-worming of children who receive ivermectin, increased school attendance, general improvements in community and individual health, and increased food production. A key component of the Programme is the co-implementation of onchocerciasis control with other health interventions that can be delivered at the community level. This approach has proved highly effective, leading to higher levels of therapeutic coverage for onchocerciasis control as well as improved delivery of other services, especially vaccination programmes. In the accompanying article, the outcome and challenges of the APOC in 2006, in 105,866 participating communities spread across 15 countries, are described.