102416 EDITORIAL 40 Years of the APOC Partnership Jean-Baptist Roungou1, Laurent Yameogo1, Chris Mwikisa1, Daniel A. Boakye1*, Donald A. P. Bundy2 1 World Health Organization/African Programme for Onchocerciasis Control (WHO/APOC), Ouagadougou, Burkina Faso, 2 World Bank, Washington, D.C., United States of America * DBoakye@noguchi.ug.edu.gh The fight against onchocerciasis (river blindness), one of the most devastating neglected tropi- cal diseases (NTDs), has mobilized significant resources and brought together diverse public and private stakeholders. Affected communities, governments of endemic countries, non-gov- ernmental development organizations (NGDOs), donors, and researchers are contributing, each in their own way, to what is considered today as one of the major public health achieve- ments of recent decades in Africa [1]. Onchocerciasis is losing ground, and its elimination in Africa is now possible within a reasonable timeframe [2,3]. Onchocerciasis is a vector-borne disease caused by the filarial worm Onchocerca volvulus. The Onchocerciasis Control Programme in West Africa (OCP), launched in 1974, initially fo- cused its activities on vector control in 11 West African countries and invested US$556 million over 28 years [4]. OCP succeeded in controlling river blindness in ten countries, with an amaz- ing 20% economic rate of return [5]. In 1987, in light of demonstrated ivermectin efficacy and safety in humans, Merck & Co. Inc. committed to providing the medicine free of charge to en- demic countries for as long as necessary to eliminate river blindness as a public health problem. This historic pledge enabled a new era in river blindness control through mass drug adminis- tration [6]. Building upon OCP, the African Programme for Onchocerciasis Control (APOC) was OPEN ACCESS launched in 1995 to extend the gains in river blindness control achieved in West Africa to the Citation: Roungou J-B, Yameogo L, Mwikisa C, 19 remaining endemic countries, mainly located in central and eastern Africa. APOC adopted Boakye DA, Bundy DAP (2015) 40 Years of the the community-directed treatment with ivermectin (CDTi) approach as its core strategy. The APOC Partnership. PLoS Negl Trop Dis 9(5): effectiveness of CDTi in improving coverage and compliance has since been demonstrated, e0003562. doi:10.1371/journal.pntd.0003562 and it is now used as a model for scaling up other public health interventions [7]. Editor: Sara Lustigman, Lindsley F. Kimball APOC’s work is underpinned by four main pillars: (i) ivermectin donation by Merck; (ii) Research Institute, New York Blood Center, UNITED commitment to the CDTi strategy; (iii) a unique partnership among the affected communities, STATES governments, donors, NGDOs, and APOC Secretariat; and (iv) continued scientific (basic and Published: May 14, 2015 operational) research, results of which were immediately ploughed in to improve performance. Copyright: © 2015 Roungou et al. This is an open Structures and mechanisms have been set up to implement, manage, and review this work. access article distributed under the terms of the APOC’s work translates on the ground into CDTi projects, which were 107 in 2012. The Creative Commons Attribution License, which permits CDTi projects deliver ivermectin once a year to the affected and at-risk communities. These unrestricted use, distribution, and reproduction in any communities are fully empowered to play their role: they select community-directed ivermec- medium, provided the original author and source are tin distributors (CDDs), decide on the most suitable period for ivermectin mass distribution, credited. monitor ivermectin distribution and provide incentives to CDDs, and report treatment adverse Funding: None of the authors received financial effects to the nearest health facilities. On their side, the health workers who are trained by ex- contribution for the development of the manuscript perts from APOC and in-country consultants ensure training of CDDs and their supervision; nor for submission of the manuscript for publication. they help with management of ivermectin supply and take charge of responding to severe Competing Interests: The authors have declared that no competing interests exist. PLOS Neglected Tropical Diseases | DOI:10.1371/journal.pntd.0003562 May 14, 2015 1/2 adverse effects of ivermectin treatment. This way, CDTi enormously contributes to primary health care implementation. The control of river blindness has been a remarkable success story. Now the focus has shifted to a more ambitious goal: the elimination of river blindness in addition to other pre- ventable NTDs from Africa. To help endemic countries achieve this aim, plans are underway to transition APOC into a new regional NTD entity, provisionally named Programme for the Elimination of Neglected Tropical Diseases (PENDA), in 2016. As river-blindness–endemic countries in Africa engage in the elimination of the disease and APOC transforms into a new regional entity, it is important to widely share the APOC partnership experience. This series of articles will highlight the different aspects of the fight, focusing on the history and governance of APOC, the management of the ivermectin donation [8], the technical foundations of the work of APOC, the country programs and perspectives, NGDOs action [9], mechanisms for financial sustainability [10], and the future of regional NTD elimination efforts. References 1. World Bank Group. (2011) Africa’s future and the World Bank’s support to it. World Bank, Africa Strate- gy 2011. http://siteresources.worldbank.org/INTAFRICA/Resources/AFR_Regional_Strategy_3-2-11. pdf. Accessed August 15, 2014. 2. Diawara L, Traoré MO, Badji A, Bissan Y, Doumbia K, et al. (2009) Feasibility of Onchocerciasis Elimi- nation with Ivermectin Treatment in Endemic Foci in Africa: First Evidence from Studies in Mali and Senegal. PLoS Negl Trop Dis 3(7): e497. doi: 10.1371/journal.pntd.0000497 PMID: 19621091 3. WHO. Accelerating work to overcome the global impact of neglected tropical diseases: a roadmap for implementation. http://www.who.int/neglected_diseases/NTD_RoadMap_2012_Fullversion.pdf. Ac- cessed: August 5, 2014. 4. World Health Organization. (2002) Success in Africa: the Onchocerciasis Control Programme in West Africa, 1974-2002.World Health Organ Tech Rep Ser 885: 1−72. 5. Kim A, Benton B. (1995) Cost-benefit analysis of the Onchocerciasis Control Program (OCP). Techni- cal paper 282, World Bank, Washington, DC. 6. Collins K. (2004) Profitable gifts: a history of the Merck Mectizan donation program and its implications for international health. Perspect Biol Med 47:100–109. PMID: 15061171 7. Molyneux DH. (2005) Onchocerciasis control and eliminatin: coming of age in resource-constrainged health systems. Trends Parasitol 21(11): 525–529. PMID: 16154387 8. Lawrence J, Sodahlon YK, Ogoussan KT, Hopkins AD (2015) Growth, challenges, and solutions over 25 Years of Mectizan and the impact on onchocerciasis control. PloS Negl Trop Dis. In press. 9. Cross C, Olamiju F, Richards F, Bush S, Hopkins A, et al. (2015) From river blindness to neglected trop- ical diseases—lessons learned in Africa for programme implementation and expansion by the non-gov- ernmental partners. In press. 10. Bundy DAP, Dhomun B, Daney X, Schultz LB, Tembon A, et al. (2015) Investing in Onchocerciasis Control: Financial Management of the African Programme for Onchocerciasis Control (APOC). Plos Negl Trop Dis. In press. PLOS Neglected Tropical Diseases | DOI:10.1371/journal.pntd.0003562 May 14, 2015 2/2