Providing mass drug administration of praziquantel, at a cost of 32 cents per child, to school-aged children to prevent female genital schistosomiasis could also reduce and possibly interrupt HIV/AIDS transmission throughout many rural areas of sub-Saharan Africa, according to a new analysis published in the open-access journal PLoS Neglected Tropical Diseases.

The analysis was authored by Professor Peter Hotez, President of the Sabin Vaccine Institute and Distinguished Research Professor at the George Washington University School of Medicine; Professor Alan Fenwick, founding Director of the Schistosomiasis Control Initiative and Professor of Tropical Parasitology at the Imperial College London; and Dr. Eryun Kjetland, a research fellow and attending physician in infectious diseases at the Oslo University Hospital of the Centre for Imported and Tropical Diseases, University of Oslo.

More than 90 percent of the world's 207 million cases of the neglected tropical disease schistosomiasis occur in sub-Saharan Africa, making it one of the most common neglected tropical diseases (NTDs) in the region. Schistosomiasis, the most deadly of the NTDs, causes chronic anemia and inflammation associated with severe disability among children, adolescents and young adults. Approximately two-thirds of the cases of schistosomiasis in the region result from urinary tract infections. This is a significant problem for girls and women who can develop female genital schistosomiasis (FGS) which often produces genital lesions making girls and women more susceptible to HIV/AIDS. Once the lesions appear, the authors note that treatment with praziquantel, while killing the worms, may not reverse the female genital symptoms, leading the authors to conclude that treatment should target school-aged children before the FGS symptoms have developed, which is also before they reach an age where they become sexually active and HIV/AIDS transmission is of much greater risk.

The authors emphasize that studies being conducted by the Schistosomiasis Control Initiative (SCI), demonstrate that a single mass treatment of praziquantel administered in Burkina Faso and Niger in West Africa can reduce the prevalence of schistosomiasis infection by 84 percent among girls. Similar results are being seen in other pilot countries.

Mass drug administration (MDA) of praziquantel has proven to not only be effective, but also extremely lost cost. MDA of school-aged children in Burkina Faso was conducted for only 32 cents per child. With this low-cost solution, 70 million infected children could be treated for $22 million, which if repeated biannually for 10 years would cost around $112 million. For this relatively small investment, the reproductive health of young women would be improved, and there is a reasonable chance that HIV/AIDS transmission can be reduced.

The authors conclude that the 32 cents solution could prevent the suffering from FGS and potentially reduce the spread of HIV/AIDS in sub-Saharan Africa, leading them to urge that a small amount of the PEPFAR (President's Emergency Plan for AIDS Relief ) funding be used for praziquantel administration in at least the PEPFAR countries of Mozambique, Tanzania and Zambia to support SCI activities through the Global Network for Neglected Tropical Diseases.

"The 32 cents solution could have enormous benefits for young African women and a huge potential beneficial impact on Africa's AIDS epidemic," stated Drs. Hotez, Fenwick and Kjetland.

Dr. Hotez added, "President Obama has stated his commitment to building upon our nation's strong record of fighting global health diseases through the continued infusion of resources and creating efficiencies in the global health system. Investing in NTD control is not only a cost effective solution to ending the suffering from many NTDs, research is now demonstrating that NTD control can also reduce the incidence of HIV/AIDS as well as malaria. Simply put, an investment in NTDs reaps significant dividends across the global health spectrum."

Sabin Vaccine Institute

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