Organization

In 2000, the Ministry of Public Health established a national coordinating center for the LF program, along with 4 technical subcommittees – mass treatment, clinical care, social mobilization, and diethylcarbamazine (DEC) fortified salt.  In 2003, the national program created a management team to direct activities throughout the country. 

Mass Drug Administration Activities

Mass drug administration (MDA) campaigns, using once-yearly albendazole and DEC, have been ongoing in Leogane since 2000.  The MOPH has begun campaigns in other areas, prioritizing those with greatest prevalence.  By 2002, 10% of the at-risk population was covered by MDA campaigns.  The program plans to implement MDAs in 16 areas, covering a million people in 2003. 

DEC-fortified salt use will be the strategy to interrupt transmission in three implementation units.  Honeywell International has donated 300 kg of DEC and WHO has donated 3000 kg of powdered DEC to add to local salt.  The program expects to treat 100,000 people with fortified salt in 2004.

Social Mobilization

Posters, flipcharts, radio spots, songs and lymphedema treatment materials have been developed in Haitian Creole.  These materials are used for education and advocacy purposes.  In 2003, 25 local leaders were educated about LF and how to interrupt transmission, 229 people were trained on how to transmit LF information to the public, and 1,628 local distributors were trained.

When drug coverage decreased in Leogane after the second round of MDA, the social mobilization team conducted focus groups to discover the cause.  Using results from these groups, they decided to increase awareness regarding adverse side effects and to increase the number of distribution posts.  Because of these efforts, coverage increased for the third round, completed in 2002.

Health Worker Training

A conference was held in 2002 for private physicians in Haiti.  It focused on the epidemiology of the disease and the objectives of the national elimination program.  In addition, a training manual was developed for physicians-in-training to inform them regarding LF and the lymphedema and urogenital disorders that can follow.  Also in 2002, Haiti hosted an international conference on urogenital ultrasound and surgery.  In total, 15 training sessions occurred, in which 2,300 health care workers were educated about different program components.  The program's next goal is to expand training for lab technicians in diagnosing LF infection.

Monitoring and Evaluation

Four sentinel sites were established in Leogane in 2000, surveying microfilarial (mf) and circulating antigen levels before treatment and after each round of MDA.  MF prevalence in sentinel sites has decreased from 9% positive in 2000 to 2% positive in 2002.  In 2002, eleven sites in other areas were established. 

A study of different strategies to assess coverage found little difference between community-based cluster surveys, surveys based on distribution points and school-based surveys.  This result will help the national program use cost-effective and accurate ways to monitor the program activities. 

Morbidity/Disability Activities

 In 2002, over 1200 patients were treated at the LF clinic in Leogane and over 500 were treated at the clinic in Milot.  In 2003, the Leogane clinic treated 176 new patients and the Milot clinic treated 72 new patients and enrolled 514 people in support groups.  In addition, in total, the Leogane clinic has performed 171 hydrocele surgeries and facilitated 864 support group meetings.

The program aims to expand LF clinics so that the six areas with greatest LF burden will each have a functioning LF clinic, complete with urologic surgery facilities, by 2004.

Economic Research

A cost analysis of the Haiti MDA program is ongoing in conjunction with the Emory LF Support Center.  The Haiti MOPH is using information from the cost analysis on the first two years of MDA in Leogane to create a budget for the national program.  A cost-effectiveness analysis of prevention and treatment programs will be completed in 2004. 

Operational Research