Group of smiling women and children from Solomon Islands. Credit: Flickr/Antony Robinson (CC BY-NC-SA 2.0)

The AIM Study

A field trial of co-administration of azithromycin and ivermectin mass drug administration

The challenge

Scabies is a neglected tropical disease (NTD) that contributes greatly to global morbidity and mortality particularly in tropical developing countries. A large-scale, comprehensive trial of mass drug administration (MDA) for endemic scabies has been advocated as a global health need, but never implemented. Resource-limited settings faced with multiple NTDs are challenged by how to manage MDA programs in an efficient and coordinated manner. This study addresses the problem of how to scale-up MDA for scabies control in high prevalence countries, and specifically in settings where there is already an infrastructure and established need for trachoma MDA.

The project

The Azithromycin Ivermectin Mass drug administration (AIM) trial was conducted in the province of Choiseul in the Solomon Islands. The province has a population of approximately 28,000 people and was the last province to receive MDA for trachoma. The study was designed to assess the feasibility of conducting a joint MDA program for trachoma and scabies control in a large population of the Solomon Islands. Additionally we investigated the safety of co-administration of this two-drug regimen and the effectiveness of ivermectin-based MDA for scabies and its complications, including impetigo and skin and soft tissue infections, in this large island population. 

The method

This was a prospective community intervention trial to assess the feasibility, safety and efficacy of MDA for trachoma and scabies control in Choiseul, therefore all residents of the province were invited to participate and receive the treatment regimen proposed. The MDA regimen included a single dose of oral azithromycin (or topical tetracycline eye ointment if azithromycin was contraindicated) for trachoma and two doses of oral ivermectin (or topical permethrin cream if ivermectin is contra-indicated) for scabies. Participants in 10 randomly selected villages had their skin examined (pre and post treatment) to determine the prevalence of scabies in the province.

The impact

NTDs are widespread public health problems that affect impoverished populations in tropical developing countries. There is increasing interest in pursuing control strategies for scabies as part of other NTD programs in endemic populations in the Pacific and beyond. Previous studies conducted by our team in smaller populations prove we have a highly effective intervention to reduce the burden of scabies and other NTDs. However, it is important to investigate whether the results can be replicated on a larger scale and whether multiple NTD programs could be integrated. The results of this study will directly translate into enhanced program cost-effectiveness through the adoption of integration strategies.

Project collaborators
  • Ministy of Health and Medical Services, Solomon Islands