Impact of Mass Drug Administration of Ivermectin, Diethylcarbamazine, Albendazole, and Azithromycin on Lymphatic Filariasis, Scabies, and Yaws in West New Britain Province, Papua New Guinea

<jats:p>West New Britain province (WNBP), Papua New Guinea, is the first to combine ivermectin, diethylcarbamazine, albendazole (IDA), and azithromycin for mass drug administration (MDA). We describe the impact of four-drug MDA on lymphatic filariasis (LF), scabies, and yaws through active and passive surveillance. At baseline, 43 villages were surveyed following selection using model-based geostatistics. Repeat surveys were conducted in 10 high burden villages, one year after MDA. Circulating filarial antigen (CFA) and microfilaria (Mf) microscopy detected LF infections; skin examinations identified yaws and scabies. Electronic data from 27 health centers (HCs) compared monthly attendances in the six months before/after MDA. Pre-MDA, 151/3,552 (4.3%) participants tested CFA-positive, with 49 (1.4%) Mf-positive. Scabies was identified in 489/3,552 (13.8%) and yaws-like lesions in 130/3,552 (3.6%). In the 10 villages surveyed pre- and post-MDA, CFA positivity decreased by 49% (RR 0.51; CI 0.38, 0.70; p&lt;0.0001; 11.5% to 5.9%), Mf prevalence 85% (RR 0.15; CI 0.07, 0.30; p&lt;0.001; 4.7% to 0.9%), scabies 78% (RR 0.22; CI 0.14 - 0.33; p&lt;0.0001; 11.1% to 2.4%) and yaws 31% (RR 0.69; CI 0.41 - 1.14; p=0.15; 3.8% to 2.5%). Mean (SEM) monthly HC attendances for yaws-like lesions decreased from 27.4 ± 0.9 to 15.5 ± 1.6 (p&lt;0.0001) and for other skin diseases from 95.6 ± 3.4 to 72.9 ± 7.7 (p&lt;0.0001), with no significant change in total non-skin disease attendances (728.8 ± 30.9 to 796.8 ± 44.4, p=0.178). MDA with IDA and azithromycin reduced LF and other skin infections burden in WNBP, demonstrating the effectiveness of four-drug MDA and the potential for using active and passive surveillance to monitor impact.</jats:p>