Control of Taenia solium in a hyper-endemic region of Uganda: Assessing optimal mass drug administration strategies in the human and porcine hosts

We address the major global health challenge posed by Taenia solium cysticercosis in highly endemic areas. This zoonotic tapeworm infection is a neglected tropical disease (NTD) with substantial health and economic impacts in regions where pork consumption is high, and pig farming is practised extensively in areas with low sanitation and stark poverty. Northern Uganda is one such area, but this parasite is endemic or suspected endemic in at least 65 countries across central & South America, sub-Saharan Africa and Asia making T. solium a parasite of truly global concern.
Context and Global Health Challenge: Uganda and other endemic countries face a substantial burden from neurocysticercosis (NCC), a severe neurological condition in humans resulting from T. solium infections. The parasite's life cycle involves pigs as intermediate hosts and humans as definitive hosts. NCC arises when humans are infected through faecal-oral contamination with infectious eggs resulting in NCC as an aberrant intermediate infection. The disease's global impact is profound, with an estimated annual burden of 1.2million Disability Adjusted Life Years (DALYs).  Of the NTDs considered by the Global Burden of Disease study 2021, cysticercosis has the third highest burden after malaria and schistosomiasis. In addition to its health impact, T. solium has an economic burden, resulting in a reduction in the value of infected pigs. In Uganda, where widespread free-roaming pigs and low sanitation levels increase the risk of T. solium transmission, the economic burden is estimated as at least $75million/yr.
Project Goals and Objectives: Our primary goal is to evaluate the incremental effectiveness of a joint human-porcine mass anthelmintic administration strategy compared to human only treatment, for the control of T. solium in Northern Uganda. We will determine the difference in effect through a cluster randomised controlled trial where the primary outcome is prevalence of porcine cysticercosis (PCC) (infection of pigs with the intermediate stage of the tapeworm), and secondary outcome is human cysticercosis (HCC) prevalence. Transmission simulations will inform projection of future impact on transmission and burden of disease estimates over a 10yr time frame, feeding into an economic evaluation of cost-effectiveness from the health system perspective and cost-benefit analysis from a societal perspective. Finally, we will determine the feasibility and acceptability of such joint One Health interventions from the perspective of policy makers in the health and agriculture sectors.
Potential Applications and Benefits: This proposal seeks to demonstrate how interventions implemented across non-human and human hosts can improve public health, emphasising the importance of interdisciplinary, collaborative working. It represents an important step in addressing a neglected health problem in Uganda through reducing the burden of T. solium infections. Our intervention, supported by modelling, will benefit the community at large and enhance the livelihoods of smallholder pig farmers whilst providing valuable insights and frameworks that could be applied to similar health challenges worldwide. The proposal provides opportunities to influence resource allocation and policymaking, focusing on sustainable and locally acceptable control strategies. This proposal represents an example of the One Health concept in practice and is reflected in the multi-disciplinary background of the research team which represents a wide range of relevant expertise in the epidemiology and control of NTDs in Low- and Middle-Income Countries (LMIC) contexts.