- The Australian Centre for the Control and Elimination of Neglected Tropical Diseases (ACE-NTD)s
Working toward a scabies control strategy for northern Australia: Methods to map the burden of scabies and consideration of a community-wide preventative chemotherapy strategy
- To estimate the burden of scabies and observe changes in prevalence over time in selected Aboriginal and Torres Strait Islander communities in northern Australia
- To consider the impact of social and cultural contextual factors, as well as local community-driven initiatives and engagement strategies, which may change the trajectory of scabies prevalence in the community
- To consider the appropriateness of a community-wide treatment program in an Australian context and evaluate the impact of an ivermectin-based mass drug administration (MDA) treatment strategy if implemented by the community.
- To use community randomisation and modelling methods to estimate the burden of disease of scabies and common skin conditions in Aboriginal and Torres Strait Islander communities. Assessing the true burden of scabies across northern Australia is a significant challenge due to extreme geographical distances, remoteness, low population density, a variable climate and access to remote communities with socioeconomic and cultural considerations. Owing to these factors and the ongoing burden of scabies, it is important to consider recent evidence to determine the optimal strategy for the management of scabies in northern Australia.
Scabies is a Neglected Tropical Disease which is endemic in northern Australia and estimated to affect up to 25 per cent of the population of Aboriginal and Torres Strait Islander communities. It is caused by the transmission of a parasitic mite which burrows under the skin after contact with an infected person and can also lead to serious secondary complications which contribute to the health and life expectancy gap that exists between Aboriginal and Torres Strait Islander people and other Australians.
The burden of skin disease is underreported and underrepresented on the national policy agenda, but there has been a renewed focus on the control and elimination of scabies in response to the ongoing public health concern. This builds on previous Healthy Skin work at Menzies and the work of One Disease. This study will aim to estimate the burden of scabies through conducting prevalence assessments in Aboriginal and Torres Strait Islander communities at different time-points (3-months, 6-months and 12-months) to determine whether targeted health interventions and community education may lead to a reduction in prevalence and address the high burden of disease at a regional level.
A World Health Organization (WHO) informal consultation conducted in 2019 developed a framework for scabies control, in which mass-drug administration programs were recommended if the prevalence of scabies is estimated to be greater than 10 per cent. If an MDA treatment program is implemented by an Aboriginal Medical Service as a gold-standard community health intervention, a prevalence assessment may investigate the intervention effectiveness and success of a treatment strategy to achieve disease control after the administration of ivermectin to all community members.
Implications for policy and practice:
There have been few recent prevalence assessments of scabies in northern Australia since the East Arnhem Healthy Skin Project was run between 2004 - 2007 and it is not known whether historical assessments are still representative of the disease burden. Furthermore, mapping prevalence and identifying the burden of scabies is the critical next step towards considering an MDA treatment program or alternative strategies for disease control.
If a community-wide treatment regime is highly effective for scabies control, this may lend support for the implementation of ivermectin-based MDA strategies at a larger scale in wider regions across northern Australia. This may be an important step towards achieving a long-term strategy for the control and elimination of scabies in Australia, which is in line with global priorities for skin-NTDs as directed by WHO.
For more information about the project contact Dr Victoria Cox via email.
The project commenced in December 2021 and is due for completion in July 2023.