Background Lymphatic filariasis (LF) is a neglected tropical disease targeted for elimination as a public health problem by 2030. Although mass treatments have led to huge reductions in LF prevalence, some countries or regions may find it difficult to achieve elimination by 2030 owing to various factors, including local differences in transmission. Subnational projections of intervention impact are a useful tool in understanding these dynamics, but correctly characterizing their uncertainty is challenging. Methods We developed a computationally feasible framework for providing subnational projections for LF across 44 sub-Saharan African countries using ensemble models, guided by historical control data, to allow assessment of the role of subnational heterogeneities in global goal achievement. Projected scenarios include ongoing annual treatment from 2018 to 2030, enhanced coverage, and biannual treatment. Results Our projections suggest that progress is likely to continue well. However, highly endemic locations currently deploying strategies with the lower World Health Organization recommended coverage (65%) and frequency (annual) are expected to have slow decreases in prevalence. Increasing intervention frequency or coverage can accelerate progress by up to 5 or 6 years, respectively. Conclusions While projections based on baseline data have limitations, our methodological advancements provide assessments of potential bottlenecks for the global goals for LF arising from subnational heterogeneities. In particular, areas with high baseline prevalence may face challenges in achieving the 2030 goals, extending the “tail” of interventions. Enhancing intervention frequency and/or coverage will accelerate progress. Our approach facilitates preimplementation assessments of the impact of local interventions and is applicable to other regions and neglected tropical diseases.

中文翻译：

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在精细空间尺度上预测撒哈拉以南非洲地区淋巴丝虫病干预措施影响的整体框架

背景 淋巴丝虫病（LF）是一种被忽视的热带疾病，预计到 2030 年作为一个公共卫生问题予以消除。尽管大规模治疗已导致 LF 患病率大幅下降，但一些国家或地区可能会发现，由于各种原因，到 2030 年难以实现消除。因素，包括传播的局部差异。对干预影响的地方预测是理解这些动态的有用工具，但正确描述其不确定性具有挑战性。方法 我们开发了一个计算上可行的框架，使用集成模型在历史控制数据的指导下，为 44 个撒哈拉以南非洲国家的 LF 提供地方预测，以评估地方异质性在实现全球目标中的作用。预计方案包括从 2018 年至 2030 年持续进行年度治疗、扩大覆盖范围和每年两次治疗。结果 我们的预测表明进展可能会持续良好。然而，目前采用世界卫生组织建议覆盖率（65%）和频率（每年）较低的策略的高流行地区预计患病率将缓慢下降。增加干预频率或覆盖范围可以分别将进展速度加快 5 或 6 年。结论 虽然基于基线数据的预测存在局限性，但我们的方法进步提供了对因地方异质性而导致的全球 LF 目标的潜在瓶颈的评估。特别是，基线患病率较高的地区在实现 2030 年目标方面可能面临挑战，延长干预措施的“尾巴”。提高干预频率和/或覆盖范围将加速进展。我们的方法有助于对当地干预措施的影响进行实施前评估，并适用于其他地区和被忽视的热带病。