{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T03:06:15Z","timestamp":1767927975736,"version":"3.49.0"},"update-to":[{"DOI":"10.1371\/journal.pntd.0013493","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T00:00:00Z","timestamp":1757635200000}}],"reference-count":57,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T00:00:00Z","timestamp":1757289600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"R2HC","award":["78719"],"award-info":[{"award-number":["78719"]}]},{"name":"FWO","award":["G0A0522N"],"award-info":[{"award-number":["G0A0522N"]}]},{"name":"FWO","award":["1296723N"],"award-info":[{"award-number":["1296723N"]}]},{"DOI":"10.13039\/100010434","name":"'la Caixa' Foundation","doi-asserted-by":"publisher","award":["B005782"],"award-info":[{"award-number":["B005782"]}],"id":[{"id":"10.13039\/100010434","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>A high onchocerciasis disease burden and a low coverage of community-directed treatment with ivermectin (CDTI) have been observed in many parts of South Sudan. In the Maridi County, CDTI was re-introduced in 2017 and various interventions implemented to improve coverage.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Through successive community-based surveys, we investigated whether an onchocerciasis awareness campaign and a switch from annual to bi-annual distribution of ivermectin in Maridi County increased CDTI coverage. We also reviewed the evolution of ivermectin distribution in Maridi since 2017 and identified the determinants for ivermectin uptake.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>For past years in Maridi, CDTI programme performance has been highly variable due to security concerns, limited funding, misconceptions about ivermectin, and poor organisation of mass treatment campaigns. Community-based surveys conducted between 2018 and 2024 in Maridi found that upon switching from annual CDTI (2017\u20132019) to bi-annual CDTI (2021 onward), therapeutic coverage significantly increased from 40.8% in 2017 to 70.3% in 2023. Lower age, male gender, more CDTI information sources, and awareness of a link between onchocerciasis and epilepsy were all associated with increased uptake of ivermectin.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>This study showed that with reinforced awareness raising accompanying biannual CDTI, a higher ivermectin treatment coverage is achievable. 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