{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T18:10:58Z","timestamp":1788977458501,"version":"build-2803163510"},"update-to":[{"DOI":"10.1371\/journal.pntd.0014164","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000}}],"reference-count":81,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001713","name":"European and Developing Countries Clinical Trials Partnership","doi-asserted-by":"publisher","award":["RIA2017NCT\u20111843"],"award-info":[{"award-number":["RIA2017NCT\u20111843"]}],"id":[{"id":"10.13039\/501100001713","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003130","name":"Fonds Wetenschappelijk Onderzoek","doi-asserted-by":"publisher","award":["G0A0522N"],"award-info":[{"award-number":["G0A0522N"]}],"id":[{"id":"10.13039\/501100003130","id-type":"DOI","asserted-by":"publisher"}]},{"name":"MRC Centre for Global Infectious Disease Analysis","award":["MR\/X020258\/1"],"award-info":[{"award-number":["MR\/X020258\/1"]}]},{"DOI":"10.13039\/501100001713","name":"European and Developing Countries Clinical Trials Partnership","doi-asserted-by":"crossref","award":["RIA2017NCT-1843"],"award-info":[{"award-number":["RIA2017NCT-1843"]}],"id":[{"id":"10.13039\/501100001713","id-type":"DOI","asserted-by":"crossref"}]}],"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>The Kakoi\u2013Koda focus in Ituri Province was historically hyperendemic for onchocerciasis, yet screening for a recent trial suggested a marked decline, including in Logo Health Zone, which had never received routine ivermectin. We explored whether this decline extended across the focus and how infection indicators corresponded spatially with ivermectin delivery, entomological observations and deforestation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methodology<\/jats:title>\n                    <jats:p>We conducted a scoping evidence synthesis of epidemiological, programmatic, entomological and geospatial sources. Against a 2003 nodule-mapping baseline, change was assessed from repeated cross-sectional moxidectin trial screenings in 2010\u201311 and 2021\u20132023, which applied the same four-skin-snip protocol to community-recruited residents aged \u226512 years. Anti-Ov16 serology (2015\u201321), two-skin-snip surveys (2015\/17), exploratory blackfly observations (2009\u201318) and remotely sensed tree-cover loss (2001\u201324) provided further contextual evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Principal findings<\/jats:title>\n                    <jats:p>\n                      Between the two trial screenings, microfilarial prevalence significantly declined from 79.0% to 9.0% (Draju) and 68.9% to 8.6% (Kanga) in Logo, similar to declines observed in villages of Nyarambe Health Zone (72.2% to 2.9%), which received routine ivermectin for lymphatic filariasis. Mean infection intensity mirrored this pattern, from 17-26 to 1 microfilariae per milligram of skin in Logo, and 11 to 0.4 in Nyarambe. Seroprevalence in children aged 3\u201310 years from 2016 onward was low (0\u20135%), geographically circumscribed and broadly concordant with the skin-snip spatial pattern. Opportunistic blackfly collections and breeding-site prospections detected\n                      <jats:italic>Simulium dentulosum<\/jats:italic>\n                      and\n                      <jats:italic>S. vorax<\/jats:italic>\n                      as the current anthropophagic species, with no evidence of\n                      <jats:italic>S. neavei<\/jats:italic>\n                      after 2009. Extensive dense forest loss (75\u201390% in historically hyperendemic Logo) and canopy opening are consistent with a shift from crab-associated\n                      <jats:italic>S. neavei<\/jats:italic>\n                      habitats towards more open-habitat vectors, providing a plausible ecological mechanism.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>\n                      Parasitological, serological, entomological and geospatial evidence consistently indicates substantial declines in\n                      <jats:italic>O. volvulus<\/jats:italic>\n                      infection indicators across Kakoi-Koda, compatible with reduced transmission. Residual positive indicators were spatially circumscribed, including in Logo where no routine ivermectin was delivered. Whether the current simuliid species can sustain transmission above elimination thresholds remains uncertain. Standardised, representative surveys in the Muda\/Kuda and Lebu River basins are warranted to guide decisions on starting and stopping ivermectin delivery.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pntd.0014164","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T17:47:51Z","timestamp":1788198471000},"page":"e0014164","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Declining Onchocerca volvulus transmission despite limited ivermectin delivery in the Kakoi\u2013Koda focus, Ituri, Democratic Republic of the Congo: An epidemiological, entomological and landscape evidence synthesis"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8155-9014","authenticated-orcid":true,"given":"Lu\u00eds-Jorge","family":"Amaral","sequence":"first","affiliation":[{"name":"University of Antwerp","place":["Antwerpen, Belgium"],"department":["Global Health Institute, Faculty of Medicine and Health Sciences"]},{"name":"School of Public Health, Imperial College London","place":["London, United Kingdom"],"department":["UK Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tony","family":"Ukety","sequence":"additional","affiliation":[{"name":"Centre de Recherche en Maladies Tropicales (CRMT)","place":["Rethy, Democratic Republic of Congo"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jules","family":"Upenjirwoth","sequence":"additional","affiliation":[{"name":"Centre de Recherche en Maladies Tropicales (CRMT)","place":["Rethy, Democratic Republic of Congo"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deogratias Ucima","family":"Wonya\u2019Rossi","sequence":"additional","affiliation":[{"name":"Centre de Recherche en Maladies Tropicales (CRMT)","place":["Rethy, Democratic Republic of Congo"]},{"name":"Ministry of Health","place":["Bunia, Democratic Republic of Congo"],"department":["Provincial Health Division Ituri"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel Ndahura","family":"Mandro","sequence":"additional","affiliation":[{"name":"Ministry of Health","place":["Bunia, Democratic Republic of Congo"],"department":["Provincial Health Division Ituri"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran\u00e7oise","family":"Nyisi","sequence":"additional","affiliation":[{"name":"Erasmus University Rotterdam","place":["Rotterdam, The Netherlands"],"department":["Department of Public Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal","family":"Adroba","sequence":"additional","affiliation":[{"name":"Centre de Recherche en Maladies Tropicales (CRMT)","place":["Rethy, Democratic Republic of Congo"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilma A.","family":"Stolk","sequence":"additional","affiliation":[{"name":"Erasmus University Rotterdam","place":["Rotterdam, The Netherlands"],"department":["Department of Public Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph N. Siewe","family":"Fodjo","sequence":"additional","affiliation":[{"name":"University of Antwerp","place":["Antwerpen, Belgium"],"department":["Global Health Institute, Faculty of Medicine and Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda-Gloria","family":"Bas\u00e1\u00f1ez","sequence":"additional","affiliation":[{"name":"School of Public Health, Imperial College London","place":["London, United Kingdom"],"department":["UK Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Laudisoit","sequence":"additional","affiliation":[{"name":"University of Antwerp","place":["Antwerpen, Belgium"],"department":["Evolutionary Ecology Group, Faculty of Sciences"]},{"name":"Nature.Health.Global","place":["New York, New York, United States of 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