Perceived barriers and opportunities to the continuous distribution of ivermectin in the Cameroon primary health care system: an exploratory study of major stakeholders

BACKGROUND: Onchocerciasis, a debilitating parasitic disease transmitted by blackflies, remains a significant public health concern in Cameroon. While mass drug administration (MDA) campaigns with ivermectin offer success in controlling transmission, logistical and financial challenges threaten long-term sustainability. Integrating ivermectin distribution into the existing primary healthcare system (PHC) could offer a promising alternative. We aimed to explore challenges and opportunities associated with this integration. METHODS: This study employed a mixed-methods approach conducted across five regions in Cameroon. Qualitative methods (in-depth interviews and focus group discussions) were used to explore stakeholder perceptions at all levels of the distribution ladder. Quantitative data on program costs and drug coverage were extracted from district campaign reports. RESULTS: Stakeholder perspectives on Ivermectin Integration (n = 130) revealed strong support for partial integration within the primary healthcare system. Stakeholders from various levels (health system, healthcare workers, and community members) perceived this approach as simple and readily implementable. Most stakeholders viewed this approach as viable to ensure a continued ivermectin administration despite funding shortfalls. However, concerns were raised regarding management of adverse events and a potential misuse of ivermectin. Additionally, our analysis revealed an estimated cost of 53 CFA francs (0.1 USD) per person treated. CONCLUSION: By exploring the partial integration of ivermectin distribution within Cameroon's primary healthcare system, this research paves the way for sustainable onchocerciasis control. Clinical trials and community education initiatives are crucial next steps to validate and optimize this promising strategy.