Skin NTDs: an opportunity for integrated care

Simplifying disease recognition and treatment through the use of common diagnostic or therapeutic strategies has long been practiced as a means of bringing more people under the umbrella of limited health resources. In many clinics these form the basis of diagnostic algorithms, triage criteria, national treatment guidelines as well as management and care pathways. The extension of this principle to diseases that affect the poorest of communities has also provided the impetus for integration of major intervention strategies.1 For instance, analysis of the wider impact of mass drug administration (MDA) has awakened interest in what diseases, and their management, have in common rather than what distinguishes them. For example, community administration of ivermectin as part of the lymphatic filariasis and onchocerciasis control programmes has had a welcome, but unintentional, major impact on the prevalence of other common diseases, from soil helminth infections to tungiasis and scabies2 in treatment areas. In the case of the latter, these observations have provided an incentive to pursue control of the disease in regions where scabies is recognised as a scourge, such as Fiji, where a recent clinical trial of ivermectin for the elimination of infestation, as well as the benefits of reducing recognised complications, such as poststreptococcal nephritis in vulnerable communities, has provided further scientific evidence in favour of broadening the concept of MDA programmes.3 The benefits of integrated management through extending disease coverage using the same primary treatment has been reported in other fields; the use of azithromycin for both yaws and trachoma is a further example.4