Reaching elimination of onchocerciasis transmission with long-term vector control and ivermectin treatment in Togo

The Onchocerciasis Control Programme in West Africa implemented vector control (VC) and ivermectin mass drug administration (MDA) to eliminate blindness, intensifying efforts in Special Intervention Zones (SIZ). Togo aims to eliminate onchocerciasis transmission (EOT) by 2030. We use the EPIONCHO-IBM model to project microfilarial prevalence trends across Togo's five regions by SIZ status, MDA coverage (65%-80%) and VC efficacy (60%-100%). We compare projections with prevalence surveys (400 villages, 1970-2017) stratified by hypoendemic, mesoendemic, hyperendemic, and holoendemic baseline endemicity, and calculate EOT probabilities for 2024, 2027, and 2030. Combined VC and MDA reduced prevalence nationwide. After cessation of VC, prevalence continued to decline in hypo-to-mesoendemic areas under annual MDA, while hyperendemic areas required biannual MDA. In holoendemic areas, prevalence rebounded even with biannual MDA, indicating that alternative strategies are needed. EPIONCHO-IBM reproduces Togo's onchocerciasis trends throughout five decades of intervention and provides a transferable framework to guide policy towards 2030 goals.