A Study Protocol for Facility Based Surveillance of Lymphatic Filariasis Integrated into Routine Malaria Diagnostic Services in Districts That Have Stopped Transmission Assessment Surveys

Abstract Lymphatic filariasis (LF) is a neglected tropical disease targeted by WHO for elimination as a public health problem by 2030. The main strategy involves Mass Drug Administration (MDA) of ivermectin and albendazole, to entire endemic communities for several years to interrupt transmission. After MDA ends, continued surveillance is essential to detect signal of resurgence and maintain gains. In 2024, a preliminary assessment in Gomoa West, Ghana, where MDA ceased in 2014, found low LF antigen prevalence in humans (0.4%) but mosquito infection rates above the WHO’s 1% threshold. These findings require confirmation before any re-initiation of interventions. This project proposes a post validation surveillance (PVS), using facility-based surveillance (FBS), to assess LF transmission in post-validation settings in two Ghanaian districts that have stopped MDA and three rounds of Transmission Assessment Surveys (TAS). FBS will integrate LF and malaria testing at community level health facilities. Objectives include validating the FBS surveillance approach, confirming LF prevalence in Gomoa West and Komenda-Edina-Eguafo-Abrem (KEEA) Districts, evaluating feasibility, cost of FBS, stakeholder perspective of the approach and identifying implementation barriers and enablers. Data on human infection rates, and cost-effectiveness will be collected. Additionally, in-depth interviews with health workers and community members will explore perspectives on integrated surveillance. This study aims to provide actionable evidence for the National NTD program to guide post-validation surveillance. Integrating malaria and LF diagnosis is expected to improve testing efficiency and reduce costs, supporting sustainable LF elimination efforts in Ghana.