At the last mile of disease elimination efforts, it is crucial to prioritize communities most directly affected by and proximate to the vectors. The Neglected Tropical Disease (NTD) road map 2021- 2030 highlights the critical role of community engagement in addressing NTDs and advocates for integrating community engagement and participation across all NTD activities to ensure sustainable and effective interventions. Community-directed treatment with ivermectin (CDTi) is a cornerstone strategy for mass drug administration (MDA) in African countries endemic for onchocerciasis and Lymphatic Filariasis. This approach directly involves communities in the planning of MDA, fostering local ownership and accountability. Barriers to CDTi include distrust of government entities and the process for identifying community drug distributors, fears of adverse events following treatment, low baseline knowledge and understanding of the disease, and broader community fatigue. These persistent issues pose significant obstacles to the effective delivery of MDA, contributing to high transmission areas and groups of never-treated individuals in several countries, even after decades of MDA efforts. The NTD community must pause to reflect on these persistent challenges and draw lessons from countries that have sought a deeper understanding of the root causes of ongoing transmission. Such reflections should involve learning directly from the communities themselves. As 2030 approaches—the target year for achieving the elimination goals outlined in the NTD road map—it is critical to explore how community-driven approaches can enhance elimination efforts and ensure these strategies are sustainably financed.

Recognizing these challenges, the Global Institute for Disease Elimination (GLIDE) hosted a stakeholder roundtable on November 15, 2024, during the American Society of Tropical Medicine and Hygiene (ASTMH) Annual Meeting in New Orleans, Louisiana, USA. This roundtable emphasized community-centered delivery approaches, aiming to develop informed strategies for advancing onchocerciasis elimination.