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Researchers are comparing two treatments, ivermectin and moxidectin, to find out which is more effective at reducing onchocerciasis, also known as river blindness, through mass drug administration MDA in Angola. Both drugs are approved by the FDA for this disease. The study also examines how these treatments affect other common infections in the area, such as intestinal worms and scabies. It aims to understand their impact on reducing disease prevalence and transmission, and how communities respond to these treatments. The trial involves 20 groups of villages randomly assigned to receive either moxidectin or ivermectin once a year for four years. Moxidectin is given as a single oral dose of 8 mg four 2 mg tablets, while ivermectin is dosed by height with between one and four 3 mg tablets per dose. Before each treatment round, researchers collect skin, stool, and blood samples from selected participants to monitor infection levels and other health indicators. Participants will be involved in yearly treatment rounds for four years, with regular sample collections before each treatment to assess infection prevalence and intensity. Researchers will also test blackflies that transmit the disease and conduct genetic tests on parasites to evaluate transmission changes. The main outcome is the presence of Onchocerca volvulus microfilariae 36 months after the first treatment, alongside various secondary measures of infection and disease signs. The study may continue monitoring through 2029 to guide future disease control policies.