Defining optimal implementation packages for delivering community-wide mass drug administration for soil-transmitted helminths with high coverage

Abstract

Background Recent evidence suggests that community-wide mass drug administration (MDA) may interrupt the transmission of soil-transmitted helminths (STH), a group of intestinal worms that infect 1.5 billion individuals globally. Although current operational guidelines provide best practices for effective MDA delivery, they do not describe which activities are most essential for achieving high coverage or how they work together to produce effective intervention delivery. We aimed to identify the various packages of influential intervention delivery activities that result in high coverage of community-wide MDA for STH in Benin, India, and Malawi. Methods We applied coincidence analysis (CNA), a novel cross-case analytical method, to process mapping data as part of the implementation science research of the DeWorm3 Project, a Hybrid Type 1 cluster randomized controlled trial assessing the feasibility of interrupting the transmission of STH using bi-annual community-wide MDA in Benin, India, and Malawi. Our analysis aimed to identify any necessary and/or sufficient combinations of intervention delivery activities (i.e., implementation pathways) that resulted in high MDA coverage. Activities were related to drug supply chain, implementer training, community sensitization strategy, intervention duration, and implementation context. We used pooled implementation data from three sites and six intervention rounds, with study clusters serving as analytical cases (N = 360). Secondary analyses assessed differences in pathways across sites and over intervention rounds. Results Across all three sites and six intervention rounds, efficient duration of MDA delivery (within ten days) singularly emerged as a common and fundamental component for achieving high MDA coverage when combined with other particular activities, including a conducive implementation context, early arrival of albendazole before the planned start of MDA, or a flexible community sensitization strategy. No individual activity proved sufficient by itself for producing high MDA coverage. We observed four possible overall models that could explain effective MDA delivery strategies, all which included efficient duration of MDA delivery as an integral component. Conclusion Efficient duration of MDA delivery uniquely stood out as a highly influential implementation activity for producing high coverage of community-wide MDA for STH. Effective MDA delivery can be achieved with flexible implementation strategies that include various combinations of influential intervention components.

Uncovering determinants of perceived feasibility of TF-CBT through coincidence analysis

“…Among teachers, we found four solutions that led to high feasibility ( Table 5 ). Given similar consistency and coverage scores across all four solutions, we followed previous literature to explore model ambiguity ( Gwayi-Chore et al, 2022 ). We found high levels of implementation climate across all four solutions, with high implementation climate (i.e., positive implementation climate) a necessary component of six of the seven possible pathways for high feasibility among teachers (only the third pathway in solution 4 did not include high implementation climate).…”

“…CNA identifies the minimum set of configurations (i.e., combinations) of conditions (i.e., determinants) that are necessary and sufficient for the presence or absence of a specific outcome (i.e., feasibility; Baumgartner & Thiem, 2015 ). Necessary conditions must be present for the outcome, while sufficient conditions are ones that alone can lead to the outcome ( Gwayi-Chore et al, 2022 ).…”

Adolescents’ Perspective Regarding a Community-Wide Mass Drug Administration Program for Soil-Transmitted Helminths in India

“… 13 , 14 In addition to the clinical trial component, DeWorm3 included implementation science research to identify facilitating factors and barriers to cMDA implementation through a number of mixed-methods studies with stakeholders ranging from the community to ministries of health. 15 – 17 The DeWorm3 study includes qualitative research from in-depth interviews with policymakers and focus group discussions (FGDs) with community members, including village leaders, men, women, and adolescents aged 10–15 years to identify barriers and facilitators to the implementation of STH cMDA programs. 18 – 20 In this article, we present the results of the FGDs conducted among adolescents in India to understand their perspectives on STH infections, modes of spread and prevention, challenges, and possible solutions in implementing STH cMDA program with high coverage with specific reference to adult community members.…”

Optimal control analysis of a transmission interruption model for the soil-transmitted helminth infections in Kenya

“…However, only a few STH modeling analysis ( Lambura et al, 2020 ; Oguntolu et al, 2023 ), have applied optimal control analysis to an STH transmission model in formulating public health control strategies targeting elimination. Optimization of the existing interventions and tools is necessary as a priority research area in order to maximize the intervention impact and sustainability ( Gwayi-Chore et al, 2022 ). Thus, the study on the practical implementation of these public health control measures and their optimal delivery is of great importance.…”