Policy stakeholder perspectives on barriers and facilitators to launching a community-wide mass drug administration program for soil-transmitted helminths

Abstract

Background Recent evidence suggests that soil-transmitted helminth (STH) transmission interruption may be feasible through community-wide mass drug administration (cMDA) that deworms community members of all ages. A change from school-based deworming to cMDA will require reconfiguring of STH programs in endemic countries. We conducted formative qualitative research in Benin, India, and Malawi to identify barriers and facilitators to successfully launching a cMDA program from the policy-stakeholder perspective. Methods We conducted 40 key informant interviews with policy stakeholders identified as critical change agents at national, state/district, and sub-district levels. Participants included World Health Organization country office staff, implementing partners, and national and sub-national government officials. We used the Consolidated Framework for Implementation Research to guide data collection, coding, and analysis. Heat maps were used to organize coded data and differentiate perceived facilitators and barriers to launching cMDA by stakeholder. Results Key facilitators to launching a cMDA program included availability of high-quality, tailored sensitization materials, and human and material resources that could be leveraged from previous MDA campaigns. Key barriers included the potential to overburden existing health workers, uncertainty of external funding to sustain a cMDA program, and concerns about weak intragovernmental coordination to implement cMDA. Cross-cutting themes included the need for rigorous trial evidence on STH transmission interruption to gain confidence in cMDA, and implementation evidence to effectively operationalize cMDA. Importantly, if policy stakeholders anticipate a cMDA program cannot be sustained due to cost and human resource barriers in the long term they may be less likely to support the launch of a program in the short term. Conclusions Overall, policy stakeholders were optimistic about implementing cMDA primarily because they believe that the tools necessary to successfully implement cMDA are already available. Policy stakeholders in this study were cautiously optimistic about launching cMDA to achieve STH transmission interruption and believe that it is feasible to implement. However, launching cMDA as an alternative policy to school-based deworming will require addressing key resource and evidence barriers. Trial registration This study was registered in the U.S. National Library of Medicine Clinical Trials registry (NCT03014167).

Health workers’ perspectives on school-based mass drug administration control programs for soil-transmitted helminthiasis and schistosomiasis in Ogun State, Nigeria

“…Hence, a common barrier highlighted was the inadequate funding allocated to the program. This shortage of resources limits the program’s scope, preventing comprehensive coverage and outreach efforts, as stated in similar studies [ 19 , 22 , 46 , 47 ].…”

“…We recommended a comprehensive approach to enhance school-based MDA control programs and strategies for controlling STH and SCH, which involves tailored community engagement involving local leaders to dispel misconceptions and ensure accurate information dissemination [ 25 , 47 ]. Collaboration among health workers, educators, and community leaders, supported by effective communication strategies, is crucial for program acceptance.…”

Community views on mass drug administration for soil-transmitted helminths: a qualitative evidence synthesis

“…Most literature about MDA programmes focusses on compliance rates, and the associated programme-level barriers and facilitators to achieving compliance (Krentel 2013;Maddren 2023;Oswald 2020;Roll 2022;Shuford 2016;Silumbwe 2017). Here, we intend to explore community views and experiences of MDA programmes for STH, to develop a more encompassing and holistic understanding of the relationship between the programme and the individuals (thereby, focusing on adherence rather than compliance, as explored in the How the intervention might work section).…”

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

“… 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.…”