"Our desire is to make this village intestinal worm free": Identifying determinants of high coverage of community-wide mass drug administration for soil transmitted helminths in Benin, India, and Malawi.

• Main Authors: Malvika Saxena (Author), Amy Roll (Author), Judd L Walson (Author), Emily Pearman (Author), Hugo Legge (Author), Providence Nindi (Author), Chawanangwa Mahebere Chirambo (Author), Angelin Titus (Author), Jabaselvi Johnson (Author), Elijan Abiguël Bélou (Author), Comlanvi Innocent Togbevi (Author), Félicien Chabi (Author), Euripide Avokpaho (Author), Khumbo Kalua (Author), Sitara Swarna Rao Ajjampur (Author), Moudachirou Ibikounlé (Author), Kumudha Aruldas (Author), Arianna Rubin Means (Author)
• Format: Book
• Published: Public Library of Science (PLoS), 2024-02-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 1935-2727; 1935-2735; 10.1371/journal.pntd.0011819
• Keywords: Arctic medicine. Tropical medicine; RC955-962; Public aspects of medicine; RA1-1270
• Source: PLoS Neglected Tropical Diseases, Vol 18, Iss 2, p e0011819 (2024)

<h4>Background</h4>Soil-transmitted helminth infections (STH) are associated with substantial morbidity in low-and-middle-income countries, accounting for 2.7 million disability-adjusted life years annually. Current World Health Organization guidelines recommend controlling STH-associated morbidity through periodic deworming of at-risk populations, including children and women of reproductive age (15-49 years). However, there is increasing interest in community-wide mass drug administration (cMDA) which includes deworming adults who serve as infection reservoirs as a method to improve coverage and possibly to interrupt STH transmission. We investigated determinants of cMDA coverage by comparing high-coverage clusters (HCCs) and low-coverage clusters (LCCs) receiving STH cMDA in three countries.<h4>Methods</h4>A convergent mixed-methods design was used to analyze data from HCCs and LCCs in DeWorm3 trial sites in Benin, India, and Malawi following three rounds of cMDA. Qualitative data were collected via 48 community-level focus group discussions. Quantitative data were collected via routine activities nested within the DeWorm3 trial, including annual censuses and coverage surveys. The Consolidated Framework for Implementation Research (CFIR) guided coding, theme development and a rating process to determine the influence of each CFIR construct on cMDA coverage.<h4>Results</h4>Of 23 CFIR constructs evaluated, we identified 11 constructs that differentiated between HCCs and LCCs, indicating they are potential drivers of coverage. Determinants differentiating HCC and LCC include participant experiences with previous community-wide programs, communities' perceptions of directly observed therapy (DOT), perceptions about the treatment uptake behaviors of neighbors, and women's agency to make household-level treatment decisions.<h4>Conclusion</h4>The convergent mixed-methods study identified barriers and facilitators that may be useful to NTD programs to improve cMDA implementation for STH, increase treatment coverage, and contribute to the successful control or elimination of STH.<h4>Trial registration</h4>The parent trial was registered at clinicaltrials.gov (NCT03014167).