Morbidity management for hard to reach populations in insecure areas in Burkina Faso: analysis of barriers and determination of the resilience of the health system
The study aims to identify the most effective approaches for case management and delivery of surgical services for IDPs and migrants suffering from LF and/or trachoma in security compromised areas. Barriers to reaching morbidity patients will be assessed, in addition to determinants of the institutionalizatoin of NTD morbidity management within the national health system. Research aims will be addressed through the following key activities: document review and direct inspection protocols to determine health facilities' ability to provide MMDP services; active case finding including creation of WhatsApp groups and SMS messaging to help keep track of patients and refer them to care; key informant interviews with health workers and community leaders to assess behavior change communication strategies for raising awareness among affected individuals; one-on-one interviews and focus group discussions with patients to understand barriers to care; and stakeholder engagement to increase buy-in and identify ways to operationalize MMDP services within national program.
The Neglected Mind-Skin Link: Promoting mental health and wellbeing of people affected by skin NTDs: Formative piloting of the WHO Guide on Mental Health and NTD Integration
This study is designed as a proof-of-concept to test the feasibility and acceptability of a proposed intervention package outlined in a soon to be published WHO manual on NTDs and mental health. The primary output of this study is to adapt a model of intervention from the soon to be published WHO guide on Mental Health and NTDs. The team aims to achieve this output through:
- Screening 300 individuals for symptoms of depression and anxiety, refer where necessary, and sample 30 of those individuals for participation in qualitative interviews.
- Conducting peer-led focus group discussions (separate groups for leprosy and LF) to better understand the needs, priorities, and barriers related to affected individuals’ mental wellbeing and quality of life.
- Conducting a workshop with health leaders, community health workers, nurses, service users, family/caregivers, and experts to develop a feasible and applicable theory of change that aligns with WHO guidelines.
- Conducting in depth interviews with key stakeholders to assess the developed model’s feasibility and accessibility Conducting quantitative measures for feasibility and acceptability to assess the stepped-care approach model which involves: improved screening, referral, uptake of service, knowledge uptake following training, and an assessment of whether supervision was carried out. They also plan to triangulate health information data to determine uptake of services.
- Conducting follow-up FGDs with those 30 individuals after a one-month period to understand their experience with primary health center mental health services.
Integrating Preventive Treatment for Female Genital Schistosomiasis within the National Health System: a Pilot Study in Cote d’Ivoire
This study aims to integrate screening and preventive treatment with praziquantel for FGS into routine HIV and reproductive health care visits for women. A pilot study will be conducted in four health facilities with a target sample size of 4800 women over a six-month period. Trainings will be conducted for health workers and the team will use a participatory design process with key stakeholders to ensure that barriers to integration in the health system and community participation are addressed. A scale-up report will be written with stakeholder engagement and all training materials that were developed will be instantly available for use in other clinics in Cote d’Ivoire. Delivery of praziquantel to the four facilities in the pilot study will utilize existing drug-procurement and delivery systems to ensure sustainability.
Utility of screening easy to access population sub groups as a surveillance tool in monitoring interruption of LF transmission
The question of how to conduct post-elimination surveillance is a high priority for the NTD community, given that most NTD programs scale back or shut down completely once elimination as a public health problem is achieved. Few solutions exist and this proposal provides an interesting and useful case study for surveillance moving forward. The study team plans to target 1708 pregnant women as a proxy for measuring LF resurgence in a post-elimination context. As a comparison group, they plan to conduct a prevalence survey of 427 households (1708 participants) in the same community to compare LF prevalence found in each methodology. Each participant at the health facility’s residence will be geo-referenced to understand the coverage area. They also plan to conduct interviews with patients and health workers, a time-motion study, and a cost analysis to assess the additional burden on health care workers and the health system. The study will occur in 14 facilities in one district of Malawi where LF was highly endemic prior to the launch of the program.
Urban dwellers have frequently been included as "hard to reach" when examining MDA coverage and uptake. Poor coverage in urban settings is a key factor that prevents programs in some settings from achieving success. This research study proposes a community-based participatory action research (CBPAR) strategy to better understand the reasons why this population isn’t reached and/or their decision not to participate in onchocerciasis and lymphatic filariasis MDAs. The results will help identify last mile strategies for urban populations and will generate a technical toolkit for how to conduct rapid participatory research in areas that require novel outreach methods amongst hard-to-reach populations. This form of social science methodology has not been used frequently within the NTD community and this proposal offers an opportunity to build the evidence base for these methods within the context of hard to reach populations.
The researchers plan to conduct a number of activities in order to determine the effectiveness of the participatory approach in targeting urban populations as compared to the standard mobilization and delivery approach.
- Rapid ethnographic interviews, a new technique aimed at rapidly collecting and analyzing qualitative data, to gather community feedback regarding barriers in accessing treatment
- An intervention development workshop with community leaders, health workers, researchers, and the ministry of health
- Deliver the newly designed strategy in Za-Kpota district and compare coverage in urban settings to Ouinhi district
- Finalize a rapid participatory approach toolkit and conduct a time-motion study of the approach to improve the business case to the MoH for uptake 5. Surveys and individual interviews with key stakeholders to determine acceptability, appropriateness, and feasibility of the proposed approach and toolkit
A knowledge co-production strategy to address systematic non-compliance with MDA for Lymphatic Filariasis in Leogane, Haiti
The researchers propose taking a novel approach to increase coverage and reach previously neglected populations by engaging non-compliant individuals in devising a more effective strategy through a technique called knowledge co-production. The researchers plan to address the following questions:
- Can an intervention package co-produced with systematically non-compliant individuals result in increased MDA coverage between the 2019 and 2020 LF MDA rounds?
- Who and where are the systematic non-compliers in Leogane and Gressier?
- What are the reasons motivating systematic non-compliance?
- Is MDA non-compliance associated with hotspots of LF transmission?
The researchers plan the following activities:
- A household cluster survey with 1300 individuals of all ages. This will define coverage in the past MDA and identify non-compliant individuals. In addition, ‘hidden’ non-compliers (NCs) will be located by a networking approach (respondent-driven sampling [RDS]).
- All NCs will then be eligible to be selected into groups of 10 by age (18-25; 26-50; >50), sex (M, F) and demography (urban/rural). These 12 groups will each work with the national health team to devise new approaches to the non-compliance issue. These will be put into place for the 2020 MDA and then assessed by the co-production strategy groups. After the 2020 MDA a second survey will occur to assess impact.
- The relationship between non-compliance and hotspots will be assessed using spatial analysis and defined serologically (FTS and DBS for antibodies) in collaboration with CDC.
Haiti, like many other countries, has made considerable progress in the elimination of lymphatic filariasis. To date, 118 out of 140 communes have passed TAS and stopped MDA. However, little is understood about why some communes have persistent transmission despite five or more rounds of MDA. The proposed study aims to identify alternative approaches to MDA that may help to increase access, uptake, and coverage, particularly for individuals who typically do not comply with MDAs. This cluster-randomized design will test a novel approach (door to door strategy) against the standard health post-based delivery method. Additionally, the study aims to identify non-compliant individuals and better understand their reasons for non-participation. Furthermore, a cost analysis will be undertaken as part of this study to understand the potential implications for the country program should the door-to-door strategy prove effective in reaching higher numbers of people.
Female Genital Schistosomiasis in rural Madagascar: improving community understanding and promoting integration into primary health care services- FIRM-UP
The study will take place in the context of a larger clinical trial (FIRM-UP) that includes 4000 women affected by schistosomiasis. For the current study, the team will develop the following “work packages” to better understand community awareness of FGS, clinical diagnosis, and how to provide enhanced training:
- Work Package 1: design and implement a community-based awareness campaign, using community surveys, focus group discussions, and in-depth interviews, to determine uptake and acceptability of FGS services. This will be followed with an end-line survey to assess change in the indicators following the campaign.
- Work Package 2: establish a diagnostic package with digital colposcopy (using smartphones to capture images) and on-site microscopy.
- Work Package 3: provide a refresher training for FIRM-UP study workers, organize a colposcopy and digital imaging workshop, and extended training for staff coming from other endemic regions in Madagascar. An open-source learning platform (‘Moodle’) will be developed to exchange training and learning materials.
IMPRESS – Improving access to integrated Morbidity management and disability PREvention Services through Stigma reduction for people with lower limb lymphoedema in Ethiopia: Feasibility and quasi-experimental study (year 2)
- Formative component: What is the capacity of the integrated morbidity management and disability prevention (MMDP) programme to incorporate a stigma reduction intervention for people with lower limb lymphoedema, and what are the barriers and facilitators to this?
- Intervention component: Is the stigma reduction intervention effective in increasing demand and access to services within an integrated MMDP programme for people with lower limb lymphoedema?
Integration of LF morbidity management and disability prevention (MMDP) into community health services: exploring the coverage and equity of community health worker-driven LF MMDP burden assessment and service uptake in Côte d’Ivoire.
This study will test the reliability of community health worker-led (CHW) MMDP burden estimates by having CHWs first estimate MMDP burden, followed by a rigorous population-based survey to get a representative estimate of MMDP burden for the district. Six months later, these cases will be followed up to see whether they accessed the MMDP services and assess the quality of care. The study will examine the accuracy of the CHW estimates, CHWs’ ability to diagnose properly, social biases of health care workers that may prevent equitable care delivery, and the cost comparison of the CHW method vs. population-based survey. In addition, the team plans to conduct an evaluation of the quality of MMDP service provision, including available psychosocial support, at all facilities in the selected health district. Programs need a feasible and reliable method for coming up with MMDP burden estimates for LF and strategies to ensure that people have access to care and utilize that care. This study addresses the two pillars of WHO dossier development for MMDP and will provide the Ministry of Health with essential information to plan and adapt their program to accommodate MMDP services.