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Understanding the best uses of the Supervisor's Coverage Tool for monitoring school-based distributions

To compare the feasibility and programmatic implications of employing the Supervisor's Coverage Tool in schools vs. communities to monitor a school-based MDA.

The Supervisor’s Coverage Tool (SCT) is a rapid in-process monitoring tool for improving mass drug administration (MDA) coverage that has been approved by WHO for use in communities.  However, questions remain as to whether it may also serve as a useful tool when implemented in schools.  To answer this question, a direct comparison of school- vs. community-based SCT implementation was conducted in 13 Supervision Areas (SAs) in 7 Local Government Areas (LGAs), in 3 states in Nigeria.  Within each SA, one SCT was conducted in the school and an independent SCT was conducted in a village within the catchment area of the same school. The SCTs were all monitoring the coverage for the same school-based MDA for praziquantel and mebendazole. The goal was to understand how the information learned through the SCT would vary based on the two different sampling frames. 

Findings and lessons learned:

-          The SCT helped find targeted schools for which a mass drug administration (MDA) was planned but were missed. Several unregistered (illegal) schools were missed as their existence was not known, therefore they were not targeted and included in the MDA; however, upon identification of these schools through the SCT, the schools were reached during mop-up and added to the database for future MDAs.

-          An existing school feeding program increased students’ praziquantel intake in all northern Nigeria schools that were visited.

-          In two SAs, school SCT results showed good coverage; however, the actual reported school coverage was below the recommended threshold. The discrepancy was due to a great number of student absences because of farming activities or drop outs after enrolment. Since any selected student who is absent is skipped by the SCT and a new student is selected in their place, the resulting coverage classification could be an inflation of the true coverage.

-          Surveyors preferred SCT implementation in schools vs. community because household enumeration can be time-consuming.

-          When SCT results from the school and the village were directly compared for the same population, the community-based SCT always resulted in an equal or lower classification of coverage, likely because community-based SCTs include the entire target population in the sampling frame, as opposed to being limited to school-attending children.

Countries: Nigeria

Supervisor's Coverage Tool for school-based STH and community-based LF in Philippines

To determine the feasibility and best practices of using the Supervisor's Coverage Tool to monitor community and school-based distribution and integrated MDA.

The Supervisor’s Coverage Tool (SCT) is a rapid, simple, and inexpensive tool designed for use in Neglected Tropical Diseases (NTD) programs mass drug administration (MDA) to monitor drug coverage and compliance, to supervise community drug distributors (CDD), and to identify areas that may need mop-up. After successfully piloting the SCT in Ethiopia and Nigeria in 2015, additional testing of the tool was suggested to assess the feasibility of the tool in different regions and new settings. Therefore, the SCT was implemented in the Philippines in July 2016.

After the completion of training, the field work was conducted in two provinces, in six Supervision Areas (SA) consisting of one or more puroks (subdivisions) per barangay (village). Two survey populations were represented in the SCT implementation covering a community-based distribution for Lymphatic Filariasis (LF), excluding children aged 5-18 years and a school-based distribution for LF for all children aged 5-18 years. 

Findings and lessons learned:

  • The most common reasons for not swallowing drugs were fear of side effects, not feeling well, forgetting, being too busy, and the taste of the medicine.
  • When an accurate register of all the households in the SA exists, it is possible to complete the SCT in each SA in less than a day because the registers greatly aid the random selection process.
  • Implementing the SCT during the last week or two of the MDA was advantageous as it enabled the program to implement the action plan to improve the current MDA using the personnel, budget, and infrastructure that was already in place for the MDA.
  • It is important to consider whether or not Community Drug Distributors (CDD) should accompany the SCT teams during interviews, as their presence may influence the answers of the respondents.
  • It is strongly recommended that when possible, CDDs use directly observed treatment (DOT). If DOT is not possible, CDDs should remind participants that there is no advantage in delaying swallowing the drugs, and that it is actually better when everyone swallows the drugs at the same time.
  • Overall, the Philippines SCT pilot was a success, as it was the first time it was implemented in the Western Pacific region, and it was also used to monitor multiple distributions (both school- and community-based). 
Countries: Philippines

Comparison of Kato-Katz and PCR for STH

To compare the sensitivity of double-slide Kato-Katz and multi-parallel real-time polymerase chain reaction (PCR) in the detection of Ascaris, hookworm, and Trichuris infection among children in rural Bangladesh

Countries: Bangladesh

Comparison of muti-parallel qPCR and Kato-Katz for detection of STH in Kenyan children

Is the multiparallel quantitative polymerase chain reaction technique superior to Kato-Katz microscopy in assessing the intensity and prevalence of soil-transmitted helminth infections in stool?

Preliminary Findings and Lessons Learned

  • qPCR was more sensitive than Kato-Katz at detecting Ascaris, Trichuris, and hookworm infections in child fecal samples.
  • Very few samples were helminth positive by Kato-Katz microscopy that were not also positive by qPCR, suggesting minimal human classification error during microscopy.
  • Duplicate qPCR analysis on ~10% of samples by two separate labs (Smith and KEMRI) showed excellent concordance (97-100% agreement for each helminth species).
  • A reanalysis of the effect of a combined water, sanitation, and hand washing (WASH) intervention on child helminth infections with qPCR data compared to Kato-Katz data gave very similar results.
Countries: Kenya

Relationships among clinical signs (Follicular Trachoma) and infection and antibody

The purpose of this study is to analyze the relationships among clinical signs (follicular trachoma) and the prevalence of infection and antibody and to determine whether it may be appropriate to consider one or more alternative indicators for deciding whether trachoma programs can stop MDA.

Diseases: Trachoma

Community implementation and comparison of Human landing and Non human landing collection methods for vectors of Wuchereria bancrofti and Onchocerca volvulus for entomological monitoring of transmission (Ghana)

To determine the feasibility of the use of entomological traps by community members for onchocerciasis and lymphatic filariasis entomological assessments.

Countries: Ghana

Community implementation and comparison of Human landing and Non human landing collection methods for vectors of Wuchereria bancrofti and Onchocerca volvulus for entomological monitoring of transmission (Uganda)

To determine the feasibility of the use of entomological traps by community members for onchocerciasis and lymphatic filariasis entomological assessments.

Countries: Uganda

Correlating Ov16 Serology with Skin Snip Assessments (Malawi)

Comparison of different diagnostic tools during onchocerciasis mapping, including Ov16 ELISA, OV16 rapid diagnostic test (RDT) and skin snip test.

Countries: Malawi

Correlating Ov16 Serology with Skin Snip Assessments (Guinea Bissau)

Comparison of different diagnostic tools during onchocerciasis mapping, including Ov16 ELISA, OV16 rapid diagnostic test (RDT) and skin snip test.

Countries: Guinée-Bissau

Development of a Mobile Reader for Rapid Diagnostic Tests

Can a mobile reader be used to standardize the reading of rapid diagnostic tests (RDTs)?

Community-wide Surveys for Evaluation of LF transmission Interruption, Oncho Transmission Assessment and Comparison of Diagnostic Tools in LF-Onchocerciasis Areas

Assess the performance of LF and Oncho diagnostic tools after stopping LF MDA but continuing Oncho MDA.

Countries: Nigeria

A Programmatic Comparison of School- and Community-Based TAS

Determine whether school-based TAS results in the same programmatic conclusion as a community-based TAS in EUs where school attendance is poor.

Preliminary Findings and Lessons Learned

This USAID project represents an innovative approach to resolve critical questions about the performance of the TAS and in particular, the question of how important 75% school attendance is to a valid TAS result.  At its core, this study addresses the concern that LF (specifically antigenemia) could be associated with school attendance, which leads to the programmatic research question: does a school-based TAS result in the same programmatic conclusion as a community-based TAS in EUs where school attendance is poor? This study will lead to a better understanding of the validity of the TAS in programmatic settings where school attendance and/or reporting of school enrollment may be poor.  It will also generate important results for the Haitian program that is looking to the TAS for guidance on stopping MDA in several EUs. The school- and community-based TAS were both conducted in a commune considered to be highly endemic (‘zone rouge’) at baseline.  Both surveys passed the TAS, with only 1 ICT positive child identified in the school TAS and 4 ICT-positive children in the community-based TAS.  The conclusion is that there appears to be no meaningful difference between school- and community-based TAS for stopping MDA decisions, even where school attendance is poor. This is the third LFSC/NTDSC study to return a null result -- perhaps it can now be considered a "non-issue" for LF.

Countries: Haiti

Post-MDA Estimated LF Prevalence

To develop models that can predict MF prevalence after a given number of rounds of MDA as a tool to identify program settings in which the response to MDA is less than predicted. 

Co-Endemicity of Lymphatic Filariasis and Loiais in the Republic of Congo

Determine Co-Endemicity of Lymphatic Filariasis and Loiais in the Republic of Congo

Countries: Congo

Schistosoma Prevalence in Mekong River Basin of Cambodia and Laos Border

Determine the Schistosoma prevalence in the Mekong River Basin on the border of Laos and Cambodia

Diseases: Schistosomiasis

Development of Mobile Reader Application at Point-of-care for POC-CCA

Develop a mobile reader application for use at the point-of care for the POC-CCA assay used for mapping and surveillance of Schistosoma mansoni. The reader apk will provide results consistent with the visual human reading of the test. Distinguishing intensity bands and reading 'Trace' results can be problematic and leads commonly to 'false positive' readings. The apk being developed will utilize a testing algorithm to better distinguish between true positive and false positive "Trace" test results. 

Countries:
Diseases: Schistosomiasis

Evaluation of rapid diagnostic test prototypes detecting Wb123 antibodies in populations with Loa loa

This is a cross-reactivity evaluation of rapid tests detecting Wb123 antibodies. The test should perform similarly in sub-populations of individuals who are positive and negative for other filarial diseases, most importantly Loa loa. This field evaluation will determine the specificity of the tests in two separate populations, those positive and negative for Loa loa, and will be used to inform the product design and the product insert. This evaluation will recruit adults and children from regions that are known to have Loa loa in Cameroon.

 The study’s principal objective is to determine test specificity in individuals who are positive and negative for the filarial worm Loa loa. Secondary objectives are to determine the test specificity in individuals who are positive and negative for Mansonella perstans, and identify failure modes and failure rates of the rapid tests under surveillance conditions.

Countries: Cameroon

Feasibility, acceptability and cost implications of utilizing the SD BIOLINE Onchocerciasis IgG4 rapid test for onchocerciasis surveillance activities in Senegal

The demonstration study of the SD BIOLINE Onchocerciasis IgG4 rapid test aims to provide operational research data on the use and implementation of the test. The performance of the SD BIOLINE Onchocerciasis IgG4 rapid test has been verified in both reference laboratories as well as in controlled field settings. PATH and partners will explore the feasibility of incorporating the test into multiple sites in sub-Saharan Africa, with Senegal as a pilot country.

 We aim to demonstrate the acceptability and feasibility of the SD BIOLINE Onchocerciasis IgG4 test in the Senegal Onchocerciasis Control Programme surveillance activities relative to the diagnostic and collection tools currently used. 

Countries: Senegal
Diseases: Onchocerciasis

Evaluation of the Short Term Impact of MDA on Prevalence and Intensity

The purpose of this study is to determine differences between cure rates vs re-infection levels.  The fundamental question is to see what the prevalence and intensity are before MDA, and then, see what those are 7 to 8 weeks after MDA.  Since there are villages that continue to have high prevalence from year to year, we will determine if this primarily represents reinfection occurring since the last annual MDA or if it is related more to treatment efficacy.

Countries:
Diseases: Schistosomiasis

Persistent Hot Spots for Schistosoma mansoni Transmission in Western Kenya

A selected number of 5 villages near Lake Victoria shown to maintain very high levels of infection with S. mansoni following at least three rounds of annual praziquantel chemotherapy will be compared with 5 villages where infection rates have been much more responsive to similar levels of treatment, with respect to the following general considerations and questions:

1) What is the general situation for each village with respect to proximity of water bodies where intensive human contact occurs?

2) For each village, what is the role of each major habitat in transmission, as assessed by three separate techniques: water filtration; use of sentinel mice; and standard snail survey techniques?                                                                                                                                                                                                                                                                    

 

Countries: Kenya
Diseases: Schistosomiasis

Stigma Assessment and Reduction of Impact (SARI) Project

How effective are the following stigma reduction interventions when implemented in pairs to decrease leprosy-related stigma: 1) counselling and empowerment, 2) socio economic development, and 3) contact between community and people affected?

Countries: Indonesia

Molecular Xenomonitoring for Lymphatic Filariasis in Bangladesh

Mass drug administration (MDA) programs have dramatically reduced lymphatic filariasis (LF) incidence in many areas around the globe, including Bangladesh. Post-treatment surveillance activities as recommended by WHO include repeated transmission assessment surveys (TAS) among children and ongoing surveillance to detect new foci of transmission and collect data on infection trends in the general population. The contribution of molecular xenomonitoring (MX, or detection of filarial DNA in mosquitoes) to confirm the interruption of transmission during the post-treatment surveillance phase has not been well defined. There is also a need to better understand the relationship between the prevalence of W. bancrofti DNA in mosquitoes and infection in humans.

Countries: Bangladesh

An evaluation of the effectiveness of the trachoma surveillance strategy and the use of alternative diagnostic indicators to validate the elimination of blinding trachoma in Ghana

To determine if PCR or serology techniques are better than TF for assessing Trachoma prevalence during the surveillance phase of Trachoma Elimination Programs.

Countries: Ghana
Diseases: Trachoma | Yaws

Exploring alternative indicators for trachoma endpoint decision-making (Uganda)

Analyze the relationships between the prevalence of the clinical sign follicular trachoma (TF) and the prevalence of infection and antibody to determine whether it may be appropriate to consider one or more alternative indicators for deciding whether trachoma programs can stop MDA.

Countries: Uganda
Diseases: Trachoma

Exploring alternative indicators for trachoma endpoint decision-making (Tanzania)

Analyze the relationships between the prevalence of the clinical sign follicular trachoma (TF) and the prevalence of infection and antibody to determine whether it may be appropriate to consider one or more alternative indicators for deciding whether trachoma programs can stop MDA.

Countries: Tanzania
Diseases: Trachoma

Exploring alternative indicators for trachoma endpoint decision-making (Malawi)

Analyze the relationships between the prevalence of the clinical sign follicular trachoma (TF) and the prevalence of infection and antibody to determine whether it may be appropriate to consider one or more alternative indicators for deciding whether trachoma programs can stop MDA.

Countries: Malawi
Diseases: Trachoma

Piloting the Supervisor's Coverage Tool in Cross River State, Nigeria

To pilot a rapid coverage supervision tool (now known as the Supervisor's Coverage Tool) that can be used to determine if the supervision areas under investigation are likely to have exceeded the WHO threshold for coverage and to serve as an in-process monitoring tool for supervising the MDA distribution. Report to WHO M&E working group; potential for inclusion in future WHO program assessment guidelines.

The Supervisor’s Coverage Tool (SCT) is a quick, simple, and inexpensive monitoring tool that can be used to assess preventive chemotherapy coverage of a mass drug administration (MDA). During the development and optimization process of the tool, the SCT was piloted in communities in Nigeria and Ethiopia. The pilot study in Cross River State, Nigeria, included seven first-level Supervision Areas (SA), which corresponded to villages in four Local Government Areas (LGAs). Drug coverage was assessed for ivermectin and albendazole in four SAs and only Ivermectin in three SAs. 

Findings and lessons learned:

-          The main reasons for not swallowing medicines were community drug distributor (CDD) not showing up, respondent being away at time of drug distribution or not collecting drug from a fixed point of distribution, fear of side effects, drug supply running out, recent migration, and lack of awareness about drug distribution.

-          The SCT permitted LGA coordinators to supervise the drug distribution systematically, which allowed them to find out that in most parts of one LGA treatment was suspended despite the CDD claiming the completion of treatment in the area.

-          Some treatment registers did not include all people living in the SA, therefore some households were not included in the CDDs treatment boundaries. On the other hand, some LGAs had very good treatment registers, proper documentation of treatment from CDDs, and their community also commended them during village gatherings expressing their gratitude.

-          All CDDs were making remarkable effort with little or no reward. Unlike previous monitoring visits where supervisors have to field numerous complaints around incentives, because the SCT gave supervisors an objective evaluation of their work, many CDDs did not feel justified in complaining about incentives.

-          Overall, the SCT was deemed feasible to implement at the supervisory area and the information generated led to programmatic action to improve treatment coverage.

Countries: Nigeria

STH TAS Surveys

Pilot Assessment of Soil-Transmitted Helminthiasis in the Context of Transmission Assessment Surveys for Lymphatic Filariasis in Benin and Tonga. A transmission assessment survey (TAS) is recommended to determine if MDA for LF can be stopped within an evaluation unit (EU) after at least five rounds of annual treatment. The TAS also provides an opportunity to simultaneously assess the impact of these MDAs on STH and to determine the frequency of school-based MDA for STH after community-wide MDA is no longer needed for LF.

Countries: Benin | Tonga

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