Compliance and adherence
Re-envisioning the "F" in SAFE: Facial cleanliness and hygiene metrics, personal hygiene practices, and trachoma risk: Operational research for enhanced evaluation in Tanzania
RQ1 - Reliability assessment: What is the intra- and inter-rater reliability of current qualitative F and novel quantitative hygiene metrics across study contexts?
RQ2 – Validity assessment: What is the validity of each metric of interest (i.e., quantitative hygiene and qualitative F metrics) with regard to recent personal hygiene practices and trachoma outcomes?
RQ3 – Utility assessment: What is the utility of each metric (i.e., qualitative and quantitative)?
RQ4 – Risk factor assessment: Do proxy facial and hand hygiene outcomes, as measured by the novel quantitative hygiene metric, represent risk factors of incident C. trachomatis infection?
Innovative Community Referral: Can it improve VL case finding, treatment adherence and success in hard-to-reach settings of northwest Ethiopia?
Research questions: Does an innovative community referral linkage improve VL case finding in hard-to-reach areas of Northwest Ethiopia? Does innovative community referral linkage improve patient adherence to VL treatment? Does innovative community referral linkage improve VL patient’s treatment outcomes? Does an electronic referral linkage system improve back and forth communication and feedback between the treatment centre and community?
Re-envisioning the "F" in SAFE: Facial cleanliness and hygiene metrics, personal hygiene practices, and trachoma risk: Operational research for enhanced evaluation
Reliability assessment: What is the intra- and inter-rater reliability of current qualitative F and novel quantitative hygiene metrics across study contexts?
Validity assessment: What is the validity of each metric of interest (i.e., quantitative hygiene and qualitative F metrics) with regard to recent personal hygiene practices and trachoma outcomes?
Utility assessment: What is the utility of each metric (i.e., qualitative and quantitative)?
Risk factor assessment: Do proxy facial and hand hygiene outcomes, as measured by the novel quantitative hygiene metric, represent risk factors of incident C. trachomatis infection?"
Evaluating the adoption of COVID-19 prevention measures during mass drug administration in Anambra State, Nigeria
Are NTD programs in Anambra State, Nigeria, adopting and implementing prevention measures for COVID-19 in their drug delivery activities? What adaptations are required by staff and volunteers to adopt these measures? What are the barriers to doing so? What are the incremental costs associated with conducting MDA during a global pandemic?
To assess community readiness to participate in LF activities (surveys, social mobilisation, MDA and evaluations) in the context of COVID-19 in Kenya.
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.
Strategies for the ENdgame: Targeting Infections among Non-compliants in the Elimination of Lymphatic filariasis (SENTINEL)
Non-compliance is a primary barrier to attaining elimination goals. This study aims to utilize data captured in MDA registers to address non-compliance in the Ahanta West District of Ghana, which has been identified as a hotspot of LF transmission with >1% microfilaria (mf) prevalence after 15-16 rounds of MDA. On the basis of information identified in the register, this study proposes to deploy two strategies:
- Engage and Treat individuals who were ill, missed treatment, or were unable to participate during the last MDA, and
- Test and Treat for individuals who might be systemically non-compliant or afraid of adverse events. The use of MDA registers to assist in locating non-compliant individuals is novel and would provide valuable evidence for other programs and represents an alternative strategy for countries struggling with the end game. It may also help provide insight as to whether systematically non-compliant individuals truly serve as a reservoir for LF in areas designated as hotspots. Qualitative data collection will aid in understanding reasons for systematic non-compliance and may lead to changes in social mobilization strategies.
Improving outcome of future transmission assessment surveys and community compliance for MDA in 14 LF endemic districts of Uttar Pradesh.
The success of MDA programs requires effective planning, community engagement, and delivery by community drug distributors. This proposal seeks to assess barriers and facilitators of effective coverage. Using in depth interviews, focus group discussions, and surveys, they will investigate factors related to acceptance, availability, and accessibility of MDA from the perspectives of drug distributors, healthcare workers, community leaders, the NTD program, and community members. Using the findings from the formative phase, an intervention package will be developed and implemented during MDA, followed by an evaluation of the impact of the intervention on coverage.
This project is part of a larger series of four studies that use a mixed methods approach to understand why particular districts that have undergone 5+ years of MDA are failing or are likely to fail transmission assessment surveys (TAS). Other studies include 169.1D Ghana, 169.2U Burkina Faso, and 177U Nepal. This study in Uttar Pradesh also provides a second opportunity to deploy the rapid ethnographic approach that will be first tested in Nepal. Team members from HERD Nepal will be traveling to India to train their team on the technique and assist with roll out.
Improving Mass Drug Administration After Pre-Transmission Assessment Survey (Pre-TAS) Failure: A Mixed Methods Study in Nepal
This study builds on the methods developed for the operational studies ongoing in Ghana and Burkina Faso. The first two research questions are the same as those earlier studies with two new questions added here- question 3 on triple drug therapy (ivermectin, DEC, albendazole – IDA) and 4 on the use of a new rapid ethnography approach.
- What factors are associated with effective (and lower) MDA coverage as defined as availability, accessibility, and acceptability in settings that have repeatedly failed Pre-TAS?
- What is the impact of an adapted and tailored intervention package on achieving effective coverage?
- What messages and community engagement approaches are needed to ensure the acceptability of IDA triple drug therapy in Nepal?
- How does the rapid ethnography approach compare to more traditional qualitative analysis methods in terms of cost, timeliness, and ability to provide required information for programmatic decisions? Can local capacity for use of this approach be built rapidly?
Assessing drug coverage following mass drug administration to monitor the impact of the WHO recommended three-drug regimen of ivermectin, diethylcarbamazine, and albendazole for the elimination of lymphatic filariasis
To validate the reported coverage of the 2018 mass drug administration in American Samoa in order to assess the impact of triple drug therapy with ivermectin, diethylcarbamazine, and albendazole (IDA) for lymphatic filariasis on infection prevalence