Investigating the role of drug delivery strategy in MDA drug coverage

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.

Countries: Haiti

District Elimination Mapping of Onchocerciasis in Burundi

To assess Onchocerciasis transmission in the districts previously called hypo-endemic or of unknown endemicity using a new more sensitive diagnostic and sampling strategy

Countries: Burundi

District Mapping Onchocerciasis, Lymphatic Filariasis, and Loiasis in Gabon

To define a cost-effective strategy to map Ivermectin-naïve districts for Onchocerciasis, Lymphatic Filariasis, and Loiasis in the context of elimination of these NTDs

Countries: Gabon

The Global Atlas of Podoconiosis

Through funding from the Wellcome Trust to develop a global atlas of podoconiosis. We aim to advance new knowledge on the geographical distribution and spatial epidemiology of the disease.

i. Conduct national cross-sectional surveys in selected countries to validate the environmental predictive model developed using the mapping data in Ethiopia.

ii. Create evidence consensus maps, develop risk maps and ground-truthing work and delineate the spatial distribution and geographical limits of podoconiosis globally.

iii. Estimate the global burden of podoconiosis by quantifying the number affected, the population at risk and DALYs attributable.

iv. Estimate how much it will cost to control or eliminate podoconiosis globally.


Countries: Ethiopia | Cameroon | Rwanda | Uganda | Burundi | India
Diseases: Podoconiosis

DeWorm3 Implementation Science

The DeWorm3 Project is a series of hybrid trials testing the feasibility of interrupting the transmission of soil transmitted helminths (STH), while conducting implementation science research that contextualizes clinical research findings and provides guidance on opportunities to optimize delivery of STH interventions.

The purpose of DeWorm3 implementation science studies is to ensure rapid and efficient translation of evidence into practice. Research methods include: (1) stakeholder mapping and network analysis, (2) qualitative research, (3) structural readiness surveys, (4) process mapping, and (5) economic evaluation (costing and cost-effectiveness). 

 Implementation science research aims include:

1)To systematically identify stakeholders influencing standard of care targeted and community-wide MDA and map their potential role and involvement in scale-up of community-wide MDA for STH.

2)To identify implementation-related barriers and facilitators to community-wide MDA for STH from the perspective of various stakeholders.

3)To quantify the readiness of the health system to deliver community-wide MDA for STH programs.

4)To map the intervention delivery process and identify any discrepancies between planned and implemented activities in order to optimize the trial intervention.

5)To compare the financial and economic costs and incremental cost-effectiveness of community-wide and targeted MDA for STH in the short- and long-term.


Countries: Benin | Malawi | India

Starworms study

The Starworms project aims to strengthen the monitoring and surveillance of drug efficacy and anthelmintic resistance in soil-transmitted helminth (STH) programs. As such, it will support deworming programs in their quest to eliminate STHs as a public health problem by 2020. The specific objectives are (1) to validate diagnostic tools to monitor drug efficacy and the spread of anthelmintic resistance, (2) to create a surveillance system that monitors the global patterns of drug efficacy and spread of anthelmintic resistance in STH programs, and (3) to develop supporting tools to plan, analyze and follow up on surveys on drug efficacy and the spread of anthelmintic resistance.

Economic analysis in SCORE projects

Economic evaluation of SCORE projects with priority given to elimination studies


Countries: Tanzania | Cote d'Ivoire
Diseases: Schistosomiasis

TakeUp: Testing the Impact of Incentives on Compliance with Community-based Mass Deworming through a Field Experiment in Kenya

•What is the influence of social and behavioural incentives on the increase in cost-effective demand for deworming medication among adult population?

•What is the impact of social incentives on take-up and cost-effectiveness of deworming treatment?

•What is the impact of consumption incentives on take-up and cost-effectiveness deworming treatment?

•Can any increase in takeup be attributed to signaling effect wherein individuals are motivated to access treatment in order to demonstrate that they have engaged in pro-social behavior?

Countries: Kenya

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