Cost-effectiveness

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

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

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

Alternative approaches to coverage surveys (Uganda)

To compare coverage evaluation methods to identify a method that is statistically rigorous and feasible for programs. This study will focus on assessing MDA coverage for lymphatic filariasis by comparing the cost, time and feasibility of 3 different methods: the EPI approach (n=1768), LQAS design (n=95) and probability sampling alternatives (n=1768).

Primary Findings and Lessons Learned

Coverage surveys are an important tool for programs to evaluate their reporting systems and to determine whether effective MDA coverage has been achieved. However, for various reasons coverage surveys are seldom implemented.  Some key challenges are: perceived technical difficulty, lack of resources, and lack of standardized guidance on how to conduct coverage surveys.  This protocol seeks to address the 1st and 3rd points by comparing the feasibility of three different coverage survey methods (EPI approach, LQAS, and segmentation).     This study was completed in 3 districts in Burkina Faso.  All 3 districts found that their survey coverage was above the WHO target threshold (65% for LF).  Furthermore, in all 3 cases the survey coverage validated (or nearly validated) the reported coverage. Taken together this suggests that the Burkina Faso program is working well.   The feasibility results found all 3 methods to be very similar with regards to time, cost and perceived difficulty.  Because only the segmentation approach results in a probability sample, this method was recommended by the M&E Working Group and ultimately approved by the STAG.  Since the approval, significant work has been underway to create guidelines for conducting coverage surveys for preventive chemotherapy.  An excel tool was created to improve the usability of the tool and online learning modules are currently in the works.

Countries: Uganda

Alternative approaches to coverage surveys (Burkina Faso)

Compare coverage evaluation methods to identify a method that is statistically rigorous and feasible for programs. This study will focus on assessing MDA coverage for lymphatic filariasis by comparing the cost, time and feasibility of 3 different methods: the EPI approach (n=1768), LQAS design (n=95) and probability sampling alternatives (n=1768).

Primary Findings and Lessons Learned

Coverage surveys are an important tool for programs to evaluate their reporting systems and to determine whether effective MDA coverage has been achieved. However, for various reasons coverage surveys are seldom implemented.  Some key challenges are: perceived technical difficulty, lack of resources, and lack of standardized guidance on how to conduct coverage surveys.  This protocol seeks to address the 1st and 3rd points by comparing the feasibility of three different coverage survey methods (EPI approach, LQAS, and segmentation).     This study was completed in 3 districts in Burkina Faso.  All 3 districts found that their survey coverage was above the WHO target threshold (65% for LF).  Furthermore, in all 3 cases the survey coverage validated (or nearly validated) the reported coverage. Taken together this suggests that the Burkina Faso program is working well.   The feasibility results found all 3 methods to be very similar with regards to time, cost and perceived difficulty.  Because only the segmentation approach results in a probability sample, this method was recommended by the M&E Working Group and ultimately approved by the STAG.  Since the approval, significant work has been underway to create guidelines for conducting coverage surveys for preventive chemotherapy.  An excel tool was created to improve the usability of the tool and online learning modules are currently in the works.

 

Countries: Burkina Faso

Alternative approaches to coverage surveys (Malawi)

Compare coverage evaluation methods to identify a method that is statistically rigorous and feasible for programs. This study will focus on assessing MDA coverage for lymphatic filariasis by comparing the cost, time and feasibility of the EPI approach (n=1768), LQAS design (n=95) and probability sampling alternatives (n=1768).

Primary Findings and Lessons Learned

Coverage surveys are an important tool for programs to evaluate their reporting systems and to determine whether effective MDA coverage has been achieved. However, for various reasons coverage surveys are seldom implemented.  Some key challenges are: perceived technical difficulty, lack of resources, and lack of standardized guidance on how to conduct coverage surveys.  This protocol seeks to address the 1st and 3rd points by comparing the feasibility of three different coverage survey methods (EPI approach, LQAS, and segmentation).     This study was completed in 3 districts in Burkina Faso.  All 3 districts found that their survey coverage was above the WHO target threshold (65% for LF).  Furthermore, in all 3 cases the survey coverage validated (or nearly validated) the reported coverage. Taken together this suggests that the Burkina Faso program is working well.   The feasibility results found all 3 methods to be very similar with regards to time, cost and perceived difficulty.  Because only the segmentation approach results in a probability sample, this method was recommended by the M&E Working Group and ultimately approved by the STAG.  Since the approval, significant work has been underway to create guidelines for conducting coverage surveys for preventive chemotherapy.  An excel tool was created to improve the usability of the tool and online learning modules are currently in the works.

Countries: Malawi

Alternative approaches to coverage surveys (Honduras)

Develop a program evaluation tool to permit program managers to effectively assess coverage and compliance. This study will focus on assessing MDA coverage for lymphatic filariasis by comparing the cost, time and feasibility of the EPI approach (n=480), LQAS design (n=95) and probability sampling alternatives (n=480).

Preliminary study findings:

  • All three survey methods were feasible for the teams to implement and cost <$5,000.
  • Preschool deworming coverage, provided through the community-based MDA, was <60%.
  • The main reason for refusing the medication was that the child had recently been dewormed.
  • Approximately 80% of preschool children surveyed received at least one dose of unprogrammed deworming in the past 12 months.
  • The main sources of unprogrammed deworming were health centers, local pharmacies, and bodegas.
Countries: Honduras

Cost-effectiveness analysis of schistosomiasis control

Cost Studies in SCORE Gaining and Sustaining

Diseases: Schistosomiasis

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